Sexually Transmitted Disease

exually transmitted disease (STD) constitutes a staggering public health

problem in the U.S. According to the government's Centers or Disease
Control! nearly "# million ne$ cases are diagnosed annually. %oung people
aged "& to #' have the highest rates o inection. (y the age o #"! almost
one American in ive re)uires treatment or a disease ac)uired through sexual
contact. Among teenagers $ho are sexually active! the inection rate is a
$hopping one in our.
Sexually transmitted diseases are more than *ust a nuisance. Some o these
diseases may be atal! particularly to $omen and their unborn babies. +ther
STDs cause pelvic inlammatory disease! tubal pregnancy! sterility! certain
types o cancer! or blindness. (abies $hose mothers are inected $ith STDs
may suer rom birth deects or mental retardation.
Although the rates o disease and disability rom sexually ac)uired illnesses
are highest among the poor! the impact o STDs on health care spending
touches all income levels. ,ndeed! STDs cost Americans more than -..& billion
a year. Almost /& percent o this amount goes to treat pelvic inlammatory
disease and its conse)uences! $hich include tubal pregnancy and emale
inertility.
During the "'/0s! the government monitored *ust ive sexually transmitted
diseases11syphilis! gonorrhea! chlamydial inection2nongonococcal urethritis!
pelvic inlammatory disease! and genital herpes2$arts.
,n the "'30s! ho$ever! the mounting A,DS epidemic triggered an explosion o
research into and monitoring o diseases that $ere transmitted sexually. The
painsta4ing study o A,DS taught scientists a great deal about other STDs5
and today the ederal government recogni6es some &0 types o sexually
transmitted inection.
Than4s to public a$areness campaigns! many people no$ 4no$ ho$ to
protect themselves rom the A,DS virus by avoiding in*ection drug use and by
aithully using 7saer sex7 techni)ues. 8ortunately! this same approach also
protects them rom the many other disease agents transmitted through
sexual contact or some other transer o bodily luids.
Basic Facts About Sexually
Transmitted Diseases
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9ere are a e$ basic acts everyone should 4no$ or his or her o$n
protection:
STDs are easily spread through any person1to1person transer o
bodily luids such as semen! vaginal secretions! or blood.
;hen someone has a sexually transmitted disease! anyone $ho has
sex $ith that person stands a good chance o becoming inected.
Thus! having sex $ith multiple partners carries a greater ris4 o
disease than staying aithul to a spouse or long1term partner. <ven a
monogamous relationship isn't necessarily ris41ree! ho$ever! since
one partner could be carrying an inection pic4ed up during a prior
sexual encounter.
=any sexually transmitted diseases are highly contagious. 8or
example! i a man has gonorrhea! a $oman $ho has sex $ith him
*ust once stands an 30 to '0 percent chance o getting inected. ,
the man has gonorrhea plus chlamydia! as re)uently happens! the
$oman could be inected $ith both diseases at the same time.
>aginal intercourse is the classic route o STD inection. 9o$ever!
other important routes include anal sex (among men or man1to1
$oman)! oral sex! sexual abuse o children! and mother1to1baby
inection during childbirth.
Sexually transmitted diseases $ea4en the immune system! so a
person inected $ith one STD has a greater ris4 o ac)uiring other
inections. Unortunately! recovering rom an STD does not ma4e a
person immune. Anyone $ho has had a particular STD is still at ris4
o getting it again.
=en are more li4ely to sho$ clear symptoms o STDs. Symptoms in
$omen may not be as obvious! and the problem could be
misdiagnosed.
=any $omen inected $ith certain types o STDs have no early
symptoms at all and may un4no$ingly inect sexual partner(s).
,n the past! gay men have tended to have an above1average rate o
inection $ith STDs. This is largely attributed to promiscuity and may
have declined in response to the A,DS epidemic. Additionally! some
men are secretly bisexual. , a man pic4s up an STD rom a
homosexual encounter! he may then pass the inection on to
unsuspecting heterosexual partners.
?esbians have a lo$er1than1average ris4 or STDs! since most
sexually ac)uired diseases are not easily spread rom $oman to
$oman.
AIDS: IN A CLASS OF ITS ON
A,DS! although deinitely an STD! has become such an overriding public
health concern that it is discussed separately in this boo4. Turn to Chapter
##.
!re"enti"e #easures
,t is important to distinguish bet$een birth control and prevention o STDs.
;hile birth control pills and ,UDs help prevent pregnancy! neither measure
oers any $orth$hile protection against disease.
@racticing 7saer sex7 is the most reliable $ay or sexually active people to protect
themselves against STDs. Using a latex condom $ith a contraceptive oam or *elly is
an excellent option. The chemical in the oam or *elly 4ills some inectious
microorganisms along $ith the sperm. (;arning: @eople $ho reach or a tube o
contraceptive *elly during sex should ma4e sure they do not accidentally grab a tube
o simple lubricating *elly! $hich has no sperm1 or germ14illing ingredients.) ,t's also
$ise to thin4 about a partner's sexual history! and avoid intimate contact $ith people
at high ris4 o inection! such as those $ith multiple sexual partners.
@eople $ho even suspect they might have ac)uired a sexually transmitted disease
should stop having sex until they consult a doctor and ind out or sure. , test results
sho$ an inection! it is essential to notiy all sexual partners so they can be tested!
too. ,t is vitally important to ollo$ the treatment exactly as prescribed and to abstain
rom sexual contact until receiving a clean bill o health.
$o% Sexually Transmitted Disease
Is NOT Spread
,n most cases! people do A+T pic4 up sexually transmitted diseases rom door4nobs!
toilet seats! or to$els. That's because the microorganisms that cause STDs thrive in a
$arm! moist environment such as the mucous membranes o the genitals or the
mouth. =any o these organisms die soon ater being exposed to dry air. (The virulent
hepatitis ( virus is a notable exception.)
Common Sexually Transmitted Diseases
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As $e've seen! the government currently monitors about &0 sexually transmitted
diseases. 9ere is a brie overvie$ o some common STDs (excluding A,DS).
&onorr'ea
Bonorrhea is an inection caused by the Gonococcus bacterium. ,n men! it is
mar4ed by a thic4! $hite discharge rom the penis and a burning pain $hen
urinating.
,n $omen! gonorrhea may inect the cervix. There may be mild pain and a
discharge. , the urethra is inected! there may be a burning sensation during
urination. 9o$ever! $omen's symptoms are most oten mild or simply
unnoticeable. <ven so! it is important to treat the inection because gonorrhea
can lead to pelvic inlammatory disease (see belo$).
;hen gonorrhea is transmitted during anal or oral sex! painul inection o the
rectum or throat may occur in both men and $omen.
C'lamydia
,nection by the Chlamydia trachomatis bacterium is the leading cause o
nongonococcal urethritis in men. This condition consists o pain or burning
during urination! a thin discharge rom the penis! and staining on under$ear.
Chlamydial inection may also inlame the sperm1collecting tubules in the
scrotum and eventually cause sterility. A man inected $ith Chlamydia may be
inected simultaneously $ith Ureaplasma urealyticum! $hich also causes
urethritis.
,n $omen! a chlamydial inection may cause a thin vaginal discharge! pain
during urination! or pain in the lo$er abdomen about "0 to #0 days ater
exposure. 9o$ever! $omen oten do not notice any early symptoms.
Chlamydia may also lead to pelvic inlammatory disease.
!el"ic In(lammatory Disease
@elvic inlammatory disease (@,D) is an inection o the uterus! allopian tubes!
or ovaries and usually results rom either gonorrhea or chlamydial inection.
The disease typically develops in t$o stages. 8irst the inection attac4s the
cervix (the lo$er part o the uterus). ,t then spreads to the uterus! allopian
tubes! and ovaries. Sometimes @,D starts directly $ithin the uterus $hen
germs gain entry ollo$ing childbirth! abortion! or the insertion o an
intrauterine contraceptive device (,UD). This! ho$ever! is rare.
Since @,D causes scar tissue to orm! there is up to a #& percent ris4 o
inertility. @,D is also the single most common cause o tubal pregnancy! in
$hich a ertili6ed egg begins to gro$ $hile still in the allopian tube! instead o
the uterus. , the tube bursts! the $oman could die.
&enital arts
Benital $arts (condyloma) are caused by the human papillomavirus (9@>) and
loo4 much li4e other $arts. They usually occur near the tip o the penis in
men. ,n $omen! the $arts appear on the vulva! in the vagina! on the cervix o
the uterus! or near the anus.
Benital $arts are lat! hard! and painless $hen they irst appear. , allo$ed to
gro$! ho$ever! they develop a 7caulilo$er7 appearance and hurt $hen
pressed. Benital $arts tend to get bigger during pregnancy. ,n rare instances!
very large $arts may interere $ith childbirth! ma4ing a Caesarean section
necessary.
C)R*ICAL CANC)R: A D)ADL+ STD
Aormal cervix: ?i4e s4in! the surace o
the cervix is constantly being replaced
$ith ne$ cells rom belo$. Benerated by
division o the basal cells! these ne$ cells
rise as older ones are shed rom the
surace.
Cervical dysplasia: Triggered by an 9@>
inection! the cervical basal cells may go
into overdrive! producing an excessive
number o ne$ 11 but malormed 11
replacement cells. These cells are not
cancerous! but signal the danger o
cancer to come.
,nvasive cancer o the cervix: As the
condition progresses! truly malignant cells
develop and migrate do$n$ard into
underlying tissues. Unchec4ed! the
disease can be atal.
There are several types o 9@>. Some types can cause precancerous cell
changes in the tissues o a $oman's vulva! anus! cervix! or vagina. An
invasive cervical cancer can be atal! $hich is $hy $omen $ith genital $arts
should have a @ap test at least once a year.
*a,initis
>aginitis! or inlammation o the vagina! is an extremely common
gynecological problem. Some types o vaginitis occur because o irritation
rom tampons! tight clothing! or re)uent douching. +ther types develop as a
side eect o birth control pills or treatment $ith antibiotics! $hich may
encourage ungal inections.
T$o types o vaginitis! ho$ever! can be transmitted sexually: (acterial
vaginosis is caused by an overgro$th o several bacteria5 trichomoniasis is
caused by a one1celled organism called a proto6oon. Although these inections
do not carry dire conse)uences! they do cause burning! itching! discharge!
and odor! and should certainly be treated.
,n either case! it is important or both sexual partners to be treated at the
same time. =en may harbor these organisms $ithout sho$ing any symptoms.
Unless both partners are cured! the couple could 4eep passing the problem
bac4 and orth.
&enital $erpes
,nection by the Herpes simplex virus causes red bumps. These bumps change
to $atery blisters and then rupture! leaving little hollo$ spots that may oo6e
or bleed. The irst attac4 is oten accompanied by high ever and s$ollen
lymph nodes in the groin.
,n men! genital herpes sores may develop on the penis! scrotum! buttoc4s!
anus! or thighs. The sores can also develop inside the urethra (urinary
passage)! remaining invisible but possibly causing a thin discharge and painul
urination.
;omen develop herpes sores on the outer genital area! buttoc4s! or thighs! or
in the vagina or cervix. The sores may cause vaginal discharge! pain during
urination! inlammation o the vulva! and aching or pain in the entire genital
region.
9erpes sores usually scab over and heal $ithin a $ee4 to "0 days! even
$ithout treatment. 9o$ever! because the virus continues to live inside the
body! a man or $oman can pass on the inection even $hen the sores have
disappeared. +utbrea4s o sores may recur periodically. A tingling sensation in
the genitals oten announces the development o a ne$ outbrea4.
@regnant $omen inected $ith herpes are at ris4 or miscarriage or premature
delivery. A $oman may pass herpes on to her baby during childbirth. This
happens rarely! but can cause blindness! brain damage! and inant death.
Syp'ilis
The spirochete bacterium Treponema pallidum causes syphilis. The inection
develops in distinct stages:
The irst symptom is oten a painless but highly inectious sore called a
chancre. The sore develops rom nine to '0 days ater exposure and is
sometimes accompanied by s$ollen lymph glands in the groin. Chancres may
occur on the genitals or on the mouth! lips! breast! anus! or even the
ingertips. The chancre oten goes unnoticed in $omen because it develops
inside the vagina. Some inected people never do get a chancre sore.
Although a chancre disappears $ithin one to ive $ee4s! the syphilis bacteria
remain in the body.
Stage t$o starts a $ee4 to six months later and involves a rash! mouth sores!
and2or lu symptoms (headache! mild ever! aching *oints). (y this time! the
bacteria have multiplied and spread! and the disease can be transmitted *ust
by 4issing.
Stage three! the latent stage! begins approximately a year ater initial
inection and lasts "0 to #0 years. There are no noticeable signs o the
disease during this period! and ater several years the disease is no longer
contagious. 9o$ever! the syphilis bacteria may be silently invading the heart!
brain! or other organs.
Stage our is the late stage. Depending on $hich organs have been attac4ed!
the accumulated damage may cause heart disease! blindness! mental illness!
or crippling.
, syphilis is not treated during pregnancy! the mother1to1be may pass the
disease on to her baby! and the inant could be born dead! deormed! or
diseased.
(eore syphilis $as curable! it $as the most dreaded o the sexually
transmitted diseases. The advent o penicillin in the "'C0s brought a large
and gratiying drop in the syphilis rate. The case load plummeted rom
&/&!D00 in "'C. to e$er than D3!000 cases in "'3&. Unortunately! rampant
prostitution among crac4 cocaine users has no$ driven the syphilis rate bac4
up to its highest level since the early "'&0s.
$epatitis B
?i4e A,DS! hepatitis ( is caused by a virus and can be transmitted via sexual
contact! bodily secretions! or blood. (ut unli4e the virus that causes A,DS!
hepatitis ( is a hardy virus and can remain inectious or )uite a $hile! even
in dried blood! saliva! or other secretions.
9epatitis ( begins $ith lu1li4e symptoms that disappear as *aundice! the
second stage! sets in. The person inected $ith hepatitis ( is thin! $ea4!
lethargic! and irritable and has an enlarged! painul liver. The resulting liver
damage is oten permanent! and one1ourth o those $ith hepatitis (
eventually die o liver ailure.
@eople $ho 4no$ about hepatitis ( ear the virus because it is so easy to
catch11especially $hen compared to A,DS. A hepatitis ( vaccine is available!
and medical personnel must be inoculated. Unortunately! the very people
most li4ely to get hepatitis (11intravenous drug users! prostitutes! and sexual
partners o inected individuals11generally don't bother to get vaccinated or
simply don't 4no$ the vaccine exists. That's $hy the incidence o this serious
disease has been rising since "'3#.
Treatin, Sexually Transmitted Diseases
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+nce again! the best $ay to handle sexually transmitted disease is to prevent
its spread by aithully ollo$ing saety precautions! including 7saer sex7
techni)ues.
, an STD does develop! it may be treated $ith medications! surgical
procedures! or possibly both.
8or a given STD! it is important to ta4e the right medication exactly as
prescribed. 8or example! even though gonorrhea and chlamydial inections
oten occur together! they re)uire dierent medications. Aever try to treat a
sexually transmitted disease $ithout a doctor's supervision. Using the $rong
medication could do more harm than good.
(y ar the most common group o medications used to treat sexually
transmitted diseases are the antibiotics that are available in ever1increasing
variety. Sometimes a disease1causing organism 7learns7 to out$it a given
antibiotic! at $hich point a dierent one is re)uired. To cope $ith this ongoing
problem! pharmaceutical companies are constantly striving to develop ne$
antibiotics.
=etronida6ole! a dierent type o antimicrobial medication! is used to combat
STDs caused by anaerobic (non1oxygen1dependent) bacteria or proto6oa.
>arious caustic creams! ointments! and solutions are used to shrin4 genital
$arts. Dry ice can be used to ree6e and remove them. ?aser surgery is also
employed.
Although not a cure! acyclovir helps prevent or reduce the severity o genital
herpes sores. To remove gro$ths on or in the vagina! cervix! or uterus!
electrosurgical excision is an option.