Bacterial infection
    Pelvic inflammatory disease
    Chlamydia
    Gonorrhea
    Syphilis
    Bacterial Vaginosis

Parasites
    Trichomonas vaginitis

Rare infections
    LGV (lymphogranuloma venereum)
    Chancroid

Introduction

There are many reliable websites available to obtain information about sexually transmitted diseases. My hope is not to replicate them but to distill them, to provide you with some valuable information and to address some issues that you may not find in your internet or library searches.

It is rare to find a sexually active individual who has not had an STD. What? How can that be? STDs are common, most existing in an asymptomatic form. Most of the STDs I'm referring to have never been a problem and never will be a problem for those that have them. Other sexually transmitted diseases, however, can have devastating consequences to one's health. In addition to the threat to a woman's health, an STD may have enormous consequences to her emotional well-being and self-esteem. A woman's initial reaction to the news that she has a sexually transmitted disease includes:

• Depression
• Despair
• Betrayal
• Loss of self-esteem
• Anger

This is quickly followed by numerous questions that include:

• How did I get this?
• Can I give it to someone else?
• How long have I had it?
• Did he cheat on me?
• Who did I get this from?
• Can I pass it on to someone else?
• Will I be able to have children?
• Do I have to let my partner know?
• Will I always have this problem?
• Does this make me "dirty"?
• How can I live with myself?

The Reality of Sexual Transmitted Diseases(STDs) is the Following:

Reality # 1: They are common!

STDs are common--especially among young people. The Alan Guttmacher Institute (AGI) analyzed and published an important survey in January of 2004 [Perspectives on Sexual and Reproductive Health, 2004, 36(1):6-10]. In their study they note the following:

• 18.9 Million new cases of STDs were reported in the year 2000
• 15-24 year-olds represent 25% of the sexually experienced population
• 9.1 Million of the newly diagnosed STDs reported in 2000 were among 15-24 year-olds
• 3 STDs (human papillomavirus, trichomoniasis and chlamydia) accounted for 88% of all new cases of STD among 15-24-year-olds.

Additionally, consider some additional information:

• In March 2007 the National Cancer Institute reported that the overall prevalence of HPV in the U.S. in women ages 14-59 was 26.8%
• At any one time there are 20-40 million Americans with HPV
• About 60 million Americans have had the virus that causes genital herpes
• As estimated 3 million Americans are infected with chlamydia each year
• In 2005 there were 339,593 cases of gonorrhea reported in the United States.
• About 10,000 women are diagnosed with HIV each year in this country—80% of these cases arise from heterosexual contact.
• Each year in the U.S. more than 1 million women experience an episode of acute pelvic inflammatory disease (PID)--more than 100,000 women become infertile as a result.

Reality #2: Not all STDs cause symptoms

Many STDs cause symptoms such as foul odor, vaginal discharge, redness, soreness, warts and other visible lesions. The majority of STDs, however, cause no symptoms at all but exist in an asymptomatic or dormant state—at least for a while. It is this asymptomatic state that allows an individual to unknowingly pass it on and cause a serious infection to his or her partner. Examples include HPV, genital herpes, hepatitis B, chlamydia, gonorrhea and HIV.

Reality #3: STDs cover a broad spectrum of diseases.

Some of these diseases are not serious and do not generally have a large emotional component for most women (examples include bacterial vaginosis and trichomoniasis).

At the other end of the spectrum are diseases that can be life-threatening such as HIV/AIDs and viral hepatitis.

There are diseases which are not life threatening but can pose a significant threat to one's future fertility—gonorrhea, chlamydia, and pelvic inflammatory disease (PID).

There are diseases which are not life threatening and generally do not pose a significant threat to future health but are not completely curable either. Examples of such STDs are human papillomavirus (HPV) and genital herpes. The emotional reaction most women have to HPV is quite variable and to some extent depends on how the disease manifests itself—warts or abnormal pap smears.

Still there are other diseases that are serious but easily eradicated such as syphilis.

There are sexually transmitted diseases that carry a tremendous emotional stigma well out of proportion to the actual damage caused by the disease—genital herpes is perhaps the perfect example of an STD that often causes an emotional breakdown well beyond what can be justified by its implications for potential harm.

Finally, there are rare diseases that you've never even heard of but should be aware of such as lymphogranuloma venereum (LGV) and chancroid.

Reality #4: The risk factors of STDs are well known. They include:

• Young age (15 to 24 years old)
• African-American race
• Unmarried status
• Geographical residence
• New sex partner in past 60 days
• Multiple sexual partners
• History of a prior STD
• Illicit drug use
• Admission to correctional facility or juvenile detention center
• Meeting partners on the internet

Reality # 5: There's lots of misinformation out there!

For over 30 years I've talked to professional women who believed that herpes increased their cancer risk, that HPV would make them sterile and that HIV wasn't as serious a problem as it "used to be". Many of these women claimed to get their information from the internet, their friends, television commercials, their parents, magazines and even another health care provider. Some women admit that their beliefs aren't based on any known facts, but instead harbor beliefs based largely on their own fears. I'm constantly amazed by the apparent willingness of ignorant, unqualified and "well meaning" individuals to offer their "help". Still more surprising is that many women accept the information they get from unqualified individuals or from dubious sources (women's magazines, paid advertising by pharmaceutical companies). Few things are as dangerous in the medical world as the intersection of good intentions, ignorance and panic.

Perhaps the only thing worse than no information is too much information! In order to obtain sound advice be certain of two things—that your information source is qualified and that they have no financial interest in the information they dispense.

So be careful of your information source! This includes your best friend, a neighbor who happens to be a nurse, your mother, boyfriend, most newspaper and magazine articles and many websites.

Also be skeptical of individuals and corporations that stand to profit from the information they dispense—various websites and pharmaceutical companies that advertise heavily on TV and in magazines.

Oftentimes, government websites are some of the best sources of information available. Consider some of these.

In some instances it isn't possible to know the medical answer with certainty. For example, if you've had a positive chlamydia culture but not had symptoms it's unlikely that it will impact your future fertility but there is virtually no way to be certain about your ability to conceive in the future—at least not until you try. If you've been diagnosed with genital herpes should you take medication to prevent possible recurrence or to decrease the likelihood of infecting your partner? The answer will depend on many factors, but ultimately involves some "guesswork" on the part of your health care provider as well as your own comfort level. Your health care provider will not be able to provide you with exact statistics on the likelihood that you'll suffer a recurrent infection or the likelihood of infecting your partner.

Reality #7: Even when medical information is available the decisions you make may depend on personal psychological factors.

For instance, it may not make much "medical sense" for someone who had a mild case of genital herpes to take prophylactic anti-viral medication for the rest of their life. Yet, rarely, some women insist on doing so. For them, the psychological benefit of feeling that they are actively preventing even a small risk of recurrence or transmission is worth the cost and burden of taking daily medications for extended periods of time.

Reality #8: In many cases there is no "one size fits all" answer.

If you had venereal warts 10 years ago and have not had a recurrence since, is it necessary to tell your partner? The answer to this question will depend on many circumstances and there is no "one size fits all" answer.

Reality #9: Asking your health care provider to "test me for all STDs" is often not realistic—worry about the ones that are important to you.

Health care providers generally test for serious STDs that can affect your health. For instance we encourage testing for HIV, hepatitis, gonorrhea and chlamydia. Whether or not routinely screen for syphilis, herpes and HPV is a more complex issue and depends somewhat on your medical history, your symptoms and lifestyle. Routine testing to determine if you've even been exposed to oral or genital herpes may or may not provide helpful information to you. The same may be true of routine HPV screening for women with negative pap smears and no physical findings. The extent to which you require testing will depend on your risk factors (see above), your understanding of these diseases and your need for reassurance. Ironically, women who seem most concerned about STDs are often at lowest risk while woman at very high risk for STDs frequently avoid testing altogether. Another irony is that women often wish to be tested for comparatively benign diseases such as bacterial vaginosis or herpes while refusing HIV or hepatitis screening.

Reality #10: Medications alone cannot heal the psychological trauma

I'm often stunned to hear the following from women: "I'd rather have cancer than herpes". What an incredible statement! Genital herpes is an STD that in the vast majority of cases causes little pain, few recurrences, does not affect future fertility and does not cause cancer. The real implication of herpes is its "stigma". So powerful is that six-letter word that it has driven some women to thoughts of suicide and even homicide--the assumption being that their husband or boyfriend "gave" it to them. But the fear and stigma associated with the word "herpes" often blocks out rational thought to such an extent that conversation isn't even possible until the crying, the anxiety and the hurt begin to subside.

Reality #11: STDs are the result of lifestyle choices

It comes as no surprise that STDs are more prevalent in younger age groups (15-24). Youth is a time of growth, experimentation and often poor choices. Many errors—some serious—result from testing the limits of vehicular speed, alcohol, drugs, sex and emotional fulfillment. No one passes through life without making some bad judgments, but a wise person learns to minimize risks, learn from mistakes and commit to self improvement. Making mistakes is human foible— to not learn from them is a human tragedy. Multiple partners multiply your risk. Condoms offer some, but only limited protection. The best protection against STDs is a mutually monogamous long term sexual relationship with a trustworthy partner.

Putting STDs in perspective

Once a woman has entered the arena of sexual expression the risks of sexually transmitted infections become real. Those who are too frightened to assume even the slightest risk of a sexually acquired infection may avoid contact altogether. Those who are careless, reckless and thoughtless expose them selves and their partners to emotional and physical pain. Most men and women live in the midst of this spectrum—desirous of an intimate relationship and intelligent enough to avoid needless risk. Arm yourself with as much knowledge as possible, practice a disciplined approach to sexuality and be thoughtful to your partner. Life is fraught with risks but a wise person learns to manage them.

Human Papillomavirus(HPV)

Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States. With more than 6 million new cases reported each year it occurs more frequently than trichomoniasis, chlamydia, gonorrhea, syphilis, genital herpes, HIV and hepatitis B combined!



The major implications of this virus for women are two-fold: first, it can cause venereal warts and second it has the capacity to cause cellular changes of the cervix that can lead to Pap smear abnormalities (usually transient and reversible) and, in rare instances, this virus can cause cervical cancer. Despite well-funded advertising campaigns that would have you believe otherwise, HPV is common while invasive cervical cancer is classified by the National Cancer Institute (NCI) as a rare disease.

It is estimated that at any one time there are 20-40 million cases of HPV infections in the U.S. (prevalence) and that over 6 million new cases occur annually (incidence). It is estimated that 75-80% of sexually active adults will acquire a genital tract HPV infection before the age of 50. The prevalence of cervical HPV infection decreases sharply in women after the age of 30. Those with persistent infection are at the highest risk for the development of high-grade precancerous lesions or invasive cervical cancer.

Human papillomaviruses are a group of viruses called "double-stranded DNA viruses". There are over 100 types of human papillomaviruses (HPV) that can divided into two groups—those that infect the skin (such as plantar warts) and those that infect mucous membranes (such as the tissues in the vagina, vulva, the cervix and the tissue around the anus. Flat warts of the skin are most often caused by HPV types 3 and 10. Plantar warts, very common in children and adults, are most often associated with HPV types 1, 2 and 4. HPV types 16 and 18 are most commonly associated with pre-cancerous changes of the cervix. However, HPV types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 and 69 are also associated with these pre-malignant changes. Genital warts, also called, condylomata accuminata, are frequently caused by HPV types 6, 11, 42, 43 and 44.

How do women get genital HPV infections?

Genital HPV is passed by skin-to-skin and genital contact, primarily during vaginal and anal intercourse. However, actual vaginal or anal penetration isn't necessary to acquire this virus. Skin to skin contact with genital contact or "outercourse" can also transmit this disease. It might also be possible to pass it during oral sex—though this is probably rare in the absence of visible lesions.

How do I know if I have an HPV infection?

Most women who have HPV infections never know it! Pap tests are excellent tools for detecting HPV-related abnormalities (click here). Your health care provider may also send an HPV test along with your pap smear to see if you are carrying a high-risk viral type. Another way you might know if you have an HPV infection is the presence of genital warts. These warts can grow inside the vagina, on the vulva or around the anus.

Who gave me HPV?

It isn't always possible to answer this question. You may have acquired it from your current partner or from one of your past sexual partners.

Is my partner unfaithful?

Not necessarily! Your partner may have acquired HPV from a previous partner and unknowingly became an asymptomatic carrier (a carrier with lesions so small that he never noticed). In fact, you may have harbored the virus in an asymptomatic form and then developed an infection.

Is HPV forever?

About 90% of HPV infections are transient and clear within 3 years without a woman ever realizing that she had the virus. The younger the person is when she gets infected the more quickly it clears. Sixty to eighty percent of new HPV infections clear within 1 year. This is true of women who have skin or mucous membrane lesions as well as women with mild Pap smear abnormalities, such as mild dysplasia (click here). Approximately 90% of young women with mild dysplasia will spontaneously revert to normal within 1 year.

Do condoms protect against HPV?

The answer is "not completely" and perhaps not at all. Condoms do not cover the base of the penis, the scrotum, anus etc. The HPV virus is easily spread during foreplay without penile penetration. Condom use is only one "piece of the puzzle" in reducing the risk of STDs and not as important as lifestyle choices. Simply put, the greater your exposure to different sexual partners the greater your risk.

Should my partner use condoms?

Given the fact that HPV is very easily transmitted from one partner to the next it's important to understand that condoms are of limited usefulness and then only partially helpful, even if used consistently.

What about the new HPV vaccine?

In 2006 Merck released its new HPV vaccine. This is a "quadrivalent" vaccine, meaning that it offers protection against 4 different HPV types (6, 11, 16 and 18). Remember that there over 100 various types of HPV and, therefore, receiving this vaccine provides only partial protection against genital warts and pre-cancerous changes of the cervix. The vaccine is best administered in children before they become sexually active. Since the vaccine has only been available in the U.S. for a relatively short period of time it has yet to be determined what its long term effect will be on reducing pre-cancerous changes of the cervix, cervical cancer and genital warts. It's also unknown if the vaccine will require a "booster" 5 or more years later. And like any new drug that is released by the FDA it will take many years before it's long term effects can be determined. For additional information on the new quadrivalent HPV vaccine click here.

Is HPV related to promiscuity?

Not necessarily. HPV has a very high prevalence rate in the population. Simply stated—it's out there! HPV is the most common of all sexually-transmissible agents. Additionally, HPV has a much higher risk of transmission than herpes or HIV during a single sexual act.

When should I get my first Pap smear and how often should I get one?

The American Cancer Society recommends that you get your first pap smear at age 21 or within 3 years of becoming sexually active---whichever comes first. Since the Pap smear has been adopted over 50 years ago, this country has seen a sharp decline in the number of women suffering from invasive cancer of the cervix. Pap smears should be performed annually. Modern pap smears are both painless and accurate. The cells that are obtained can be tested to see if they are abnormal in appearance and even for the presence of cancer-causing viruses.

If my Pap smear is negative can I be assured that I don't have HPV?

No. You can have HPV and still have a negative Pap test. And remember than most HPV types do not cause Pap smear abnormalities.

How are genital warts treated?

Genital warts cover an entire spectrum from being virtually undetectable to large masses with multiple lesions. Most warts, fortunately, are small measuring only millimeters in size. Some can be treated at home with a prescription medication called Podofilox. This agent is applied by the patient on an every other day basis for about 3 weeks. Other methods can be used in an office setting and include Podophyllin and trichloracetic acid, which is a caustic agent commonly used in the treatment of small genital warts.

For larger warts or warts that cover a larger surface area surgery may be recommended. Warts are easily removed by a variety of methods including, simple excision, cryosurgery (freezing), electrosurgery and laser surgery.

Genital Herpes (HSV-2)

Herpes is not—in the vast majority of cases---a serious medical condition yet it almost always produces much more hysteria than the diagnosis of hepatitis, chlamydia or gonorrhea. I suspect the hysteria that surrounds this diagnosis is based on the following four issues:

• Some words, by their very sound are powerful and "loaded". Words like "herpes", ovarian "cysts" and "breast" cancer are more powerful words than "chlamydia", "hypertension" and "colorectal" cancer. The facts, however, tell another story--herpes causes few problem for most women, chlamydia may cause permanent sterility; ovarian cysts are "normal" in 99% of cases while hypertension is a major risk factor for heart disease and strokes. Breast cancer is more common than colorectal cancer but not nearly as lethal.
• Herpes is a "chronic" condition—you don't fully eliminate it from your body. The same is true, by the way of chickenpox (also in the family of herpes viruses) which rarely causes us to feel "dirty" and has no "stigma".
• There was once a time when herpes was thought to be the cause of cervical cancer. That theory has long since been dispelled, but the "fear factor" has persisted.
• The media continues to hype "herpes". There are many reasons for this not least of which is that media advertising is often paid for by pharmaceutical companies who stand to profit from evoking fear from a disease for which they can sell the "cure".

In summary, the word "herpes" evokes shame, fear and self-loathing out of all proportion to the reality of the diagnosis. The combination of this diagnosis with underlying guilt and anxiety often results in consequences far greater than the disease itself. That said, it's important to learn about the specifics of this sexually transmitted disease.

What are the different types of herpes viruses?

We generally hear of two types of herpes virus infection—HSV-1 (oral) and HSV-2 (genital). The majority of genital herpes is caused by HSV-2. However, an increasing number of genital lesions are also caused by HSV-1—likely from oral-genital sex

How common is genital herpes?

Up to 80% of Americans have oral herpes (HSV-1) at some time in their lives. Between 45 and 60 million Americans have HSV-2—the virus that causes genital herpes. It is estimated that up to a million people become infected each year with genital herpes. Women are more susceptible to genital herpes than men.

What are the risk factors for genital herpes?

The major risk factors for genital herpes include:

• History of a prior STD
• African American race
• Three to five years of sexual experience
• Female gender
• History of a partner with oral ('cold") sores

What are the symptoms of genital herpes?

In all likelihood the majority of individuals with genital herpes have no symptoms whatsoever. However, blood tests can reveal a history of a past subclinical infection. In other cases the symptoms are so mild that they are easily overlooked.

At the other end of the spectrum individuals whose symptoms can be so severe and disabling that they require prompt medical care. Symptomatic cases generally begin with one or more blisters around the genital or rectum. The blisters become increasingly sore and filled with pus (pustules). After these pustules break they leave a tender sore (ulcer) that may take 7-21 days to heal.

The first episode of symptoms of a genital herpes infection is called the "primary" infection. The localized symptoms of the primary infection include:

• A "tingling" sensation
• Blisters (vesicles or pustules)
• Open sores (ulcers)
• Pain in the infected area
• Itching
• Burning when urine comes into contact with a sore
• Inability to urinate if sores are in the area of the urethra

In addition to these symptoms, primary herpes is often accompanied by systemic symptoms that include:

• Fever
• Swelling of lymph nodes in the groin
• Headaches
• Achy flu-like symptoms

The "average" primary infection takes about 2-3 weeks to clear up.

Can genital herpes recur?

Yes. Symptoms of genital herpes can come and go but the virus stays in the nerve cells of your body even after all signs of the infection have disappeared. In many people, the virus becomes "active" from time to time creating a "recurrent" outbreak. Some women have an outbreak only once or twice in their lifetimes. Others have many outbreaks each year. In general, recurrent outbreaks tend to be less severe than the initial one. Over time women generally experience fewer and fewer recurrences. In some cases outbreaks appear to be precipitated by stress, other illness, excessive sun exposure or even the onset of menstrual flow.

About half of women with recurrent infections have prodromal symptoms before an eruption of visible lesions. These symptoms include mild tingling or shooting pains in the buttocks, legs and hips. The average recurrence lasts for about 10 days.

How do I know for sure if I have genital herpes?

Health care providers can often diagnose genital herpes by the classic appearance of visible sores. In other cases, especially when the appearance is atypical, viral cultures can offer conclusive evidence of an infection. Blood tests, which detect antibodies to HSV-1 or HSV-2, can help to detect herpes in people without symptoms.

Can genital herpes be treated?

While there is no cure for genital herpes it can certainly be treated. The virus will remain in the nerve cells of your body. However, certain drugs such as acyclovir, Valacyclovir (Valtrex) and famciclovir (Famvir) can shorten the duration of recurrent outbreak, decrease the frequency of outbreaks and often prevent them from occurring entirely. When used in conjunction with safe sex practices Valacyclovir can help to prevent you from passing the infection to someone else.

During outbreaks, you should:

• Keep the infected area clean and dry
• Try not to touch the sores
• Wash your hands after contact with the sores
• Avoid sexual contact from the time that symptoms are first notice (often "tingling" is the first symptom) until the sores have completely healed.

In addition to these anti-viral medications the use of painkillers and even local anesthetic ointments can be very helpful during an outbreak.

What about genital herpes and pregnancy? Is there a problem?

If the mother is having her first outbreak while she is pregnant she is more likely to pass the virus to her baby. In general, transmission to the baby happens only if the baby passes through the birth canal and is exposed to the virus. Women who have herpetic lesions or who experience a prodrome (the symptoms one experiences just prior to the appearance of lesions) generally undergo Cesarean section in order to avoid the possibility of transmitting the virus to the fetus. The overwhelming majority of women with a history of herpes infection do not transmit the virus to their babies.

What can be done to protect myself from contracting genital herpes?

Aside from abstinence there is no way to completely avoid the risks of a herpes infection. However, these risks can be minimized. Here are some suggestions:

• Have sex in the framework of a long term mutually monogamous relationship.
• When in doubt, use condoms.
• Understand that most methods of contraception (birth control pills, Depo-Provera, Implanon, Diaphragms, Intrauterine Devices and sterilization procedures do not protect against most STDs.
• If you have any questions about symptoms you are experiencing contact your health care provider.
• Talk frankly with your prospective partner before you establish sexual contact.

Is it possible to spread genital herpes to someone else if I don't have an active infection?

Yes. Even after resolution of the primary genital herpes infection, intermittent viral shedding can occur in the absence of any visible lesion. This has been documented in both men and women and is called subclinical herpes virus shedding.

Where can I get additional information?

CDC Info, HHS
Phone: (800) CDC-INFO or (800) 232-4636

CDC National Prevention Information Network (NPIN), CDC, HHS
Phone: (800) 458-5231
Internet Address: http://www.cdcnpin.org

National Center for HIV, STD and TB Prevention, CDC, HHS
Internet Address: http://www.cdc.gov/std

National Institute of Allergy and Infectious Diseases
Phone: (301) 496-5717
Internet Address: http://www.niaid.nih.gov/publications/stds.htm

American Social Health Association's National Herpes Resource Center and Hotline
Phone: (919) 361-8488
Internet Address: http://www.ashastd.org/hrc/index.html

Hepatitis B Virus  (HBV)

Hepatitis is an inflammation of the liver, which over time can lead to cirrhosis (scar tissue within the liver), liver failure and even liver cancer. Although there are several different kinds of hepatitis, including A, B and C, it is hepatitis B that is most often associated with sexual transmission.

Hepatitis B virus (HBV) is a blood-borne and sexually transmitted virus that can be spread from exposure to blood or semen as well as other bodily fluids. In the United States, approximately 1.2 million persons have chronic hepatitis B and are sources for HBV transmission to others. Since the late 1980s the incidence of acute hepatitis B has declined steadily, especially among vaccinated children. In fact, between 1990 and 2002 the Center for Disease Control (CDC) reported a 67% decline in the incidence of acute hepatitis B. The most common risk factor for hepatitis B is multiple sex partners and I.V. drug use. About 50% of hepatitis B in the U.S. is sexually acquired.

What are the symptoms of Hepatitis B?

About 30% of individuals with hepatitis B don't have symptoms. The majority, however will exhibit one or more of the following: jaundice, fatigue, abdominal pain, loss of appetite, nausea and vomiting as well as joint pain.

Who is at risk?

The major risk factors include:

• Women with multiple sex partners
• Women with a diagnosis of a sexually transmitted disease
• Women who have sex with bisexual men
• Sexual contact with an infected person
• Intravenous drug use
• Sexual contact with an I.V. drug user
• Health care and public safety workers
• Hemodialysis patients

So Hepatitis B can be transmitted by sexual contact?

Yes. Sexual transmission is less likely if condoms are used. In long-term relationships, the partners of carriers should be tested and, if susceptible, vaccinated against hepatitis B.

How can Hepatitis B be prevented?

If you haven't received the hepatitis B vaccine you should consult with your health care provider. The vaccine is safe and effective. Here are other precautions.

• Use latex condoms if you are not in a long term mutually monogamous sexual relationship.
• Do not use intravenous drugs. Never share needles, syringes, etc.
• Do not share razor blades or toothbrushes
• If you are a health care provider use routine "universal precautions"

What happens after infection with hepatitis B?

There are three possible responses to a hepatitis B infection.

• About 50-60% who are infected get rid of the virus without becoming ill and become immune (protected from further infection).
• About 20% of those that get infected will become ill with full-blow jaundice, abdominal pain, weakness and lethargy—they get "acute hepatitis". They will eventually get rid of the virus and not become a carrier.
• Another 20% will develop acute hepatitis and become chronic carriers of the virus.

Do people carrying a chronic infection become ill?

Chronic carriers do not get ill when they are infected or for many years after their initial infection. Most will probably never suffer from the effects of the virus. However, some chronically infected people do develop cirrhosis, a serious liver disease, as adults. Cirrhosis can lead to liver failure and is often the setting for liver cancer. Women are less likely to develop liver cancer than men.

How do I know if I might be chronically infected?

A simple blood test can tell. If you are chronically infected you will need to check your liver functions periodically and be referred to specialists who can help you manage and avoid many of the long term consequences of being chronically infected.

Where can I get additional information?

You may wish to consult these additional websites.

http://www.cdc.gov/ncidod/diseases/hepatitis/b/

http://www.hepb.org/

http://digestive.niddk.nih.gov/ddiseases/pubs/hepb_ez/

HIV/AIDS

The most pernicious of sexually-acquired infections is HIV/AIDS. Though there are different mechanisms for contracting this infection (see below) it is extremely important for women to understand that this is not a disease limited to gay men or I.V. drug users. Women now constitute the most rapidly growing segment of the HIV-infected population in the U.S.

HIV infections were first reported in 1981, although the disease was probably around for 20 years prior to that. According to the World Health Organization (WHO) the human immunodeficiency virus (HIV) has claimed more than 25 million people worldwide making it one of the worst pandemics in history. In 2005 alone AIDS claimed almost 3 million lives of which more than half a million were children. Only the Black Death or bubonic plague (1347-1351) and the Great Influenza Pandemic (1918-1919) claimed more lives. But unlike those terrible disasters the final chapter on HIV/AIDS has yet to be written. In 2006 over 39.5 million people were living with HIV/AIDS—an increase of 2.6 million since 2004. As of May 2007 over 40.3 Million people worldwide are living with HIV/AIDS. To see the "AIDS Clock" visit http://www.unfpa.org/aids_clock/index.html.

According to the Center for Disease Control (CDC) there are 1.185 million people with HIV/AIDS in the U.S.—25% of them unaware of their infection. About 42,000 new cases appear each year. At any one time 25 out of every 100,000 New Yorkers have the HIV virus.

America's African American and Hispanic communities have been disproportionately affected by HIV/AIDS. Currently 50% of new HIV and 50% of new AIDS diagnoses are in African Americans. Of newly infected women, 64% are black, 18% are white and 18% are Hispanic.

What is HIV?

HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immune deficiency syndrome). HIV weakens a person's immune system. Specifically HIV attacks and destroys a type of white blood cell called a CD4 cell. This cell's main function is to fight disease. When a person's CD4 cell count gets low they become more susceptible to disease. Your immune system plays two important roles: first, it protects you against infection and second, it protects you against developing cancer. People with HIV generally go on to develop full blown AIDS, though treatment can forestall this progress for many years. Those with AIDS most often die of infections or cancers.

What is AIDS?

People with HIV are said to develop AIDS when:

• They develop certain infections called opportunistic infections. These are infections resulting from common everyday bacteria and spores that most healthy people can normally resist. Examples include certain pneumonia, thrush or recurrent childhood infections.
• They develop certain cancers such as Kaposi's sarcoma and non-Hodgkin's lymphoma
• When their CD4 count is less than 200.

What is a CD4 cell?

The CD4 cells are a certain type of white blood cell also called T-cells. HIV attacks these types of cells and uses them to make more copies of HIV. In doing so, the CD4 cell becomes unable to do its job of protecting the body. At first, the body can make more of these T-cells but eventually the body can't keep up and the number of working T-cells decreases. This weakens the immune system and leaves the body at risk for different types of infections.

If left untreated, 90% of HIV-infected individuals develop AIDS and die—about 10% will remain healthy for many years without noticeable symptoms. The development of new medications, called anti-retrovirals, increases life expectancy and improves quality of life so that HIV-infected individuals can lead normal productive lives with near normal life expectancy.

A person gets HIV when an infected person's body fluids (blood, semen, fluids from the vagina or breast) enter his or her blood stream. The virus can enter the blood through linings of the mouth, anus or sex organs (penis and vagina), or through broken skin. Both men and women can spread HIV. Moreover, someone with HIV can feel fine and still give the virus to others.

There are 3 major routes of transmission of HIV. They are:

• Unprotected sexual intercourse (vaginal, oral or anal)
• Contaminated needles
• Transmission from an infected mother to her baby at birth or through breast milk.

Fortunately, in the United States, HIV transmission through blood transfusions has been virtually eliminated though this remains a problem in underdeveloped countries.

The years that followed the discovery of HIV/AIDS were years of hysteria during which those infected with HIV were marginalized. The disease itself was the subject of unfounded rumors. Just to be clear, you cannot get HIV from:

• Touching or hugging someone who has HIV/AIDS
• Coming into contact with someone's saliva who has HIV/AIDS
• Public bathrooms or swimming pools
• Sharing cups and utensils with someone who has HIV/AIDS.

Can HIV/AIDS be cured?

No. The past decade has seen tremendous strides in helping those affected with HIV manage their disease and lead longer and healthier lives. But there is no known cure at this time for the disease.

HIV Testing

The best way to be certain if you have HIV is to take a blood test. Your blood test results are kept absolutely confidential. In fact they are not sent to the lab with your name, but instead a number is assigned to your blood specimen (anonymous testing). A negative test means that no signs of HIV were found in your blood.

Why should I get HIV testing?

There are many reasons to get an HIV test. Here are just a few:

• If your test it negative it will put your mind at ease.
• If your test is positive 
• Your doctor will want you to start antiretroviral medications (see "HAART" below) to help slow the progression of the infection
• A health care provider can monitor your health.
• If you do fall ill, knowing your HIV status in advance will help your health care provider interpret any signs or symptoms you may develop.
• If you know you are HIV positive you can protect other people.
• If you know you are HIV positive it may affect your future decisions.

How can I tell if I have the virus that causes AIDS?

People with HIV may look and feel healthy. Many do not even know they have the virus, but they can still infect others through blood-to-blood or sexual contact. Typically, a blood test will show whether you have antibodies to HIV (the virus that causes AIDS). If you have HIV antibodies, it is assumed that you have the HIV infection. It can take up to two weeks to get these results. But now there is a faster test with results in as little as 20 minutes. Go to http://www.achcrochester.org/hiv.php to learn more about HIV testing.

Who should be tested?

Our current recommendations are that people who engage in risky behaviors be tested. This includes:

• Unprotected intercourse in multiple short term relationships
• Unprotected intercourse with a partner who is suspected of having other sexual partners
• I.V. drug users
• People who share needles

Additionally, all pregnant women should be tested for HIV infection.

If I have HIV will I get AIDS?

People with HIV are said to be "infected" with HIV. As of 1992 scientists estimated that about half of people who become infected with HIV will develop AIDS within 10 years. However, with newer treatments the pace of the disease can be slowed down dramatically in many individuals.

How is HIV Treated? How can I prevent HIV from progressing to AIDS?

There was a time when HIV was considered a death sentence. Today, however, there are a variety of treatments which can retard the progression of the disease and in some cases stop altogether the progression of HIV infection.

After HIV infection is confirmed your doctor will start you on a drug regimen consisting of several drugs: combination of different types of anti-HIV drugs sometimes called HAART (highly-active-retroviral therapy). These drugs must be taken at exactly the right time each day.

You can help prolong your own life by taking good care of yourself and insisting on good medical care from providers who are experienced in treating HIV infection. It is absolutely essential to be consistent about taking your HIV medications as prescribed.

What is the outlook for someone with HIV or AIDS?

The majority of people with HIV who take care of themselves and adhere to their drug regimens can expect to live long and healthy lives. No one can give you a precise answer to the question of "how long do I have?" That said, however, our ever increasing knowledge and treatments offer tremendous hope to those who test positive. HIV is no longer a death sentence.

How can I get more information?

Our best local resource is the

AIDS Community Health Center
At 87 North Clinton Avenue Suite #4
Rochester, NY 14604
585 244-9000. You can visit them at http://www.achcrochester.org/history.php

You can also get information at the CDC National AIDS Hotline: 1-8000-CDC-INFO (232-4636)

Pelvic Inflammatory Disease (PID)

Unlike the other sexually transmitted diseases discussed in this chapter, pelvic inflammatory disease (PID) does not refer to a single bacteria or viral infection. Instead, pelvic inflammatory disease is generally caused by a variety of sexually-transmitted bacteria that can cause acute infection of the upper genital tract—the uterus, fallopian tubes and ovaries as well as other intra-abdominal structures. These bacteria include some you may have heard of—chlamydia and gonorrhea—as well as one's you're probably unfamiliar with—anaerobic streptococci, enterococcus, Klebsiella and E.coli. When infection is confined to the uterus the condition is called endometritis. Infections that involve the fallopian tubes are called salpingitis and ones that involve the ovaries are called oophoritis. Frequently these infections coexist. PID can also involve neighboring pelvic structures including the bowel or upper abdominal structures such as the liver (perihepatitis). Chronic pelvic infections can result in a tubo-ovarian abscess, which is a serious infection often requiring the surgical removal of the tubes and ovaries and even the uterus. Lastly, not all pelvic inflammatory disease is called by sexually transmitted bacteria—some are the result of severe endometriosis, pelvic surgery or even related to diseases of the bowel such as Crohn's disease and chronic appendicitis.

How common is pelvic inflammatory disease?

The National Ambulatory Medical Care Survey estimated that the number of cases of PID in women ages 15-44 was nearly 170,000 in 2003. This represented a decrease of nearly 20,000 cases from the previous year. About 70,000 women per year are hospitalized for acute PID. The numbers are decreasing primarily because of more aggressive screening for chlamydia, one of the major culprits in pelvic inflammatory disease.

What can happen if I get pelvic inflammatory disease?

The major problems associated with pelvic inflammatory disease are infertility, tubal pregnancies and chronic pelvic pain. About 8% of women who have had PID once become infertile. Another 20% will develop chronic pelvic pain.

What are the symptoms of acute pelvic inflammatory disease?

Acute pelvic inflammatory disease can happen after sexual intercourse with an infected partner. Your partner may not even be aware that he is carrying the infection. The symptoms often include fever, chills, lower abdominal bilateral (both the right and left sided) pain, headaches and generalized muscle aches that may or may not be associated with a vaginal discharge. The symptoms will generally force you to seek medical attention. In other cases the symptoms may be more subtle. Some women experience pain with intercourse.

Can acute pelvic inflammatory disease be treated? Is it curable?

The answer to both of these questions is yes. If you contact your health care provider he or she will conduct several tests which may include a complete blood count (CBC), cervical cultures and perhaps a pelvic ultrasound examination. The treatment generally involves a course of oral antibiotics. In severe cases you may be admitted to the hospital to receive intravenous antibiotics. If the infection is treated early in its course damage to the fallopian tubes and ovaries can be prevented and the disease will not prevent a threat to your future fertility. If the diagnosis is delayed the disease can progress to a chronic form which will may cause damage to the fallopian tubes and result in infertility and chronic pelvic pain.

Who is at risk for PID?

The risk factors include women who

• are less than 25 years old
• are less than 17 years old when they first become sexually active
• who don't use condoms
• who have a new partner
• have multiple partners
• have a prior history of PID
• have tested positive for chlamydia, gonorrhea or bacterial vaginosis

How is the diagnosis of pelvic inflammatory disease made?

In general the diagnosis of pelvic inflammatory disease is what's known as a "clinical diagnosis". To be blunt, the diagnosis is in-exact and imperfect. Why? Given the current state of technology the most precise method of diagnosing pelvic inflammatory disease is by a diagnostic laparoscopy. A laparoscopy is a surgical procedure in which a lit fiberoptic telescope is place through a small incision in the abdomen--this requires anesthesia and is not without risks. For that reason we often make the diagnosis of PID when a woman's medical history, physical exam, blood work, cervical cultures and ultrasound findings are consistent with the diagnosis of pelvic inflammatory disease. This method works out well for uncomplicated cases—particularly those that respond quickly to antibiotics. For more complex cases—such as those that involve a pelvic mass, do not respond quickly to antibiotics or when the symptoms and physical exam are equivocal a laparoscopy may be necessary. Fortunately, laparoscopy is rarely required to establish the diagnosis of PID.

How can I avoid pelvic inflammatory disease?

The methods of avoiding PID are common sense methods:

• Use condoms to protect yourself.
• Talk to your partner about STDs before beginning a sexual relationship. Find out whether he or she is at risk for having an STD. Consider getting tested for STDs before you initiate sexual contact with each other. Remember that many STDs such as genital herpes, HPV, chlamydia and even many cases of gonorrhea do not cause symptoms. Even HIV may not show up as a positive blood test for up to 6 months following exposure and infection.
• If you're under the age of 25 or have reason to doubt the fidelity of your partner get cervical cultures even if you're not having symptoms.
• If you're having multiple sex partners use condoms, get regular cervical cultures and strongly consider a lifestyle change.
• Avoid sexual contact with anyone who has symptoms of an STD or who has been exposed to an STD and not been treated.
• Avoid multiple sex partners.

For additional information visit to the following websites:

http://www.webmd.com/a-to-z-guides/Pelvic-Inflammatory-Disease-Topic-Overview

http://women.webmd.com/Women-Medical-Reference/sexual-health-your-guide-to-pelvic-inflammatory-disease

Chlamydia

"Chlamydia" – short for chlamydia trachomatis-- is the most common of the sexually-transmitted bacterial pelvic infection in women. It is referred to as the "Silent Epidemic" because it often produces no symptoms—especially in women. About 4 million cases of Chlamydia occur in the U.S. each year and about 1 million are actually reported each year to the Center for Disease Control (CDC). In various populations of individuals between the ages of 18 and 26 approximately 4% will test positive for chlamydia. In African American women that number may be as high as 14%. Chlamydia can produce a serious infection and is responsible for a quarter to half-a-million cases of PID each year in the U.S. and may render women exposed to HIV five-times more likely to become infected.

What are the symptoms of chlamydia?

Chlamydia is often a silent disease—a fact that enables these truculent little bacteria to be widely spread. About 75% of women infected have no symptoms. Almost half of the men infected have no symptoms (such as a penile discharge). When symptoms do occur they generally manifest themselves 1-3 weeks following exposure.

In women the bacteria often infects the cervix and the urethra (the canal from which urine is passed).

The urethral infection may manifest itself with a burning sensation on urination.

The cervical infection may produce the following:

• No symptoms
• A white or yellowish discharge that looks unfamiliar
• Lower abdominal pain
• Back pain
• Nausea, vomiting
• Fever
• Pain with intercourse
• Abnormal vaginal bleeding—bleeding between normal menses.

With anal intercourse chlamydia can also infect the rectum causing rectal bleeding, discharge or pain.

Oral genital sex can even produce a pharyngitis (sore throat).

What are the risk factors for getting this infection?

The risk factors are the same as for most STDs and include:

• Adolescents and young adults
• Multiple sex partners or a partner with many exposures
• Inconsistent use of condoms
• History of prior STDs
• Lower socioeconomic class

How can I be tested for chlamydia?

There are laboratory tests to diagnose chlamydia. Most often we simply obtain a specimen from the cervix. In other instances tests can be performed on urine.

Can Chlamydia be prevented?

The best way to avoid infection is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who's been tested and is known to be uninfected.

Other recommendations include

• Use latex condoms correctly and consistently if the above does not apply to you
• Have chlamydia screening annually if you are under 25 years of age and sexually active
• If you have symptoms that include a vaginal discharge, burning during urination or any sore or rash please get evaluated by a medical professional.
• Notify your recent partners of any STD so that they can be treated as well.
• Do not resume sex until you and your partner have been re-tested and your tests are negative.

Can chlamydia be cured?

Yes--if it is caught in time! If you have an uncomplicated case of chlamydia (no evidence of pelvic inflammatory disease) a simple course of oral antibiotics should cure you. You will be re-tested to be certain that the infection has cleared. It will be very important, however, that you institute life style changes so that you don't become re-infected. Antibiotic therapy consists of: one of the following:

• Azithromycin 1 gram orally as a single dose
• Doxycycline 100 mg twice a day for 7 days
• Erythromycin 500 mg four times a day for 7 days

Chlamydia as a public health issue

NYS law requires that all positive chlamydia cultures be reported to the local Department of Health. Your sexual contacts will be notified of the need for testing. You should not resume intercourse with your partner until you've both been tested and re-cultured to be certain that you are cured of this infection.

Where can I get more information?

http://www.cdc.gov/std/

http://www.monroecounty.gov/health-diseases.php

STD information and referrals to STD Clinics
CDC-INFO
1-800-CDC-INFO (800-232-4636)
TTY: 1-888-232-6348
In English, en Español

Gonorrhea (GC)

Gonorrhea is a bacterial infection caused by the bacterium Neisseria gonorrhoeae. The CDC estimates that more than 700,000 men and women contract new gonorrheal infections each year in the U.S. Gonorrhea is an important cause of urethritis (infection of the tube that carries urine) in men. In women, gonorrhea can cause a cervicitis (infection of the cervix) as well pelvic inflammatory disease (PID) –a cause of infertility and chronic pelvic pain. Gonorrhea can also cause proctitis (infection of the anus) as a result of anal intercourse, pharyngitis (sore throat) as a result of oral-genital transmission and even infection of the Bartholin's glands and Skene's glands. Compared to other infections the "attack rate" of gonorrhea is very high. The odds of a woman becoming infected with gonorrhea after a single episode of intercourse with an infected man (without the use of a condom) are about 50%.

What are the symptoms of gonorrhea?

For women, the early symptoms of gonorrhea ar often mild and usually appear within 2-10 days after sexual contact with an infected partner. Early symptoms include:

• Bleeding associated with vaginal intercourse
• Yellow or blood vaginal discharge

More advanced symptoms may indicate an ascending infection—pelvic inflammatory disease. The symptoms of PID include

• Fever, chills
• Vomiting
• Cramps and pain
• Bleeding between menstrual periods

What are the risk factors for becoming infected with gonorrhea?

The risk factors for becoming infected with GC are identical to those mentioned above under chlamydial infections.

How can I tell if I have gonorrhea?

The most commonly used method of detecting gonorrhea is by a simple cervical culture. A swab is taken from the cervix and results are often reported within 48 hours.

What is the treatment of gonorrhea?

The treatment of gonorrhea depends on a number of factors. However, the CDC recommends one of the following treatments.

• Ceftriaxone125 mg given as an intramuscular injection
• Ciprofloxacin 500 mg orally once
• Ofloxacin 400 mg orally once
• Levofloxacin 250 mg orally once
• Spectinomycin 2 g as an intramuscular injection

Public health issues

Gonorrhea is a reportable disease in every state. Sexual partners of patients diagnosed with gonorrhea at any site who've had contact with the infected patients within the past 2 months should be evaluated and treated.

Syphylis

Syphilis is a sexually transmitted diseases called by a spirochete bacterium known as Treponema pallidum. The first reported outbreak of this disease was in 1494 after which it spread rapidly through Europe. In the 16^th century it was known as the "great pox" to distinguish it from smallpox. At various times in history it has been called the "French Disease", the "Italian Disease" and "English Disease". The Russians called the "Polish Disease" and the Arabs called it the "Christian Disease." It was not until 1913 that the etiology of this disease was discovered—a spiral-shaped bacterial called Treponema pallidum.

An estimated 32,000 cases of syphilis were reported in 2002 by the CDC. About a quarter were diagnosed in the primary and secondary stages of the disease and majority occurred in women ages 20-24 years of age.

Prior to modern antibiotics this disease often progressed from an initial ulcer called primary syphilis to a generalized rash, secondary syphilis, and eventually to a debilitating destruction of the brain, tertiary syphilis, that caused paralysis—neurosyphillis.

The tragedy of syphilis is that many of those infected with may not have symptoms for years, yet are at risk for developing the late complications of this disease if not treated.

Primary syphilis

Primary syphilis is marked by the appearance of a painless single sore called a chancre. In some cases, however, there are multiple sores. The latent period—time between the infection and the appearance of the chancre averages 21 days (10 – 90 days). The chancre is usually firm, round and small and appears at the spot on the body where the bacteria entered. Typically the chancre lasts 3-6 weeks and heals on its own without treatment. If treatment is not rendered during this phase the disease progresses.

Secondary syphilis

The stage starts with the development of a generalized rash that begins while the chancre is still present or several weeks later. The rash appears on one or more areas of the body and does not cause itching. Typical sites for the rash of secondary syphilis are the palms of the hands and bottoms of the feet. Sometimes the rash is so faint that it is barely noticed. The rash may be accompanied by fever, chills, swollen lymph nodes, a sore throat and hair loss as well as generalized muscle aches and fatigue. Without treatment the infection progresses to the latent and tertiary stages of the disease.

Tertiary syphilis

During the latent phase of the disease the bacteria is still present though there are no signs or symptoms of the disease. The disease progresses, however and causes damage to the internal organs including brain, nerves, eyes, heart, blood vessels, liver, bones and joints. The phase of the disease is very slowly progressive but eventually causes difficulty in coordination of muscle movements, paralysis, blindness and dementia.

How do people get syphilis?

Syphilis is passed from person to person through direct contact with a chancre (sore). Sores typically occur on the vulva, vagina, anus, rectum, mouth and lips. Additionally, pregnant women may pass this disease onto their babies. Syphilis may cause stillbirth or giving birth to a baby that dies shortly after birth. Untreated babies may develop severe neurological problems.

How is syphilis diagnosed?

The simplest way to diagnose this disease is with a routine blood test. You can request this test from your health care provider.

Can syphilis be treated?

Syphilis is easily treated provided it is diagnosed in its early stages. A single intramuscular injection of penicillin (for those not allergic) will cure syphilis in those who've had it for less than a year. For those who are penicillin-allergic there are other convenient antibiotic remedies. It is important for the disease to be diagnosed early as the treatment will not reverse damage already done by this bacterium.

What's the link between syphilis and HIV?

The presence of sores makes it easy for the treponeme (type of bacterium) to enter the body and become infected with HIV if the woman is exposed. There is an estimated 2 to 5-fold increased risk of acquiring HIV infection when syphilis is present.

Where can I get additional information?

STD information and referrals to STD Clinics
CDC-INFO
1-800-CDC-INFO (800-232-4636)
TTY: 1-888-232-6348
In English, en Español

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
1-800-458-5231
1-888-282-7681 Fax
1-800-243-7012 TTY
E-mail: info@cdcnpin.org

American Social Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-9877

Bacterial Vaginosis (BV)

Bacterial vaginosis, or BV, is not necessarily a sexually transmitted disease, though sexual activity clearly plays a role for many women. Bacterial vaginosis is the name of a condition in women characterized by a disruption in the balance of bacteria normally found in the vagina. It is present in almost 30% of women in this country ages 14-49 making it the most common cause of vaginal discharge in women of childbearing age. About 50-75% of women with BV don't have any symptoms. Those with symptoms often complain of an unpleasant "fishy smelling" discharge that is more noticeable after intercourse. The discharge, when present is off-white, grey and thin. Rarely, women may complain of burning during urination or itching around the outside of the vagina.

What is BV?

The vaginal flora (microbiologic environment) is made up of many microscopic organisms including various bacteria and yeast. There is a "balance" of organisms with a "normal" percentage of E. Coli, lactobacilli, klebsiella and a host of other microbes that make up the vagina. This balance can be shifted by changing pH (acidity) of the vagina. With bacterial vaginosis there is a shift away from these microorganisms, and in particular, lactobacilli to other organisms such as Mycoplasma hominis, Prevotella species, Bacteroides species, Peptostreptococcus species as well as others. The exact mechanism by which the floral balance changes is uncertain and the role of sexual activity is also unknown.

Who is at risk for getting BV?

The risk factors include new sexual partners, multiple partners, douching and cigarette smoking. It's important to note that BV can happen in women who've never had intercourse. Women can also transmit BV to other women suggesting that oral-genital sex may be an important risk factor.

How is the diagnosis of BV made?

The most common way to diagnose BV is simply to observe a thin, grayish-white discharge that smoothly coats the vaginal walls. The vaginal pH is generally over 4.5 suggesting that the balance of lactobacilli is diminished—as this makes the vagina 'more acidic' thereby lowering its pH. A microscopic analysis also reveals "clue cells" that are present. Cultures taken from the vagina are frequently positive for Gardenerella vaginalis an organism frequently found in women with BV. That said, Gardenerella vaginalism is found in almost half of all women without symptoms of BV.

Implications of BV

It is believed that women with BV have a greater incidence of pre-term delivery with pregnancy. The major implication for women, however, is the presence of a discharge or a "fishy" odor.

BV may be a risk factor for infection with genital herpes, gonorrhea and chlamydia though the exact mechanism of this is unknown.

Treatment

These infections generally respond well to treatment with either metronidazole (taken as a tablet or vaginal gel) or clindamycin. Whether or not your partner will need to be treated is a subject you should discuss with your health care provider.

Summary

In summary, bacterial vaginosis (BV) is not an infection--it is a change in the colonization or flora of the vagina. This change may lead to a foul odor, a discharge or vaginal irritation. It may be sexually acquired, hence its listing in this webpage, but not necessarily. It is associated with multiple sex partners but does not require penile intercourse and has been associated with oral-genital sex. It's implications for your overall health is debated though it clearly plays a role in pregnancy and may play a role in increasing the likelihood of postoperative infections following hysterectomy and even abortions. It is not clear that your partner should be treated if you have BV, though this may be tried if you have recurrences. BV is commonly found in women though often in an asymptomatic form. If you have been diagnosed with BV do not—I repeat do not—go home and confront your sexual partner of infidelity! Ask your health care provider and consult some of these websites for further information.

http://www.healthywomen.org/healthtopics/bacterialvaginosis

http://www.4woman.gov/faq/stdbv.htm

Trichomonas Vaginitis

Trichomonas vaginitis is a common vaginal infection caused by a protozoan known as trichomonas vaginalis. This infection is, with rare exceptions, sexually transmitted. It is often found with other STDs and can be found in the vagina, urethra, cervix, Bartholin's and Skene's glands. Women can acquire this infection from men and other women.

The Center for Disease Control (CDC) estimates that the prevalence of this infection varies from 13% in African American women to a little over 1% in white and Mexican-American women.

Typical signs and symptoms include a foul odor accompanied by a thin greenish to yellowish frothy discharge. This may also be accompanied by vaginal itching, burning on urination, frequent urination, painful intercourse and bleeding after intercourse. Symptoms may occur from 4-30 days after exposure.

The major implications of trichomoniasis are the symptoms of vaginitis (itching and discharge) and urethritis (urinary frequency and burning). Trichomoniasis is also a risk factor for developing infections after hysterectomy and may also play a role in tubal infertility. Another, more recent concern, is that the infection may facilitate transmission of HIV.

The consequences of trichomoniasis are important for pregnant women as it is associated with premature rupture of membranes and preterm delivery.

The diagnosis of trichomonas vaginitis is beyond the scope of this webpage. However, this infection is easily treated with Flagyl (metronidazole).

LYMPHOGRANULOMA VENERUM (LGV)

LGV is a relatively rare sexually transmitted disease that affects lymph notes and is caused by serovars L1, L2, and L3 of the bacterium Chlamyida trachomatis. The infection produces a painless ulcer and may be confused with primary syphilis. The disease is rare in the U.S. with fewer than 600 cases reported annually--far fewer cases are reported in women than in men. LGVis endemic in parts of Africa, India, Southeast Asia, South America and the Caribbean. Recent outbreaks have occurred in Europe

The primary stage of the disease starts out as a painless ulcer at the site where the bacteria gain entrance to the mucous membrane or skin. Typically, in women the initial site of entry is the vaginal wall. The ulcer lasts 3-12 days. While men can easily detect their lesions it often goes unnoticed in women because it is painless and out of site. The lesion heals before the disease enters the secondary stage some 10 – 30 days later.

LGV gains entrance through breaks in the skin and travels through lymphatic channels settling into lymph nodes where it causes the formation of abscesses – also called buboes. If the affected lymph nodes are in the groin it causes the inguinal syndrome. These same abscesses occur in the lymph nodes draining the rectum the rectal syndrome of this disease appears. For a picture of what the lesions look like click on the following link:

http://members.shaw.ca/fartpipe/temp/crap/Bluesky.jpg

The secondary stage is characterized by the spread of the infection to the surrounding lymph nodes along the lymphatic drainage pathways. In women the infection may spread to the cervix (cervicitis), the internal tissues alongside the uterus (perimetritis) or the fallopian tubes (salpingitis). In addition the deep lymph nodes may become infected causing lymphadenitis. About 20% of women will develop a swelling and abscess in their inguinal lymph nodes. This is often accompanied by fever, chills, fatigue and loss of appetite.

If left untreated a tertiary stage follows characterized by permanent scarring may occur in various internal organs leading to infertility, pelvic pain and others symptoms resulting from permanent scarring.

CHANCROID

Chancroid is another rare bacterial infection caused by Haemophilus ducreyi. It is rarely found in the U.S. but frequently found in 3^rd world countries among sex workers. It is characterized by a painful ulcer (unlike LGV or syphilis). Most individuals in the U.S. who've contracted chancroid have visited countries where the disease is endemic.

The sore varies in size from 1/8 of an inch to 2 inches in diameter and makes its appearance 1-14 days after exposure to the bacterium. The base of the sore bleeds easily if scraped or traumatized. Unlike genital herpes it occurs as a single lesion. Moreover, a culture for HSV will be negative. It tends to occur on the labia minor in women as well as the opening of the vagina.

The disease is treated with antibiotics and typically responds well once the diagnosis has been made. To learn more about the disease click on one of these websites.

http://www.health.state.ny.us/diseases/communicable/chancroid/fact_sheet.htm

http://www.ashastd.org/learn/learn_chancroid.cfm

"OH MY GOD I HAVE AN OVARIAN CYST!"

Introduction

If you are a woman within the age range of 13 – 50 and you're told that you have an ovarian cyst you need to take a deep breath and stop thinking that you're going to die of ovarian cancer.

Ovarian cysts are common and are one of the leading reasons that women seek help from their gynecologists. Often they produce symptoms of lower abdominal pain. Other symptoms associated with them include distention, abnormal menstrual bleeding or pain during intercourse. However, with the large number of ultrasound examinations, CT scans and MRIs that are performed—often for reasons other than pelvic pain-- we see an increasing number of patients that are referred from their primary care doctors or radiologists that have been told that they have an ovarian cyst or cysts. These women often have no symptoms other than the tremendous anxiety that may have cancer or infertility.