Sexually Transmitted Diseases - Testing and Treatment

What is an STD, and how can I find out if I have one?

Sexually transmitted diseases (STDs), also known as sexually transmitted infections, or STIs, are among the most common of all infections in all societies. They are also prominent among the world’s major emerging infections. Since 1980, many new sexually transmitted infections have been identified, including the human immunodeficiency virus (HIV) types 1 and 2, human T cell lymphotrophic virus (HTLV) types 1 and 2, many genotypes of human papillomavirus (HPV), Mycoplasma genitalium, two species of Mobiluncus, and the Kaposi’s sarcoma-associated herpesvirus. STDs often become resistant to antibiotics. In developing countries, increasing population, war, increases in urban population and poverty contribute to the rise in STD rates. In many developing countries, HIV, gonorrhea, Chlamydia and syphilis, together rank among the top 10 to 20 diseases causing the loss of years of healthy, productive life. The incidence of STDs is declining, however, in most industrialized countries.

Prevalence
In the United States, rates of gonorrhea, chancroid and syphilis remain higher than in many industrialized countries. The Centers for Disease Control and Prevention (CDC) estimates that over 19 million new sexually transmitted infections occur in the U.S. each year. Over half of these infections occur in those ages 15-24.

Testing and Treatment
You can be tested for STDs at your physician’s office or at a family planning clinic or public health department. Many STDs are curable with antibiotics. Infections caused by viruses are generally not curable, however most can be controlled with medications.

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How can I protect against getting an STD?
The only method of protection from STDs that is 100% effective is sexual abstinence or sexual monogamy with a partner who is known to be uninfected. Condoms provide good protection from most STDs. For persons whose sexual behaviors place them at risk for STDs, correct and consistent use of the male latex condom can reduce the risk of STD transmission. However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD. Furthermore, condoms lubricated with spermicides are no more effective than other lubricated condoms in protecting against the transmission of HIV and other STDs. In order to achieve the protective effect of condoms, they must be used correctly and consistently. While condom use has been associated with a lower risk of cervical cancer, the use of condoms is not a substitute for routine screening with Pap smears to detect and prevent cervical cancer.

Sexually transmitted diseases, including HIV
Latex condoms, when used consistently and correctly, are highly effective in preventing transmission of HIV, the virus that causes AIDS. In addition, correct and consistent use of latex condoms can reduce the risk of other sexually transmitted diseases (STDs), including discharge and genital ulcer diseases. While the effect of condoms in preventing human papillomavirus (HPV) infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease. (from the CDC)

Transmission
There are two primary ways that STDs can be transmitted. Human immunodeficiency virus (HIV), as well as gonorrhea, chlamydia, and trichomoniasis – the discharge diseases – are transmitted when infected semen or vaginal fluids contact mucosal surfaces (e.g., the male urethra, the vagina or cervix). In contrast, genital ulcer diseases and human papillomavirus are primarily transmitted through contact with infected skin or mucosal surfaces. Laboratory studies have demonstrated that latex condoms provide an essentially impermeable barrier to particles the size of STD pathogens.

Theoretical basis for protection
Condoms can be expected to provide different levels of protection for various sexually transmitted diseases, depending on differences in how the diseases are transmitted. Because condoms block the discharge of semen or protect the male urethra against exposure to vaginal secretions, a greater level of protection is provided for the discharge diseases. A lesser degree of protection is provided for the genital ulcer diseases or HPV because these infections may be transmitted by exposure to areas, e.g., infected skin or mucosal surfaces that are not covered or protected by the condom.

Genital Ulcer Diseases and Human Papillomavirus (HPV)
The degree of protection which condoms provide from these infections is really unknown. Genital ulcer diseases include genital herpes, syphilis, and chancroid. These diseases are transmitted primarily through “skin-to-skin” contact from sores/ulcers or infected skin that looks normal. HPV infections are transmitted through contact with infected genital skin or mucosal surfaces. Genital ulcer diseases and HPV infection can occur in male or female genital areas whether or not they are protected by a condom. While some epidemiologic studies have demonstrated lower rates of HPV infection among condom users, most have not. A number of studies, however, do show an association between condom use and a reduced risk of HPV-associated diseases, including genital warts, cervical dysplasia and cervical cancer. The reason for lower rates of cervical cancer among condom users observed in some studies is unknown. RTop

Can I get an STD from oral sex?
Oral sex usually puts you at less risk for STDs than anal and vaginal sex. However, it is still possible to get certain STDs whether you are giving or getting oral sex. The only method that is 100 percent effective in preventing STDs is abstinence, including oral sex.

Oral Sex on a Vulva
Oral sex on a vulva is called cunnilingus. A slang term is “going down” on someone. This is a really low risk activity for HIV. But cunnilingus does put you at significant risk for things that can be passed through skin-to-skin contact, like herpes. To reduce your risk, you can use a latex barrier (dental dam) over the vulva.

Oral Sex on a Penis
Oral sex on a penis, called fellatio, is often referred to as a blow job. It is a lower risk activity for HIV transmission than is vaginal or anal sex, but it is a higher risk than cunnilingus. Oral sex on a penis will also put you at risk for infections like herpes and gonorrhea. The best way to reduce your risk is to use a condom. If you aren’t using condom, avoid taking a partner’s body fluids into your mouth.

Oral Sex on the Anus
Analingus, or rimming, refers to using your mouth on a partner’s anus. Analingus isn’t generally a risk for HIV. However, it can expose you to a number of parasites and can put you at risk for hepatitis. You can use a dental dam over the anus to help reduce your risk. RTop

What are HIV and AIDS, and how can I protect against contracting those infections?
Human Immunodeficiency Virus (HIV) is the name of the virus that causes the disease known as “Acquired Immunodeficiency Syndrome” (commonly called AIDS). AIDS was first recognized in 1981, when the CDC reported the unexplained occurrence an unusual pneumonia in five previously healthy homosexual men in Los Angeles and of Kaposi’s Sarcoma (a rare form of skin cancer) in 26 previously healthy homosexual men in New York and Los Angeles. The actual virus was not identified until 1983 and a blood test was developed in 1985. In 2006, an estimated 56,300 new HIV infections occurred – a number that is substantially higher than the previous estimate of 40,000 annual new infections. HIV is transmitted through sexual contact, blood, and sharing IV drug needles.

Symptoms
50-70 percent of people will develop a flu-like illness about three to six weeks after being infected with HIV. These symptoms last about a week. This is usually followed by a period with no symptoms of illness, which may last 10 years or more. At some point, infected persons begin to develop signs and symptoms of illness. This eventually progresses to more severe disease and death.

Treatment
While there are medications to treat HIV, there is no cure. Infected persons will eventually develop severe symptoms which lead to death, although treatment can significantly slow this process.

Prevention
The only method of prevention that is 100 percent effective is to avoid behaviors that may put you at risk for HIV. For sexually active persons, condoms are very effective. HIV infection is, by far, the most deadly STD, and considerably more scientific evidence exists regarding condom effectiveness for prevention of HIV infection than for other STDs. The body of research on the effectiveness of latex condoms in preventing sexual transmission of HIV is both comprehensive and conclusive. The ability of latex condoms to prevent transmission of HIV has been scientifically established in “real-life” studies of sexually active couples as well as in laboratory studies. Vaccines for HIV are currently under development. RTop

What is HPV, and what can I do to protect against getting it?
Human Papillomavirus, or HPV, is one of the most common sexually transmitted infections, occurring up to five times more often than all other STDs. A recent study of university women found that half were infected with HPV by the time they had two or three sexual partners. HPV is transmitted by skin-to-skin contact. Condoms offer some, but not complete, protection from this infection.

Symptoms
Most HPV infections are asymptomatic. In other words, there is no visible sign of infection. There are over 70 strains (types) of HPV, and only certain strains cause symptoms. Several types cause genital warts. At least 10 different types can increase the risk of dysplasia (abnormal growth of cells) and overt cancer of the cervix, anus, vulva, vagina and penis. These are detectable by laboratory testing, which is done automatically on most abnormal pap smears.

Treatment
Genital warts are treated in a clinic with cryotherapy (freezing) or by application of a solution or gel prescribed by a physician. The treatment is cosmetic only; there is no cure for HPV. Dysplasia and overt cancer are usually treated with surgery and careful follow-up.

Prevention
Since there is no cure for HPV, prevention is the first line of defense for this infection in women, who are most likely to develop cervical cancer if infected with a cancer-causing type. Immunization against HPV infection is now available in a series of three injections, given at a family planning clinic or your physician’s office. This immunization is recommended for all women, ages 9-26. Women who are, or have been, sexually active should have an annual exam and pap smear to screen for cervical cancer or dysplasia.
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What is genital herpes, and what can I do to protect against getting it?
Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Most genital herpes is caused by HSV-2. Results of a recent study show that genital herpes infection is common in the United States. Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had genital HSV infection. Over the past decade, the percent of Americans with genital herpes infection in the U.S. has decreased.

Symptoms
Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Another outbreak can appear weeks or months after the first, but it is usually less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.

Treatment
There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks. In addition, daily therapy for symptomatic herpes can reduce transmission to partners.

Prevention
The only sure way to prevent Herpes is abstinence. Condoms do offer some protection. Herpes can be spread by vaginal, anal or oral sex, and sometimes by skin-to-skin contact. A person is most infectious during outbreaks.RTop

What is Hepatitis B, and what can I do to protect against getting it?
Hepatitis B was originally found to be transmitted by blood transfusions, and was first known as “serum hepatitis”. However, improvements in screening of blood donors and serum over the last 30 years has reduced the rate of transmission by blood transfusion to almost zero. The major ways Hepatitis B is transmitted today is through sexual or intimate contact, and sharing of needles by IV drug users. As in HIV, both semen and saliva are infectious.

Symptoms
The onset of symptoms in Hepatitis B may be slow, or they may come on suddenly. It usually takes two to three months after being infected before symptoms appear. These may include nausea and vomiting, fatigue, joint and muscle pain, headache, sore throat and cough. Jaundice (yellow coloring of the skin and eyes) may occur one to two weeks later. In acute Hepatitis B, 95 percent of patients recover completely. However, a small number may go on to have chronic (long-lasting) hepatitis, and some will have severe symptoms requiring hospitalization. Of these, 1 percent may die.

Treatment
While there are medications to treat Hepatitis B, there is no cure. Infected persons may remain “carriers” of the disease, even after they have recovered from the initial illness.

Prevention
A vaccine against Hepatitis B was first introduced in 1982, and is now in widespread use in the United States. Today, most infants born in the U.S. receive Hepatitis B vaccine as part of their routine immunizations. The vaccine is also available for adults who were not vaccinated as children. RTop

What is Gonorrhea, and what can I do to protect against getting it?
Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb) and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus. In 2007, 1,928 cases of Gonorrhea were reported in Iowa.

Symptoms
Neisseria gonorrhoeae, like Chlamydia Trachomatis may cause infections in different areas of the body. There may be no symptoms at all, especially in men. The symptoms are similar in many cases, and both infections may occur together. Urethritis (infection of the urethra) in men may cause a purulent (milky or yellow) discharge and painful urination. Infection of the cervix in women also causes purulent discharge and may cause bleeding. Gonorrhea can lead to pelvic inflammatory disease (PID) in women, which may result in infertility. Infection of the mouth and throat may cause sore throat and tonsillitis, or may cause no symptoms at all. Infection of the anus may cause pain, itching and bleeding.

Treatment
Gonorrheal infections are all treatable with antibiotics, which must be prescribed by your physician, STD clinic or family planning clinic. Sex partners must also be treated.

Prevention
The regular use of condoms is effective at preventing the spread of Gonorrhea. A condom must be used correctly, every time you have sex, including oral sex. RTop

What is syphilis, and what can I do to protect against getting it?
Syphilis is a chronic (long-lasting), systemic (body-wide) disease that is usually sexually transmitted. It is caused by a microorganism called Treponema pallidum. In the United States, health officials reported over 36,000 cases of syphilis in 2006. Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal or oral sex.

Symptoms

Primary Syphilis
Syphilis first appears as a small, painless blister that rapidly becomes eroded and forms an ulcer. This happens about three weeks after a person is infected. In heterosexual men, the ulcer is usually located on the penis, but in homosexual men it may be found in the anal canal or rectum, or in the mouth. In women, common sites are the cervix and labia. Swollen lymph nodes are usually present in the groin.

Secondary Syphilis
Symptoms of the second stage include rashes and lesions over various areas of the body, hair loss, sore throat and weight loss. These can occur within four to six weeks, and the primary ulcer may still be present.

Latent Syphilis
If left untreated, symptoms may go away, but a person can continue to carry Treponema pallidum in their bloodstream for years. Up to 30 percent of these infected persons can develop “Late Syphilis”.

Late Syphilis
In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness and dementia. This damage may be serious enough to cause death.

Treatment
A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis.

Prevention
As with all sexually transmitted infections, abstinence is the only certain way to prevent syphilis. Condoms offer some protection. However, syphilis may also be transmitted by nonsexual personal contact, blood transfusions or from pregnant mother to fetus. RTop

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