STIs and Related Infections

Sex can be an exciting thing, but there are some precautions one must take when being sexually active. One large concern is reducing one's risk for sexually transmitted infections (STIs). STIs are any infections that are acquired primarily through sexual contact. There are over thirty STIs, and most have serious consequences and require medical care. Women often do not experience symptoms after being infected, so if you're sexually active, it is extremely important to have a gynecological appointment that includes a pelvic exam ("pap smear") every year.

The public and private costs of STIs are tremendous. A conservative estimate of total costs associated with the most common types is approximately $10 billion. This increases to $17 billion when HIV/AIDS infections are included. Despite these tremendous health and economic burdens, the scope and impact of the STD epidemic are still underappreciated. And, to a large extent, the diseases are largely hidden from public discourse.

Many people do not feel comfortable talking about STIs, which makes it difficult to really know how prevalent certain STIs are in particular age groups. For instance, adolescents (10- to 19-year-olds) and young adults (20- to 24-year-olds) have a higher risk for acquiring STIs. Some explanations for this is that they may be more likely to have multiple sexual partners rather than a single, long-term relationship; they may be more likely to engage in unprotected intercourse; and they may be involved with partners at higher risk.

Here are some rather stunning statistics about college age students:

• 2/3 of all STIs occur in people 25 years of age or younger.
• 1/4 of new STI infections occur in teenagers.
• By the age of 24, 1 in 3 sexually active people will have contracted an STI.
• The highest rates of genital HPV infections are found in adults between the ages of 18 to 28.
• In 2000, 15- to 19-year-old women had the highest rate of gonorrhea compared to all other age categories. In addition, 20- to 29-year-old women had the highest rates of primary and secondary syphilis.
• Among men, 20- to 24-year-old men had the highest rate of gonorrhea and 4th highest rates of primary and sec ondary syphilis. (American Social Health Association and Planned Parenthood.)

Discussion about STIs is deficient because STIs are often asymptomatic and someone can be unaware that they have an infection. That means that any statistics about STIs are underestimates. Unfortunately, because some people don't know they have an STI, they might not take precautions to practice safe sex and could more easily infect their partner, perpetuating the STI cycle. That's why we always recommend practicing safer sex (to reduce STIs and/or pregnancy); you and your partners minimize the risk of acquiring STIs during sexual activity overall.

This chapter lists some sexually transmitted infections, along with their symptoms and treatments.

IMPORTANT: If you think you may have an STI, it is important to see your gynecologist or medical provider as soon as possible.

Prevention

Different sexual activities pose different levels of risk for STIs. If you know your risks, it will help you make more informed decisions. Overall, you should always be cautious.

And, don't forget, there are some activities that are very low risk or have no risk at all that are fun, too: self-masturbating, hugging, dry kissing, dry humping, or non-genital massaging.

Here are some ways to reduce your risk of getting an STI:

• Know your partner(s). Don't be shy to ask about his/her sexual history, because it could save you a lot of trouble in the future. Be specific and ask if s/he has experienced any symptoms or signs of a sexually transmitted infection, such as unusual discharge, itching, soreness or swelling, pain during intercourse or urination, rashes or sores, unusual odor, fever and fatigue, or visible organisms. Also, inspect your partner for any of the visible symptoms of infection. (But, always remember, sometimes STIs exhibit no symptoms and sometimes partners don't know they have a STI ? or are truthful about their history.)
• Limit the number of partners with whom you have sexual encounters. Each partner increases your risk of getting an STI.
• Use a latex product during all sexual acts (male/female condom, dental dam, cut condom), making sure to follow the directions (usu ally on or in the box) carefully
• Put the latex product in place early in the sexual encounter to avoid contact with any body fluids (i.e., pre-ejaculatory fluid, blood, feces).
• When using a male condom, hold the bottom of the condom to the base of the penis during withdrawal.

• When using a female condom, be certain that your partner enters into the center of the condom and not to the side.
• Use a new latex product for each sexual encounter.
• Go for treatment immediately if you suspect that you might be infected with a sexually transmitted infection.
• Get regular checkups because some infections have no symptoms.

The General Physical Examination for STIs

Generally females are told to have an annual check-up with her gynecologist once a year after she becomes sexually active or by the time she is 18. Some women find the procedure uncomfortable, but if you go into it calmly, it is quite painless and quick. During the examination, the patient generally lies on her back with her feet resting in stirrups at the end of the examination table. The physician or nurse practitioner begins by examining the external genitalia and surrounding area for any signs of infection. Next, the practitioner examines the vagina and cervix by inserting a speculum (a duck-billed instrument) into the vagina. The speculum helps the practitioner check for ulcers, unusual discharge or bumps, and signs of infection such as abnormal odors or unusual redness of the skin. The practitioner will then perform a pap smear, collecting some cells from the cervix and placing them on a slide to check for infections, precancerous, and cancerous cells. Following the speculum examination, the practitioner will perform an examination of the pelvic, and sometimes a rectal exam. Here he/she is checking for any abnormalities, including cysts or unusual lumps.

More about STIs and Women

• Complications associated with STIs are more severe and more frequent among women than men. For example, women are more susceptible to reproductive cancers and infertility once infected.
• Women are biologically more susceptible than men to becoming infected if exposed to an STI. For example, a woman's risk of contracting gonorrhea from one act of unprotected intercourse is as high as 90 percent while the risk to a man is approximately 30 percent.
• Among couples with one infected partner, the annual risk of herpes infection is 19 percent when transmitted from a man to a woman and 5 percent when transmitted from a woman to a man.
• STIs are less likely to produce symptoms in women and are therefore more difficult to diagnose until serious problems develop. Up to 80 percent of Chlamydia infections in women are asymptomatic compared to 40 percent in men. From 30 to 80 percent of women with gonorrhea are asymptomatic while fewer than 5 percent of men are asymptomatic.

STIs vs. STDs?

You might wonder why some people use the term sexually transmitted infection (STI) instead of the term sexually transmitted disease (STD). "STI" more accurately describes conditions where sexual partners may not have symptoms and may not be aware that they havean infection. Furthermore, many of these infections are actually curable. The term "infection" also carries less of a social stigma than the term "disease." Planned Parenthood and other leading organizations now use the term "STI."

Gonorrhea

What It Is:
Bacterial infection

How Do You Get It:
Vaginal, anal, or oral sex

Symptoms:
Women may not show symptoms. Women can experience discharge and swollen, tender labia. Men have extreme pain when urinating and discharge from penis. Sore throat can come from unprotected oral sex.

Prevention:
Latex condoms and dental dams can reduce risk. Avoid sex until your partner is fully cured.

Treatment:
Antibiotics

Long-Term Consequences:
If untreated, can lead to pelvic inflammatory disease and/or sterility

Crabs

What It Is:
Lice (little white bugs/parasites) in the pubic area that feed off blood. May live in any area with hair.

How Do You Get It:
Through close contact with someone who has it and their things (e.g., underwear, clothes, bedding).

Symptoms:
Mild to severe itching. Possibly little specks of blood in underwear from bites.

Prevention:
Avoid close contact with someone who has it.

Treatment:
Medication from doctor. Wash all clothes worn recently and any place the bugs may live. There is also special shampoo treatment, which you can use a few times.

Long-Term Consequences:
None.

Chlamydia

What It Is:
bacterial infection

How Do You Get It:
Vaginal, anal, or oral sex

Symptoms:
burning sensation when peeing, change in texture and smell of vaginal discharge, itchy genitals, abdominal pain. Often no symptoms.

Prevention:
Latex condoms and dental dams can reduce risk. Avoid sex until your partner is fully cured.

Treatment:
Antibiotics

Long-Term Consequences:
If untreated, can lead to pelvic inflammatory disease and/or sterility

Genital Herpes

What It Is:
Painful, itchy, blisterlike sores anywhere in the genitals, mouth, anus, or other skin areas. Outbreaks are sporadic and range from minor to severe. They can be triggered by stress or fatigue.

How Do You Get It:
Oral, genital, anal, or skin contact with an active, or "shedding" herpes sore.

Symptoms:
Blisterlike sores at the infection site (mouth, anus, gentials, etc.).

Prevention:
Use latex condoms even if no sores are visible - there is always risk of transmission. Female condoms are better because they cover more genital surface.

Treatment:
There is no "cure" for a virus, only treatment to lessen symptoms. Ointments can reduce discomfort by reducing itching and speeding up the drying process. Sitz baths and anesthetic creams also reduce discomfort. There are prescription oral antiviral medications that can reduce severity and frequency of outbreaks. Eating right and getting plenty of sleep is also helpful.

Long-Term Consequences:
Once you get herpes, you have it forever. You should wash your hands frequently during outbreaks, and avoid touching your eyes and face after contact with a sore. (Herpes in the eyes can cause blindness.) During childbirth, there are also some implications; vaginal delivery during a herpes outbreak poses danger to the baby. If you are ever pregnant, be sure to tell your doctor that you have herpes.

Human Papillomavirus (HPV)

What It Is:
A virus that causes warts

How Do You Get It:
Skin-to-skin contact; or by vaginal, anal, or oral sex with someone who has the virus

Symptoms:
Usually painless, sometimes itchy warts anywhere in the genital region (internal or external): harder, whiter or browner warts on the outer genitals and softer, pinker warts inside the vaginal canal or on the cervix. They may appear individually or in clusters.

Prevention:
Barrier methods (condoms, diaphragms) reduce risk, but since it's transmitted from skin to skin, you can still get it. Furthermore, a lot of people have the virus or warts and don't even know it.

Treatment:
Once the warts have been diagnosed, a doctor can freeze, burn, laser, or cut them off. Take-home opical medications are also available.

Long-Term Consequences:
Some warts can keep growing if untreated, which could result in breaking and bleeding if irritated. Some strains of HPV that cause warts are also linked with cervical cancer and precancerouos conditions of the cervix (although this is rare). An annual pap smear can help catch cervical cancer before it becomes serious. Those who are already diagnosed with HPV need a Pap smear more frequently.

Hepatitis B

What It Is:
Virus that causes liver damage

How Do You Get It:
transmitted through infected blood and fecal matter passed through oral, anal, or vaginal sex or through sharing needles, razors, toothbrushes, and piercing or tattooing supplies.

Symptoms:
rashes, jaundice, fatigue, nausea, vomiting, body aches, abdominal aches, loss of appetite. Sometimes, however, people do not experience any symptoms.

Prevention:
Vaccine, which is a series of three shots. Latex condoms and dental dams can reduce risk.

Treatment:
The vaccine is effective even after exposure. Shots of immune globulin also help strengthen the immune system to fight it off.

Long-Term Consequences:
Hepatitus B is a chronic disease where sysmptoms can subside and recur. Untreated and unmanaged cases can lead to liver damage and death. Latex condoms and dental dams can reduce risk.

Syphilis

What It Is:
Bacterial disease that gets into the bloodstream, causing chancre sores and rashes.

How Do You Get It:
Oral, anal, or vaginal sex. If there are sores on the muoth, it can also be transmitted from kissing.

Symptoms:
There are three stages: First a painless sore appears where contact was made - this is the most infectionus stage. The sore will heal, followed by a body rash. The rash will disappear, but the infection is still in the body. The third stage (many years later) results in dimentia and death. Although the sores & rash diasappera the person can still transmit syphilis to others.

Prevention:
Latex condoms and dental dams can reduce risk. Avoid sex until your partner is fully cured.

Prevention:
Penecillian effective in stages 1 and 2. No cure at stage 3.

Long-Term Consequences:
unreated syphilis can lead to degeneration of vital organs, brain damage, and death.

Human Immunodeficiency Virus (HIV)

What It Is:
Viral infection that lives in the blood and breaks down the immune system; AIDS is the more advanced disease (Acquired Immune Deficiency Syndrome)

How Do You Get It:
Transmitted through bodily fluids (blood, semen, vaginal fluid, breast milk) but not vomit, mucus, sweat, tears, or saliva. Women who are pregnant can also pass the virus to their children in utero or through breast milk.

Symptoms:
The virus itself does not kill but leaves the body's immune system vulnerable to many infections, which are the true symptoms.

Prevention:
Latex condoms and dental dams can reduce risk.

Treatment:
Unfortunately, there is no cure. But, you can take good care of yourself to delay HIV from turning into AIDS and to avoid other infections. The window period of HIV (the time between infection and the presence of the first HIV antibody) ranges anywhere from seven days to eighteen weeks. As a result, HIV antibody tests that are taken soon after unprotected sex and are negative could be falsely negative. The incubation period of HIV (the time from HIV infection to the first signs of AIDS) can range from a few months to several years. HIV and AIDS have no cure, and regardless of a patient's medical history, there is no way to restore a failing immune system.

Here is a list of possible symptoms and STIs generally associated with them. This table only hits common STIs, however. (Remember that there are over 30 STIs!) Furthermore, some STIs share symptoms with other types of diseases, like urinary tract infections, yeast infections, bacterial vaginosis, and trichomoniasis. If you are concerned, the best thing to do is to go to your gynecologist or medical provider ASAP.

After you have a confirmed STI, always remember to tell your partner in case s/he needs to be examined as well.

more on H I V / A I D S:

• Thirty percent of new HIV infections are found in women
• Women accounted for 7% of new AIDS cases in 1986 and 25% in 2002
• Three?quarters of new HIV infections are due to heterosexual sex
• African?American women account for 64% of new AIDS cases reported among women and Latinas account for 17%

Though lesbians have been identified in the past as a low-risk group, there is no evidence that lesbian sexual activity is any less risky than heterosexual activity. In fact, the number of HIV-positive lesbians in this country has not yet been determined. There are many ways that HIV can be transmitted throughwoman-to-woman sex. In addition to transmission through oral sex, HIV may also be transmitted through penetration by a dildo, especially if the same dildo is used by both partners. HIV can also enter the bloodstream through cuts on the fingers and in the mouth.

How do I talk with my partner about getting tested for STIs?

After you've made your own appointment to get tested, you think your partner would benefit as well. Hos do you bring it up?

First, role-play the situation in your head ? think about what you want to say and where you want to say it. For instance, having a conversation about STIs is more effective when you and partner can sit down someplace quiet (not in the bedroom or during the heat of passion) and talk about what you each want to get out of your relationship & steps to be healthy about it. Talking about STIs and sexual intimacy is important to do well-before you become sexually active. You both might even go get tested together. Now that you've walked through this mental conversation, ask you partner if you can make time to meet and talk. Yes, this conversation may be awkward, but taking this step to talk shows your partner that you care about his/her health, as well as your own and value their perspective about your relationship intimacy.

Here are some ways to bring up the topic

• I really care about you, so there's something I want both of us to do.
• We've been dating for a while, and I think we're ready to take the next step together.

You don't have to talk in depth about former partners or sexual experiences to emphasize the importance of getting tested. Instead you should focus on your current relationship and increasing trust. You and your partner(s) can choose to get tested at the same time, or you can make your own appointments and agree to talk about the results later on. Choose the option that is comfortable for the both of you.

Now, you might be wondering if you should tell your partner you tested positive for an STI

There are several reasons why you should tell your partner:

• Telling your partner shows that you respect them and have a concern for their well being. Your honesty can build intimacy and trust.
• Telling your partner helps prevent transmitting STIs to other people or between each other, back and forth.
• Telling your partner can begin an important discussion about sexual health. There are over 30 STIs with a range of health consequences. Your honesty encourages your partner to share sexual history and health information with you.
• Telling your partner can prevent future misunderstandings.

At the same time, if you test negative, that does not mean you should stop practicing safer sex. If you are in a mutually monogamous relationship and you've both been tested, you and your partner can decide what's right for you. If you are not in a mutually monogamous relationship, it's safer to assume there's a risk of STI exposure and to practice safer sex. As always, the most effective way to prevent STIs is to always use a condom or latex barriers.

Another concern is that particular tests, like the test for HIV, can give false negative results if you are tested too close to your exposure and your body has not developed detectable levels. During your test appointment, your medical provider will be able to determine whether you will need to re-test.

If I test positive for an STI, how do I tell my partner?

First, it's most important to come to terms yourself with having an STI. If you haven't yet, it's probably unrealistic to expect another person to understand. Gather up all the information you can, and figure out how to reduce risk for your partner. Make sure you are knowledgeable before you can explain the infection to someone else. The more you know about the STI, the more you can relieve your partner's fears. If s/he has questions, you will be more prepared. You can gather information about the STI and have it on hand. (For instance, there are many pamphlets available at the Student Care Center.)

Now, the conversation might feel like the toughest part of all, but remember to be as honest and open as you can be. You would want your partner to tell you if s/he had an STI. Plus, you are being responsible and caring by telling your partner the truth.

Here are some suggestions that can help you decide the best time to tell your partner

• Pick a time when both of you have few distractions and can be relaxed. Choose a private place with as few distractions as possible.
• Since the way you say things can affect the way your partner reacts, make sure you are calm when talking about your STI. (If you feel like it's the end of the world, it's likely that your partner will feel the same way.)
• Make sure you are having a conversation; allow your partner to speak as well.
• Encourage your partner to ask questions, and to let you know what s/he is thinking and feeling. Let them know you're con cerned about them and that you're willing to find a way to make your relationship work, if they are. Recognize that this might not be your only discussion before things are resolved.
• Realize that even after you have said everything you want to say, you cannot predict how your partner will react. S/he might need some time to think, or s/he might act impulsively. At the same time, s/he might be very understanding and hopeful. No matter what the reaction is, remember that your partner has a right to his/her feelings and reactions and might need to take some time to figure out how s/he truly feels.

Resources

Listed below are hotlines and addresses of institutions that can provide further information on sexually transmitted infections (still referred to as sexually transmitted diseases, or STDs, by many service providers)

Illinois AIDS Hotline
1-800-AID-AIDS

Centers for Disease Control National STD Hotline
Provides STD information and referrals to clinics nationwide.
English (800) 227-8922; 24 hours, Mon-Fri
Spanish (800) 344-7432; Mon-Fri, 8 a.m.-2 a.m. (EST)

Centers for Disease Control National AIDS Hotline
Provides HIV/AIDS information and nationwide referrals to testing sites, crisis centers, or other HIV-related need. (24 hours, Mon-Fri)
English (800) 342-2437 or Spanish (800) 344-7432 or Hearing Impaired TTY (800) 243-7889

National Herpes Hotline
(919) 361-8488

Student Care center Sexual Health

STIs and Women of Color