SEXUALLY TRANSMITTED DISEASES

Dr.Joe's Data Base--------------------------------------------------------

Sexually transmitted diseases (STDs) are quite common. More than
13 million new cases are diagnosed each year. Approximately one
in every four Americans between the ages of 15 and 55 will become
infected by a STD. Of the more than 20 STDs, the information
below focuses on some of the most common-chlamydia, syphilis,
gonorrhea, and genital herpes-and the single most serious,
acquired immunodeficiency syndrome (AIDS).

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How Are STDs Contracted?

As the name implies, sexually transmitted diseases can be and usually are
spread through sexual intercourse, whether vaginal, oral or anal. In
certain cases in which a STD has infected the throat or mouth, it is
possible that the disease can be transmitted to another through deep
kissing in which saliva is exchanged.

Certain STDs, including syphilis, gonorrhea, chlamydia, and the virus that
causes AIDS, can be carried in the blood; therefore, there is risk in
handling contaminated hypodermic needles and syringes. Various tests are
performed on donated blood to minimize the risk of patients who receive
blood transfusions.

Some STDs can be passed from an infected mother to her child in utero (in
the womb), during childbirth, and through breast milk.

How Can STD Be Prevented?

A person can take many steps to avoid contracting a STD or passing a STD to
another person. Here are some important facts to know:

* A monogamous sexual relationship between uninfected partners is the
best way to avoid contracting a STD.

* Newborn babies can contract certain STDs from an infected mother,
including AIDS, gonorrhea, syphilis, genital herpes and chlamydia. In
some cases risk can be reduced

and even eliminated if the mother is diagnosed and treated for the STD
during her pregnancy.

* When engaging in sexual activities, correct and consistent use of a
new latex condom with each act of intercourse is a highly effective
method for preventing transmission of human immunodeficiency virus
(HIV)-the virus that causes AIDS-and reduces risk of contracting other
STDs, including gonorrhea, syphilis, genital herpes and chlamydia. The
condom should be lubricated with a water-based lubricant (such as K-Y
JellyTM or glycerine) because an oil-based lubricant (such as
petroleum jelly) can weaken latex.

* Natural-membrane condoms are not as safe as latex because they have
naturally occurring pores that are small enough to prevent passage of
sperm, but large enough to allow passage of viruses in laboratory
studies.

* According to the Centers for Disease Control and Prevention (CDC),
"The effectiveness of spermicides in preventing HIV transmission is
unknown. Spermicides used in the vagina may offer some protection
against cervical gonorrhea and chlamydia. No data exist to indicate
that condoms lubricated with spermicides are more effective than other
lubricated condoms in protecting against the transmission of HIV
infection and other STDs. Therefore, latex condoms with or without
spermicide are recommended."

* When a male condom cannot be used, couples should consider using a
female condom. This is a lubricated polyurethane sheath with a ring on
each end that is inserted into the vagina. Laboratory studies indicate
the female condom is an effective mechanical barrier to HIV and other
viruses, according to the CDC. However, whereas male condoms are
unlikely to slip or break during proper use, clinical studies indicate
that the female condom has a higher failure rate for pregnancy
prevention.

* A condom, even if properly used and properly functioning, does not
always provide complete protection for either partner; for example, a
man with a herpes lesion on a testicle could infect a woman during
sexual intercourse because the condom does not cover the testicles.

* Adolescent children must be educated about the risks of unprotected
sexual activity. They must also be warned against the dangers of
handling hypodermic needles and syringes, which may be contaminated
with certain STDs.

* A person who suspects he or she has contracted a STD, has been exposed
to a STD, is being treated for a STD or has an active herpes lesion
should seek medical treatment or counseling before:

- Engaging in further sexual activity.

- Trying to conceive a baby.

- Donating blood.

* Someone who has been diagnosed with a STD should notify any sexual
partners he or she may have unknowingly infected and urge that person
or persons to seek professional medical attention.

* Once a person has been cured of a STD, they are not immune to that
STD-in other words, it is possible to become reinfected.

* Regular checkups by a family doctor or gynecologist can help to detect
and diagnose STDs.

How Are STDs Diagnosed?

When a physician suspects a patient may have contracted a sexually
transmitted disease, the diagnosis is made by testing the blood or
analyzing cultures of fluid or tissue taken from the site of the infection.
When there is reason to suspect gonorrhea, syphilis or chlamydia or
exposure to any of these diseases, doctors routinely test for all three. It
is possible to have more than one STD at a time.

Can STDs Be Cured?

If treatment begins early, most sexually transmitted diseases can be cured,
with little or no serious or permanent effects to health. Two exceptions
are herpes simplex and AIDS. Herpes simplex cannot be cured, but it can be
treated and managed through medication and lifestyle changes. AIDS, the
most serious STD facing the world today because it is ultimately fatal, is
described below (and in greater detail under the AIDS heading.) The drug
AZT, approved by the Food and Drug Administration in March 1987, may slow
the production of the virus that causes AIDS. Though not a cure, AZT may
delay symptoms and eventual death in some AIDS patients. AIDS-related
illnesses, such as pneumonia, are treated with drugs specific to those
illnesses.

AIDS

AIDS is preventable and easily avoided, yet we are witnessing a worldwide
epidemic of this deadly disease. If recent estimates are correct, the
number of people infected with the virus that causes AIDS may increase as
much as tenfold in the next eight years-from 13 million to 130 million men,
women and children worldwide. Tragically, most-if not all-of these people
will eventually die of the disease. Ten years ago, AIDS was a disease
primarily contracted by male homosexuals. This is no longer true. Women
account for about 40 percent of persons currently infected with the AIDS
virus. By the year 2,000, women with AIDS are predicted to outnumber men
with AIDS.

Signs And Symptoms Of HIV Infection And AIDS

After becoming infected with HIV, a person may continue to enjoy good
health for a year, two years, or even 10 years. Eventually, however,
the virus begins to weaken the body's immune system and, thus, its
ability to fight illness. People infected with HIV may experience a
variety of symptoms, including: loss of appetite, weight loss, fever,
night sweats, skin rashes, diarrhea, fatigue, lack of resistance to
infection or swollen lymph nodes.

Signs that a person infected with HIV has developed AIDS appear after
the patient's immune system has become severely weakened, and then
diseases such as Pneumocystis carinii pneumonia, meningitis or cancer
may occur.

AIDS In Newborns

HIV can also be passed from mother to child during pregnancy,
childbirth or breastfeeding. There is a one in three chance that a
woman infected with HIV will pass the virus to her baby. A woman who
knows or suspects she is infected with HIV should have a medical
examination before trying to conceive a child.

Chlamydia

Chlamydia infections, caused by various strains of the bacterium Chlamydia
trachomatis, are by far the most common type of STD in the United States.
Treated early with antibiotics, the disease can be cured. If left
untreated, chlamydia can spread to the reproductive organs, leading to
infertility in women and, possibly, men.

Signs and Symptoms

Chlamydia may produce a variety of signs and symptoms, depending on
the stage of the disease. In women, these signs and symptoms may
include a thin vaginal discharge, painful urination, vaginal bleeding
between menstrual periods or after intercourse and lower abdominal
pain. In men, these signs and symptoms may include a burning sensation
during urination, the feeling of having to urinate frequently, and a
pus discharge from the penis. Men are more likely to notice chlamydia
early on. Chlamydia signs and symptoms usually begin about 21 days
after contracting the disease.

Chlamydia In Newborns

Chlamydia can be successfully treated during pregnancy. If transmitted
to a newborn during childbirth, the newborn may develop conjunctivitis
and pneumonia, both of which can also be treated.

Syphilis

Syphilis is a complex, but usually curable disease caused by a spirochete
known as Treponema pallidum. If not treated, syphilis will progress through
several distinct stages. Some of the signs and symptoms of syphilis
disappear on their own, without treatment-this does not mean the disease
went away. Syphilis can only be cured by medication, so it is very
important to see a doctor, even if you appear to be feeling better.

Signs And Symptoms

Primary Stage

About ten days to six weeks after exposure to the spirochete, a red
sore or ulcer called a chancre (pronounced "shanker") appears where
the disease entered the body. The most common site is the genitals,
but other areas of the body such as the tongue may be affected. Lymph
nodes near the side of the infections (in the groin or neck, for
example) may be enlarged. Lesions caused by syphilis will disappear
without treatment, but the disease will not be cured.

Secondary Stage

Two to 12 weeks after the chancre disappears, a skin rash of small
scaling red bumps that do not itch appears, usually on the palms of
the hands and soles of the feet. Pink or gray lesions may appear in
mucous membranes of the mouth, vulva and penis. Both the rash and
lesions are highly contagious. Flu-like symptoms, such as fever,
aches, headache, nausea and weight loss, may also be present. Without
treatment, these signs and symptoms will disappear, but the patient
will not be cured.

Latent Stage

Eventually, the rashes and other signs and symptoms disappear. Though
the infection is still present, the person is no longer contagious.
Almost two-thirds of people with untreated syphilis remain in this
latent stage, which can last 20 years or more, until their death.

Final Stage

About one third of untreated syphilis patients reach this stage. The
disease flares up again without warning. It can attack any organ of
the body, causing paralysis, blindness, insanity and even death.

Syphilis In Newborns

Syphilis can be passed to an unborn child, even if the disease is in
its latent stage at the time of the baby's birth. A pregnant woman
with syphilis can sometimes be successfully treated, thus reducing
risks to her newborn; however, 30-40 percent of fetuses infected with
syphilis are stillborn, and those who do survive can die soon after
birth or suffer brain damage, developmental problems or sight and
hearing disorders.

Gonorrhea

Gonorrhea is a curable disease caused by a bacterium, Neisseria gonococcus.
If not treated with antibiotics, gonorrhea may become chronic, leading to a
variety of serious health complications, including permanent sterility in
both men and women.

Sign and Symptoms

The signs and symptoms of gonorrhea generally appear within two weeks of
exposure. Early gonorrhea often goes undetected by women. The most common
site of infection in women is the cervix (the canal into the uterus). An
infected woman may notice a white or yellow vaginal discharge. In men, the
most common site of infection is the urethra (the tube that carries urine
and semen through the penis). An infected man may experience pain during
urination, a more frequent need to urinate and a white or yellow discharge
from the penis. If a woman's urethra is infected, she may also experience
uncomfortable and more frequent urination and a pus discharge from the
urethra. If the anus is infected, men and women may experience inflammation
of the anus, painful bowel movements and a pus-like discharge from the
anus. If the throat is infected, it will be sore.

Gonorrhea In Newborns

Gonorrhea can be transmitted to a newborn during childbirth, causing
blindness in the newborn. To prevent this, silver nitrate drops are
routinely placed in the eyes of all newborns. A baby born with gonorrhea
can be cured with no further ill effects from the disease.

Genital Herpes

Genital herpes is caused by a virus known as HSV-2. There is no cure for
the virus and it does not respond to antibiotics. The condition can be
managed, however, with medical assistance. The drug acyclovir may be
prescribed to ease the discomfort and reduce the length of first and
recurrent episodes of genital herpes.

Herpes is a disease that goes underground for long periods, recurring from
time to time. In persons with frequent bouts of genital herpes (six or more
episodes per year), acyclovir is sometimes prescribed to help prevent
flare-ups. Herpes flare-ups are usually unpredictable, but in some patients
they seem to be triggered by factors such as stress, illness or injury.

Signs and Symptoms

Within two to 20 days of exposure, small red bumps appear in the breakout
area. In a few days they fill with clear fluid and form blisters, which are
usually extremely sore and may itch. Flu-like symptoms, including fatigue,
headache and muscle aches may precede the outbreak of the blister. When the
blisters break, they form ulcers, which eventually heal when new skin
forms. When the sores have completely healed, the virus is believed to be
no longer contagious.

In women, the herpes blisters most commonly appear in the internal or
external vaginal area, the buttocks or anus. In men, they commonly appear
on the penis, scrotum, buttocks or anus. Herpes can also be present in a
woman's cervix or man's urethra, where a lesion would not be visible.
Herpes can also affect the eyes if the virus is transmitted there by an
infected finger. There is some evidence that genital herpes may be
associated with a higher risk of cervical cancer.

Herpes In Newborns

Herpes can be passed to a newborn during childbirth if the baby comes in
contact with a mother's active herpes lesion. There is some evidence that
the disease can be transmitted to the baby while it is still in the womb,
due to viral shedding of the disease. Congenital herpes can have very
serious consequences, including blindness, brain damage, and even death.

When a pregnant woman nearing the end of her term is diagnosed with active
genital herpes, delivery by cesarean section (removal of the baby through
the mother's abdomen) can reduce the risk of infection. Acyclovir has not
been proven safe for use during pregnancy.

Sources For Further Information Include:

Centers for Disease Control and Prevention
Department of Health and Human Services
Public Health Information Service
1600 Clifton Road, NE
Atlanta, GA 30333
404/639-3311

The National AIDS Hotline (operated by the Centers for Disease Control and
Prevention)
800/342-AIDS
800/344-7432 (español)
800/243-7889 (Telecommunication Device for the Deaf)

Free educational literature regarding AIDS, including the Surgeon General's
report on AIDS, can be ordered through the Centers for Disease Control and
Prevention National AIDS Clearinghouse
P.O. Box 6003
Rockville, MD 20849-6003
800/458-5231

American Foundation for the Prevention of Venereal Disease, Inc.
799 Broadway, Suite 638
New York, NY 10003
212/759-2069


© 1994 U.S. Healthcare®. All rights reserved. The above information was
compiled in January 1994. Please contact your primary care physician for
the most recent information about sexually transmitted diseases.

This medical information has been prepared for your general knowledge by or
in consultation with health care professionals. U.S. Healthcare does not
recommend the self-management of health problems, nor does U.S. Healthcare
promote any particular form of medical treatment. If you have a health
concern, you should consult your primary care physician for advice and care
appropriate to your specific medical needs.

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