STD in females

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DISEASES & TREATMENTS

SEXUALLY TRANSMITTED DISEASES

(STDs)

IN WOMEN

medicineNet POWER POINTS about SEXUALLY TRANSMITTED DISEASES IN WOMEN:

* There is no "safe" sex.
* Condoms do not necessarily prevent STDs.
* Gonorrhea and chlamydia are bacterial STDs that are frequently found
together.
* Gonorrhea is NOT transmitted from toilet seats.
* Women infected with gonorrhea may not have any symptoms.
* Early syphilis causes a mouth or genital ulcer (chancre) and later can
cause hair loss, headaches, sore throat, and skin rash. Even later,
syphilis can lead to heart and brain damage.
* Genital herpes is a viral infection that can cause painful genital
sores.
* Genital warts are caused by viruses and can increase a woman's risk
for cancer of the cervix.
* AIDS is caused by the human immunodeficiency virus (HIV).
* Hepatitis B is a virus that causes liver inflammation and can lead to
cirrhosis and cancer of the liver.
* Hepatitis B can now be prevented with a vaccine.

Topics review below: Gonorrhea, Gonorrhea, Syphilis, Genital Herpes,
Genital Warts, AIDS, Hepatitis B.

What are sexually transmitted diseases?

Sexually transmitted diseases, or STDs, are infections that can be
transferred from one person to another through sexual contact. Sexually
transmitted diseases have probably been around for thousands of years, but
the most worrisome, AIDS, has only been recognized since 1984. It is
important to realize that sexual contact includes more than just sexual
intercourse (vaginal and anal). Sexual contact includes kissing,
oral-genital contact, and the use of sexual "toys," such as vibrators.

Most STDs are treatable. However, even the once easily cured gonorrhea has
become resistant to many of the older traditional antibiotics. Other STDs,
such as herpes, AIDS, and genital warts, all of which are caused by
viruses, have no cure. Some of these infections are very uncomfortable,
while others can be deadly. Syphilis, AIDS, genital warts, herpes,
hepatitis, and even gonorrhea have all been known to cause death.
Therefore, a public awareness and education about these diseases and the
methods of preventing them is important.

There really is no such thing as "safe" sex. The only truly safe sex is
abstinence. Sex in the context of a monogamous relationship wherein neither
party is infected with a STD is also considered "safe". Most people think
that kissing is a safe activity. Unfortunately, syphilis, herpes, and other
diseases can be contracted through this relatively simple and apparently
harmless act. All other forms of sexual contact carry some risk. Condoms
are commonly thought to protect against STDs. Condoms are useful in
preventing certain diseases, such as herpes and gonorrhea. However, they do
not fully protect against other diseases such as genital warts, syphilis
and AIDS.

GONORRHEA

What is gonorrhea?

Gonorrhea is a bacterial infection which is transmitted by sexual contact.
Gonorrhea is one of the oldest known sexually transmitted diseases. It is
estimated that over one million women are currently infected with the
bacteria that causes gonorrhea. In women infected with this bacteria,
25-40% will also be infected with another bacteria that can cause another
STD called chlamydia. Chlamydia infection is discussed later in this
article.

Contrary to popular belief, gonorrhea cannot be transmitted from toilet
seats or door handles. The bacteria that causes gonorrhea requires very
specific conditions for growth and reproduction. It cannot live outside the
body for more than a few seconds or minutes. Nor can it live on the skin of
the hands, arms, or legs. Gonorrhea is normally found in the vagina, and
more specifically, the cervix. (The cervix is the end of the uterus that
protrudes into the vagina.) It can also live in the tube (urethra) through
which urine is drained from the bladder. Gonorrhea can even exist in the
back of the throat and in the rectum.

What are the symptoms of gonorrhea?

Over 50% of infected women have no symptoms, especially in the early stages
of the infection. Symptoms of gonorrhea include burning or frequent
urination, a yellowish vaginal discharge, redness and swelling of the
genitals, and a burning or itching of the vaginal area. If untreated,
gonorrhea can lead to a severe pelvic infection with inflammation of the
fallopian tubes and ovaries. Symptoms of pelvic infection include fever,
pelvic cramping, abdominal pain, or pain with intercourse. A pelvic
infection can lead to difficulty in becoming pregnant or even sterility.
Occasionally, if the infection is severe enough, a localized area of
infection and pus (an abscess) forms, and major surgery may be necessary
and even life-saving.

How is gonorrhea diagnosed and treated?

Testing for gonorrhea is done by swabbing the infected site and culturing
the swab in the laboratory. The culture is positive when the gonorrhea
bacteria are found to be growing on a culture plate. Sometimes the test are
negative even when the woman has an infection because of sampling error or
other technical difficulties.

In the past, the treatment of uncomplicated gonorrhea was fairly simple. A
single injection of penicillin cured almost everyone infected with this
disease. Unfortunately, there are new strains of gonorrhea that have become
resistant to various antibiotics (including penicillin), and are therefore
more difficult to treat. Gonorrhea can still be treated by other injectable
or oral medications. Treatment should always include medication that will
treat chlamydia as well. Once the treatment is complete, it is important to
repeat the culture in order to be certain that the infection is actually
cured. Occasionally, the infection is difficult to eradicate.

Gonorrhea is one of the easier STDs to prevent because the bacteria that
causes the infection can survive only under certain conditions. Prevention
of transmission includes the use of condoms or other protective barriers to
prevent contact between moist genital skin. Since the organism can live in
the throat, oral-genital contact should include the use of condoms as well.

CHLAMYIDIA

What is chlamydia?

Chlamydia is a bacteria that causes an infection that is very similar to
gonorrhea in the way that it is spread and the symptoms it produces. It
affects approximately 3-5 million women annually. Like gonorrhea, it is
found in the cervix and urethra and can live in the throat or rectum. It is
very destructive to the fallopian tubes and can cause infertility and tubal
pregnancy. It can also cause severe pelvic infection. Because it is common
for infected women to have no symptoms, it is often untreated, leading to
extensive destruction of the fallopian tubes and fertility problems.

Chlamydia, like gonorrhea, is associated with an increased incidence of
preterm birth in women infected with this organism. In addition, the infant
can acquire the disease during passage through the infected birth canal,
leading to eye involvement or pneumonia. For this reason, all newborns are
treated with eye drops after birth. The drops contain an antibiotic which
treats chlamydia. Treatment of all newborns is routine because of the large
number of infected women without symptoms, and the dire consequences of
chlamydial eye infection to the newborn.

How is chlamydia detected and treated?

Chlamydia can be detected by cultures or certain slide tests. Unlike
cultures, which require days of observation for the growth of the bacteria,
the slide test can be performed fairly quickly. Most labs can have results
within 24 hours. However, the infection may be very mild and the more rapid
slide test results can be falsely negative. A culture can be more accurate
in detecting chlamydia.

Treatment of chlamydia infection involves antibiotics, usually tetracycline
(ACHROMYCIN) or doxycycline (VIBRAMYCIN). Unlike gonorrhea, there has been
little, if any, resistance of the disease to currently used antibiotics.
There are many other antibiotics that have also been effective against
chlamydia. Like gonorrhea, a condom or other protective barrier is
important in preventing the spread of the infection.

SYPHILIS

What is syphilis?

Syphilis is another STD that has been around for centuries and is caused by
a microscopic bacterial organism called a spirochete. The spirochete is a
worm-like spiral-shaped organism that wiggles vigorously when viewed under
a microscope. It infects the person by burrowing into the moist mucous
membranes of the mouth or genitals. From there, the spirochete produces the
classic non-painful ulcer known as a chancre.

There are three stages of syphilis. Formation of the chancre is the first
stage. It is highly contagious and can last from 1 to 5 weeks. The disease
can be transmitted from any contact with one of the ulcers, which are
teeming with spirochetes. If the ulcer is outside of the vagina or on the
scrotum of the male partner, the use of condoms may not help in preventing
transmission of the disease. Likewise, if the ulcer is in the mouth, merely
kissing the infected individual can spread syphilis.

Even without treatment, an early infection resolves on its own in most
women. However, 25% will proceed to the next stage of the disease called
"secondary" syphilis, which lasts from 4 to 6 weeks. This secondary phase
can include hair loss, a sore throat, white patches in the nose, mouth, and
vagina, fever, headaches, and a skin rash. There can be lesions on the
genitals that look like genital warts but are caused by spirochetes rather
than the wart virus. These wart-like lesions, as well as the skin rash, are
highly contagious. The rash can occur on the palms of the hands and the
infection can be transmitted by casual contact.

The third stage of the disease involves the brain and heart and is usually
no longer contagious. At this point, however, the infection can cause
extensive damage to the internal organs, such as the brain, and can lead to
death.

How is syphilis diagnosed and treated?

Symptoms of syphilis can be vague or seemingly related to some other
problem, so most physicians do not routinely test for this infection.
Syphilis is diagnosed by either scraping the base of the non-painful ulcer
and looking under a special type of microscope for the spirochetes, or by
performing special blood tests. There are two blood tests. One is the
screening test; the second is performed to verify a positive screen. The
accuracy of the screening fluctuates during the three stages of syphilis.
In the first stage, 75% of women test positive. By the second stage, nearly
100% of infected individuals test positive. In the third stage of the
infection, which can involve the brain, 70% of the infected people test
positive with the screening test. It is only in the second stage of the
disease that the blood tests for syphilis are extremely accurate.
Therefore, a single negative blood test does not mean that the person does
not have the disease. It may just mean that the infection is in a stage
where it is more difficult to detect.

Treatment of syphilis depends on the stage the disease at the time of
diagnosis. The spirochetes are very sensitive to a special long-acting
injectable form of penicillin. Oral penicillin dosages that are prescribed
for a sore throat or sinus infection are not effective against syphilis.
For women who are allergic to penicillin, there are alternative treatments
which are equally effective.

Women who are infected during pregnancy can pass on the infection to the
fetus through the placenta. Treatment of the infection during pregnancy can
unfortunately kill the unborn baby. Penicillin must be used in pregnant
patients with syphilis, since other antibiotics do not effectively cross
the placenta to treat the infected fetus. Left untreated, syphilis can lead
to blindness or even death of the baby.

GENITAL HERPES

What is genital herpes?

Genital herpes, also commonly called "herpes," is a viral infection that is
transmitted through intimate contact with the moist mucous linings of the
genitals. This contact can involve the mouth, the vagina or the genital
skin. The virus enters the mucous membranes through microscopic tears. Once
inside, the virus travels to nerve the roots near the spinal cord and
settles there permanently.

When an infected person has a herpes outbreak, the virus travels down the
nerve fibers to the site of the original infection. When it reaches the
skin, the classic redness and blisters occur. The outbreak of herpes is
closely related to the functioning of the immune system. Women who have
suppressed immune systems, either through stress, disease, or medications,
have more frequent and longer-lasting outbreaks.

What are the symptoms of herpes?

Once exposed to the virus, there is an incubation period that generally
lasts 3 to 7 days. During this time, there are no symptoms and the virus
cannot be transmitted to someone else. The outbreak usually begins as an
itching or tingling sensation followed by redness of the skin. Finally, a
blister forms. The blisters and subsequent ulcers are usually very painful
to touch and may last from 7 days to 2 weeks. The virus is most contagious
from the time of itching to the healed ulcer stages. Once the ulcers have
completely healed, the risk of acquiring the virus from an infected
individual is very small.

During the initial outbreak, cultures of the blisters are positive for the
herpes virus in only about 80% of patients. This means that in 20% of women
with an actual herpes outbreak, a negative culture result might incorrectly
lead them to believe that they do not have the herpes virus. After the
initial outbreak, subsequent outbreaks tend to be sporadic. They can occur
weekly, or even years apart. Some women only have the initial outbreak and
never have a recurrence. In women who do have recurrences, culturing the
blister fluid detects the herpes virus in only 50% of the cultures. When
there is doubt as to whether or not the woman has the herpes virus, blood
tests can be performed that can help determine if the woman was exposed to
the virus and is, therefore, most likely a virus carrier.

Genital herpes has received a great deal of publicity in recent years. It
is believed that 60% of sexually active adults carry the herpes virus. Part
of the reason for the continued high infection rate is that most women
infected with the herpes virus do not know that they are infected, because
they have little or no symptoms. The typical symptoms of itching, blisters,
and painful ulcers are not always present. In many women, there are
"atypical" outbreaks where the only symptom may be mild itching or minimal
discomfort. Often, the longer the woman has had the virus, the fewer the
symptoms they have with their outbreaks. Additionally, the virus can shed
from the cervix into the vagina in women who are not experiencing any
symptoms.

How is herpes treated?

Although there is no known cure for herpes, there are treatments for the
outbreaks. There are oral medications, such as acyclovir (ZOVIRAX), and
ointments that can be used to help lessen the pain associated with the
outbreak and even shorten the length of the eruption. Herpes can be spread
from one part of the body to another during an outbreak. Therefore, it is
important not to touch the eyes or mouth after touching the blisters or
ulcers. Thorough hand washing is a must during outbreaks. Clothing that
comes in contact with ulcers should not be shared with others. Couples that
want to minimize the risk of transmission should always use condoms if a
partner is infected with the herpes virus. Couples may also want to
consider avoiding all sexual contact, including kissing, during an outbreak
of herpes. Women who have herpes and are pregnant can have a vaginal
delivery as long as they are not experiencing symptoms or actually having
an outbreak while in labor.

GENITAL WARTS

What are genital warts?

Genital warts are wart-like abnormalities on the genitals which are caused
by viruses called human papilloma viruses (HPVs). Different strains of HPVs
also cause the common warts that are found on the hands and fingers. The
viruses that produce genital warts are transmitted through sexual contact.
This infection is now considered to be the most common sexually transmitted
disease in the United States.

The wart stage is the most contagious. However, a dormant virus can also be
infectious. Therefore, preventing the spread of genital warts can be
difficult. Condoms do not necessarily protect either partner against the
infection.

Most people infected with HPVs have no symptoms and, therefore, are unaware
that they have the condition. HPV infection can cause chronic itching or
genital pain. HPV can also cause pre-cancerous conditions of the cervix and
predispose women to cancer of the cervix.

Current treatments are targeted at removing visible warts and treating the
pre-cancerous changes. These treatments include freezing, laser removal
(ablation), burning with acid solutions, excision, and drugs designed to
improve the immune system.

For more information, please visit the GENITAL WARTS site of MedicineNet.

AIDS

What about AIDS?

Acquired immune deficiency syndrome (AIDS) is a contagious disease caused
by the human immunodeficiency virus (HIV). HIV infection weakens the body's
immune system and increases the body's vulnerability to many different
infections as well as to the development of certain cancers. AIDS is one of
the most frightening of the STDs because it is the most uniformly fatal of
the group.

Currently, it is believed that AIDS can only be transmitted through bodily
secretions, such as blood, semen, or vaginal secretions. It is known that
the virus is present in saliva. However, the concentration is believed to
be too low to actually cause infection just by kissing. This is not a
universal belief, and some members of the medical community feel that the
virus can be transmitted from any bodily fluid in which it is found. The
virus is found in about 50% of infants who are born to infected mothers.
The infection is detected through blood testing and may not show positive
for at least 4 to 6 weeks after acquiring the virus. There is no known cure
for AIDS. There has been a great deal of research related to this disease
and experts in the field believe that a vaccine or cure is still far off,
if not impossible altogether. For more information on AIDS, please visit
the AIDS site of MedicineNet.

HEPATITIS B

What is hepatitis B?

Hepatitis B is a virus that causes inflammation of the liver. Most people
do not think of hepatitis as a sexually transmitted disease. However, one
of the more common modes of the spread of viral hepatitis B is through
intimate sexual contact. Sexual transmission is believed to be responsible
for 30% of the cases worldwide. Complications from hepatitis B are
responsible for 1 to 2 million deaths yearly.

Hepatitis B virus can cause both an initial (acute) and a chronic form of
liver inflammation. Liver blood tests become abnormal 1-10 days after
infection with the virus. The initial phase of infection lasts a few weeks,
and in most people, the infection clears without medications. Once the
initial infection is cleared, the most women are permanently cured and are
usually immune to further infection. Unfortunately, in about 2-10% of women
who become infected, this virus causes a chronic infection, which cannot be
resolved. It is this chronic form that is dangerous to women. Chronic
hepatitis B is associated with cirrhosis of the liver, liver failure, and
liver cancer.

Transmission of hepatitis B can occur during the early phase of infection
or during the chronic carrier stage. Kissing and unprotected intercourse
are methods of spreading this virus. While hepatitis does not affect the
reproductive organs, it can be transmitted to the fetus by a pregnant woman
if she is infected during the pregnancy. This virus is transmitted to 80%
of the fetuses in women that are infected during pregnancy. This is
potentially dangerous, since infected infants have an 80% chance of having
the chronic form of the infection.

The symptoms of hepatitis include yellow coloration of the skin or eyes
(jaundice), fever, upper abdominal pain, generalized malaise, and nausea.

How is hepatitis B treated?

Most people infected with this virus ultimately do well, Some patients,
however, require hospitalization. Hepatitis B can now be prevented by
immunization with a vaccine. Immunization is currently recommended for
people where exposure to this virus is high, such as in hospitals,
transfusion centers, and in children. It could also be considered for women
of childbearing age, those who have multiple sexual partners or whose
partners participate in risky behavior such as the use of prostitutes or
intravenous drugs.

Treatment within 24 hours of the exposure can reduce the transmission of
hepatitis B. The treatment consists of injections of immune globulin.
Immune globulin is a protein that binds to the virus and helps the body
clear it from the blood. The best "treatment," however, is prevention of
exposure and immunization.

CONCLUSION

The most important fact to remember about sexually transmitted diseases is
that all of them are preventable. In this day of sexual freedom, the risks
of these diseases is often downplayed and thus forgotten by many. The use
of condoms can help decrease the risk of transmission of certain
infections, but they do not prevent the transmission of all infections.
There is truly no such thing as safe sex. Sex in the context of a
monogamous relationship wherein neither party is infected with a STD is ,
however, considered "safe".

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