The Facts of Life: Examining Reproductive Health

Sexually Transmitted Diseases

Syphilis
Syphilis is caused by a bacterium and transmitted through sexual or skin-to-skin contact with someone who is in an infectious stage. The disease may go through four stages, depending on when the person is treated. In the first stage of syphilis, minor skin lesions (chancres) appear on the body from 10 to 90 days after initial infection. They are open, oval-shaped sores with hard, raised borders and can appear anywhere on the body. The sores disappear after two to six weeks. They are followed by a rash (stage two) that appears two weeks to six months after the sores heal. After the rash fades, the individual may feel healthy until years later when the disease returns to attack the nervous system, bones, cartilage, blood vessels and the heart.

A person with third or "latent" stage syphilis may show no symptoms. This stage may occur two years after the rash is gone and may last for as many as 20 years. Although symptoms may be few, some may have lesions in bones, nervous tissue, and the heart. At this point, syphilis is not spread through sexual contact.

During the final stage of syphilis, which is not infectious, the serious effects of the latent stage appear. Damage to facial cartilage, paralysis, blindness, heart disease and mental incapacity may develop, depending on which organs the bacteria have attacked. If left untreated, syphilis may cause death. If treated during the first three stages it can be easily cured with penicillin or other antibiotics.

HIV
HIV (human immune deficiency virus) causes AIDS (acquired immune deficiency syndrome) and it can be passed onlythrough contact with vaginal fluid, semen, blood or breast milk. In order for HIV to be passed to a non-infected person, blood or one of the other fluids must contact an open sore (on the fingers, hands, mouth or genitals) or must be transmitted by direct introduction into the body. Like all STDs, HIV can be passed between women and women; men and women; mother and baby; and men and men. HIV infection can lead to AIDS .

Estimated Adult HIV Cases
Late 1970s/Early 1980s Until 1994

Human papillomavirus (HPV)
Genital warts are caused by the human papillomavirus, similar to the type that causes common skin warts. Over twenty types of HPV cause invisible infections, warts or flat lesions in the genital area. HPV usually spreads through sexual intercourse with an infected person and may now be the most common STD in the United States. Some HPV-caused lesions on the cervix are associated with an increased risk of cervical cancer. Unfortunately, these are not easily detected by either the health care provider or the woman with the infection.

48. Human Papilloma Virus (HPV)
Also known as condyloma accuminatum or genital warts. This is thought to be sexually transmitted and has been linked to cervical dysplasia (a precursor to cancer) and cervical cancer. The cells have abundant cytoplasm with a "punched out" appearance. This is often referred to as a halo. The nuclei have a slight irregular shape. Cells of HPV often have more than one nucleus.

Symptoms of genital warts usually appear from three weeks to eight months after exposure, although they may not appear for years. They are most contagious during the pre-symptomatic stage (as well as while they are present) so it is advisable to use a condom (male or female) if any partner has been exposed to the virus. Warts occur on the head of the penis, on the shaft of the penis or occasionally on the scrotum. In women, visible genital warts begin as small, painless, hard spots that often appear near the vaginal opening. They may also appear on the labia, vulva, inside the vagina, on the cervix or around the anus. Topical treatments and injections may be used to destroy the abnormal tissue. Warts may also be treated by cryosurgery or laser surgery.

Gonorrhea
Gonorrhea is a bacterial infection that thrives in the warm, moist passageways of the genitals and the urinary tract. Symptoms in men may include a milky discharge from the penis, and a burning sensation with urination. The symptoms develop from three to ten days after exposure to the disease, although some men never experience any symptoms. For women, the cervix is the most common site of infection. Although many women donÕt experience early symptoms, once the disease has progressed to the later stages, major complications can arise, such as pelvic inflammatory disease (PID). PID often leads to sterility.

A pregnant woman infected with the gonorrhea bacterium may transmit the infection to the eyes of her baby during childbirth. Gonorrheal infection of the eyes can result in blindness. Most hospitals, however, use anti-bacterial drops in newborn's eyes to protect them from infection.

Many strains of gonorrhea can be easily treated with antibiotics if diagnosed early, although some strains have become resistant to penicillin.

Chlamydia
Ten times more prevalent than gonorrhea, chlamydia is called the silent STD. It is estimated that chlamydia strikes three to ten million Americans each year. It is a bacterium (Chlamydia trachomatis) that causes genital infections, producing mild or no symptoms. From 10% to 20% of men and 60% to 80% of women are asymptomatic, and most people who are infected are unaware of it. As a result, they may unwittingly infect other partners.

Symptoms in women may include vaginal burning and itching or dull pelvic pain. Men may experience a watery discharge from the penis or painful urination. If untreated, chlamydia may lead to inflammation of the testicles or anus and an arthritis-like condition (Reiter's syndrome). Untreated women risk infertility, ectopic pregnancy (where the embryo develops in the Fallopian tube instead of the uterus) or PID (pelvic inflammatory disease). Chlamydia can be cured with antibiotics.

Herpes
Herpes Simplex is a common virus. It causes cold sores on or in the mouth. It can also cause sores on the genitals. There are two types of the virus: herpes simplex type 1 (HSV-1) and 2 (HSV-2). They can both infect the genitals or mouth, but it is usually type 2 that affects the genitals. Herpes is spread by skin-to-skin contact. For example, if you have a cold sore and kiss someone, you can transfer the virus to their mouth. If you have a cold sore and put your mouth on your partner's genitals, you can give them genital herpes. If you have a genital herpes sore, genital contact with another person will transfer the virus to their genitals. However, genital sores do not have to be present to spread the disease. Even before a blister appears, the virus begins to shed. Generally, a person with herpes learns to recognize the signs of an oncoming bout with the virus, and can avoid spreading the disease. Sometimes, however, there are no warning signs at all.

49. Herpes Simplex Virus
Sexually transmitted viral infection. The virus will cause the nucleus
of the cell to have a "ground glass" or smudged appearance. These cells
often contain more than one nucleus.

The symptoms of herpes include extremely painful blisters or bumps that appear at the site of initial contact. They open, and then heal. The area may burn, itch or tingle. During the first outbreak, flu-like symptoms of aches and fever may also be present. Most people experience about four outbreaks per year, but the severity and frequency may diminish over time. Stress, fatigue, poor nutrition and illness may trigger an outbreak, as the sores return when the body's resistance is lowest. At present, there is no cure for herpes and the virus hides in the body in a dormant state until the next recurrence.

Trichomoniasis
Trichomonas vaginalis is a one-celled parasite that can be found in both women and men. Although the organism may be found in a woman's vagina, she may not have any symptoms. They usually develop, however, within four to 28 days of exposure and can include a greenish discharge, frequent painful urination, itching and sometimes severe lower-abdominal pain. Men experience fewer and milder symptoms.

In order to stop the spread of the parasite, both partners need to be treated simultaneously, even if symptoms are present in only one.

50. Trichomonas vaginalis
Sexually transmitted protozoan infection. (Protozoa are organisms that have no cellular make-up and possess only one nucleus.) The organisms are small in size and are grayish-blue in color, with red granules in their cytoplasm. There is also a nucleus and flagella (hair-like structure used for motion) present.

Hepatitis
Hepatitis, a viral infection of the liver, has several serious forms. The most common are hepatitis A and hepatitis B. Hepatitis A is usually spread by food contaminated with fecal matter, although it can also be spread through anal sexual contact.

Hepatitis B, however, is transmitted in much the same way as HIV-through exposure to the bodily fluids of a person carrying the active virus. Individuals with multiple sexual partners, male or female, have an increased risk for contracting the disease. The symptoms of hepatitis include lethargy, exhaustion, loss of appetite, and especially jaundice-the yellowing of the skin and the whites of the eyes. If exposed to either type of hepatitis, immediate medical attention is essential.

Preventing STDs
Persons in a monogamous relationship with an non-infected partner are at very low risk to contract STDs. The only sure way to prevent STDs is to abstain from having sex. However, abstinence is not a reasonable course of action for many people. Reducing the number of sexual partners lowers the risk of contact with an infected person. Condoms or dental dams (any latex barrier) used during intercourse, anal, or oral sex further lower the risk of transmission.

Contraceptive foams, creams, or jellies with nonoxynol-9 kill the herpes simplex virus and many other organisms that cause STDs, but should be used with a latex barrier.