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SEXUALLY TRANSMITTED DISEASES

What are sexually transmitted diseases (STDs)? 

A term used to describe any disease acquired primarily through sexual contact.  Most are caused by bacteria or viruses and rarely by tiny parasites.  The organisms that cause these diseases generally enter the body through mucous membranes; the warm, moist surfaces of the vagina, urethra, anus, and mouth.  You may be exposed to an infection through oral, anal, or genital sex when a partner is infected.  Many men do not realize that they are infected with one of a number of diseases as they are less often to develop the characteristic sores associated with many sexual transmitted diseases.  The partner may or may not have noticed warty lesions, whitish discharge from the penis, pain with urination, or a number of other symptoms.  Generally, these diseases are carried by an unsuspecting partner.
 
Catching an STD from a toilet seat, sauna, Jacuzzi, or towels of a roommate are quite unlikely. However, if a fresh lesion of a disease such as a genital wart or genital herpes sore is touched with the hands, they can be spread to other areas of the body or the genital areas may be reinfected with the disease.
 
In any event, it is always necessary for women to be very careful when cleaning the genital area.  Bacteria may be found in the feces which sit on the skin around the vagina and anus between bowel movements, if this area is not thoroughly cleansed.   These organisms may creep into the vagina or be forced in towards the vagina or urethra by sexual intercourse.  It is from some of these intestinal type organs that pelvic inflammatory disease (PID) occurs.  The more common causes of PID include: Chlamydia and Gonorrhea, however, in up to 30% of women neither of these organisms will be found.  Pelvic inflammatory disease is one of the more serious complications of STDs.  The symptoms include pelvic pain, fever, diarrhea, and vaginal discharge.  PID often occurs during or right directly after the menses.  The bacteria found in the vagina or on the cervix, whether normal or abnormal, gain access into the uterine cavity and fallopian tubes and spread infection into the abdominal cavity and the entire female reproductive system.  This disease requires antibiotic treatment or infertility may result.  Getting checked at least once a year for sexually transmitted diseases for a sexually active woman is very important to prevent PID and other complications. 
 
Unfortunately, men do not go for regular checkups and tend to carry disease without knowing it.  Before you agree to have sex with any partner, you might want to suggest that this person be checked out and furthermore, it is mandatory that you always use condoms for every sexual relationship, no matter how "well" you know your partner.  It is not necessary to have sex with multiple partners to get an STD, one carrier is enough. Diseases such as Chlamydia and Human Papilloma Virus (HPV) listed below are very common in sexually active populations.  Most men infected with either disease have no idea that they carry it. 
 
How does birth control affect STDs?
 
The only thing that one must remember about birth control is that being on the pill gives wonderful sexual freedom; however, if you do not use condoms, you are NOT protected against any STD.  Foams, contraceptive jellies, condoms, diaphragms, and other barrier methods do afford some protection against STD's.  The chemicals in spermicidal jellies have been found to kill bacteria and viruses including HIV (AIDS virus) and the barrier methods such as condoms, diaphragms, and cervical caps provide a barrier against the spread of STDs.
 
Which are the most common STDs?
 
The most common STDs seen today include the following:
 
·         Mucopurulent Cervicitis (MPC)/Nongonococcal Urethritis (NGU)
·         Gonorrhea
·         Genital Herpes
·         Genital Warts
·         Molluscum Contagiosum
·         HPV (Human Papilloma Virus)
·         Trichomoniasis
·         Syphilis
·         Pediculosis Pedis (Crabs)
·         Scabies
·         Hepatitis B
·         HIV (AIDS)
 
 
Mucopurulent Cervicitis (MPC)/nongonococcal urethritis (NGU) refers to a range of diseases, including Chlamydia, which affects men and women, and ureaplasma, which causes disease in men and may cause infertility in women.  Technically, NGU is a disease of men only and MPC is the female equivalent, but in most texts, all these infections are lumped together.  The major symptom is an abnormal discharge.
 
Gonorrhea is a bacterial organism spread through sexual contact which can cause cervical or tubal infections.  It often accompanies the transmission of Chlamydia, and the most common symptoms included vaginal discharge, irregular periods, pelvic pain, urinary pressure or pain.  Occasionally infection of glands around the vagina occur (Bartholin cyst) and a tender swelling is noted at the entrance of the vagina.
 
GENITAL HERPES is a sexually transmitted virus that lives on the nerves of the spinal cord and travels down the nerve fibers into the genital, buttock, or hip area causing blister-like lesions and severe pain for several days.  The primary episode of genital herpes may be accompanied by fever, painful swollen lymph nodes in the groin, fatigue, and other general constitutional symptoms.  The outbreak of small bumps or blistery lesions will be seen around the genital or anal area.  It is imperative that you contact your physician during the primary episode.  Recurrent episodes occur as often as once a month but generally the recurrence rate decreases as time goes on after the primary lesion period.  Most patients know when they are getting a lesion as they will feel burning, tingling, or pain in the genital area and in several hours to days the small bumps will appear.  Talk to your doctor if you think you have had genital herpes, as there are a variety of ways to treat this problem.  Complete eradication of the virus is unlikely, but symptoms can be improved.  Occasionally, the patient spontaneously recovers from herpes.  Note - the same blisters from a non-genital herpes virus often appear on the face and lips ("cold sores", "fever blisters").  Do not have oral sex if there is an open lesion.  This virus may be spread to the genitals. 
 
GENITAL WARTS and/or abnormal pap smears caused by the Human Papilloma Virus (HPV) are in the news today and probably the most commonly sexually transmitted disease.  IT is not necessary to have obvious warty lesions in the genital area to carry the papilloma virus; in fact the virus may sit on the cervix of a woman and cause mild changes in the pap smear without any symptoms.  Apparently, this virus infects the cells of the cervix and causes changes which are precancerous and generally reversible.  However, in order for these to be diagnosed, it is necessary to have a yearly pap smear.  Ways of treating the virus on the cervix include laser therapy, cauterization (LEEP Procedure), and freezing therapy (Cryotherapy).  It is possible that being on birth control pills may promote the growth of recurrent genital wart virus and your doctor may ask you to stop the pills for several months during treatment.  It is absolutely necessary to use condoms during the treatment period and to have the male partner checked for evidence of genital warts.  In many cases, the male may have small warty lesions on the penis which are not evident until the penis is evaluated much the same as it is in the female, with a microscope.  In a female, it is called a colposcopy exam, and in the male, a colposcope may be used or a hand lens.  If the male is found to have small warty lesions, they must also be treated or else he will infect his partner repeatedly.  Your doctor may do what is called a Virapap, which actually is a test for the presence of the virus.  If the pap smear is abnormal and the doctor suspects it is due to papilloma virus, this tests may help identify which type of virus you have.  Certain viral types have been associated with cervical cancer.  If your doctor tells you that your cervical virus is one of the cancerous varieties, it will probably be necessary for you to have pap smears twice a year for the next several years.  We cannot be sure you will get cervical cancer but we have noticed the increase in cases of cancer with certain viral types.
 
MOLLUSCUM CONTAGIOSUM lesions are often transmitted by close contact and found in the genital area.  However, kids can get them from non-sexual contact.  The lesions are raised and have a central white core.  They must be scraped off or treated with Aldara (see section on Aldara).
 
CHLAMYDIA AND GONORRHEA. Chlamydia is one of the most common STDs in the United States today.  It is thought that 20 to 40% of all sexually active women have probably been exposed to Chlamydia at some time.  Chlamydia is named for Chlamydia Trachomatis, a bacteria that invades the cells in the lower genital tract and is spread through sexually activity including oral sex.  The symptoms are similar to those listed under gonorrhea.  Often these two infections are found together.  Many women have one or both of these with no symptoms. If you are sexually active you should be checked at least once a year for the presence of these bacteria.  Barrier methods of contraception such as diaphragms, cervical cap, and condoms protect against sexually transmitted diseases.  Chlamydia infections can lead to cervical infections, PID, infertility, and a range of other problems. Symptoms include the following:  burning or itching in the genital area, discharge from the vagina, painful or frequent urination, or pain in the pelvic area.  Men experience symptoms much more often than women including painful urination, burning, and inflammation of the urethra (tube leading from the bladder to the outside of the body) and discharge from the penis.  Treatment is with antibiotics and includes treatment of the partner as well.
 
Chlamydia and gonorrhea are easily treated by antibiotics when they are cervical infections.  If they have spread to the pelvic organs, hospitalization may be necessary for treatment of PID (see above).  The possibility of the scarring of the tubes and future infertility, tubal pregnancies, adhesions (scars), and pelvic pain are possible.  Once again, using condoms will prevent you from PID and all the psychological anguish that goes with this disease.
 
TRICHOMONAS is a sexually transmitted parasite which leads to a yellow, frothy vaginal discharge and itching.  It is easily treated with antibiotics.
 
SYPHILIS is a more rare form of venereal disease which is associated with a lesion generally on the genitals which is ulcer-like and painless.  A blood test called the VDRL is used to check for this disease.  It is possible to have had a lesion of syphilis and not have known it and you might ask your doctor to check your VDRL occasionally to prevent this.
 
CRABS AND SCABIES are two infections which cause severe itching in the genital area.  If you look at the pubic hairs with a magnifying glass you may see the little white crabs crawling around or the brown eggs stuck to the hairs at the bases.  Scabies lesions are more difficult to diagnose, but the doctor may do so with a microscope. In either case, the treatment is a local shampoo which is easily obtained by calling your doctor.
 
HIV (Human Immunodeficiency Virus) AIDS (Acquired Immune Deficiency Syndrome) HIV is the most dreaded of sexually transmitted diseases.  Avoiding sexual contact with intravenous drug addicts, prostitutes, and infected partners will help to decrease the incidence of this disease.  Condom usage is necessary to prevent spread of HIV.  Avoiding rectal sex will also help to decrease this infection.  The rectum was not made with a heavy lining such as the vagina for intercourse.  The rectal lining is more vulnerable to small tears and transmission of all types of disease.   Most young people are deathly afraid of getting AIDS,  however, they do not realize that the other sexually transmitted diseases listed above can cause just as much pain and suffering and are much more likely to be contracted from casual relationships.
 
RECURRENT VAGINAL YEAST INFECTIONS Recurrent vaginal yeast infections may also be sexually transmitted.  Women are very likely to have yeast infections at various times in their life.  The most common time to develop a yeast infection is after prolonged or heavy intercourse after a period of abstinence.  Yeast grows in all women's vaginas, however, if there is friction or excessive rubbing of the vagina or the outside area (vulva) the yeast seems to grow more rapidly, causing whitish, clumpy, cottage cheese-like discharge, itching, and burning with urination.  Soaking in a warm tub will help relieve the pain on the outside of the vulva, but treatment with antifungal cream is necessary and you must contact your physician for this.  Women with diabetes, women who eat a lot of sweets, and women on antibiotics for other infections, and possibly women on birth control pills may get frequent yeast infections.  Talk to your doctor about prevention of yeast infections.
 
For more information on any of the above diseases, please schedule a consultation with your doctor and make a list of questions.  There are many books and pamphlets on any subject listed above.
 
Most importantly -- protect yourself at all times!

 





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