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Introduction
to Sexually
Transmitted Diseases
Sexually transmitted
diseases (STDs), once called venereal diseases, are among the
most common infectious diseases in the United States today.
More than 20 STDs have now been identified, and they affect
more than 13 million men and women in this country each year.
The annual comprehensive cost of STDs in the United States is
estimated to be well in excess of $10 billion.
Understanding the basic facts about STDs – the ways in which
they are spread, their common symptoms, and how they can be
treated – is the first step toward prevention. The National
Institute of Allergy and Infectious Diseases (NIAID), a part
of the National Institutes of Health, has prepared a series
of fact sheets about STDs to provide this important information.
Research investigators supported by NIAID are looking for better
methods of diagnosis and more effective treatments, as well
as for vaccines and topical microbicides to prevent STDs. It
is important to understand at least five key points about all
STDs in this country today:
- STDs affect men
and women of all backgrounds and economic levels. They are
most prevalent among teenagers and young adults. Nearly two-thirds
of all STDs occur in people younger than 25 years of age.
- The incidence
of STDs is rising, in part because in the last few decades,
young people have become sexually active earlier yet are marrying
later. In addition, divorce is more common. The net result
is that sexually active people today are more likely to have
multiple sex partners during their lives and are potentially
at risk for developing STDs.
- Most of the time,
STDs cause no symptoms, particularly in women. When and if
symptoms develop, they may be confused with those of other
diseases not transmitted through sexual contact. Even when
an STD causes no symptoms, however, a person who is infected
may be able to pass the disease on to a sex partner. That
is why many doctors recommend periodic testing or screening
for people who have more than one sex partner.
- Health problems
caused by STDs tend to be more severe and more frequent for
women than for men, in part because the frequency of asymptomatic
infection means that many women do not seek care until serious
problems have developed.
- Some STDs can
spread into the uterus (womb) and fallopian tubes to cause
pelvic inflammatory disease (PID), which in turn is a major
cause of both infertility and ectopic (tubal) pregnancy.
The latter can be fatal.
- STDs in women
also may be associated with cervical cancer. One STD, human
papillomavirus infection (HPV), causes genital warts and
cervical and other genital cancers.
- STDs can be
passed from a mother to her baby before, during, or immediately
after birth; some of these infections of the newborn can
be cured easily, but others may cause a baby to be permanently
disabled or even die.
- When diagnosed
and treated early, many STDs can be treated effectively. Some
infections have become resistant to the drugs used to treat
them and now require newer types of antibiotics. Experts believe
that having STDs other than AIDS increases one's risk for
becoming infected with the AIDS virus.
HIV
Infection and AIDS
AIDS (acquired immunodeficiency syndrome) was first reported in
the United States in 1981. It is caused by the human immunodeficiency
virus (HIV), a virus that destroys the body's ability to fight
off infection. An estimated 900,000 people in the United States
are currently infected with HIV. People who have AIDS are very
susceptible to many life-threatening diseases, called opportunistic
infections, and to certain forms of cancer. Transmission of the
virus primarily occurs during sexual activity and by sharing needles
used to inject intravenous drugs. If you have any questions about
HIV infection or AIDS, you can call the AIDS Hotline confidential
toll-free number: 1-800-342-AIDS.
Chlamydial Infection
This infection is now the most common of all bacterial STDs, with
an estimated 4 to 8 million new cases occurring each year. In
both men and women, chlamydial infection may cause an abnormal
genital discharge and burning with urination. In women, untreated
chlamydial infection may lead to pelvic inflammatory disease,
one of the most common causes of ectopic pregnancy and infertility
in women. Many people with chlamydial infection, however, have
few or no symptoms of infection. Once diagnosed with chlamydial
infection, a person can be treated with an antibiotic.
Genital Herpes
Genital herpes affects an estimated 60 million Americans. Approximately
500,000 new cases of this incurable viral infection develop annually.
Herpes infections are caused by herpes simplex virus (HSV). The
major symptoms of herpes infection are painful blisters or open
sores in the genital area. These may be preceded by a tingling
or burning sensation in the legs, buttocks, or genital region.
The herpes sores usually disappear within two to three weeks,
but the virus remains in the body for life and the lesions may
recur from time to time. Severe or frequently recurrent genital
herpes is treated with one of several antiviral drugs that are
available by prescription. These drugs help control the symptoms
but do not eliminate the herpes virus from the body. Suppressive
antiviral therapy can be used to prevent occurrences and perhaps
transmission. Women who acquire genital herpes during pregnancy
can transmit the virus to their babies. Untreated HSV infection
in newborns can result in mental retardation and death.
Genital Warts
Genital warts (also called venereal warts or condylomata acuminata)
are caused by human papillomavirus, a virus related to the virus
that causes common skin warts. Genital warts usually first appear
as small, hard painless bumps in the vaginal area, on the penis,
or around the anus. If untreated, they may grow and develop a
fleshy, cauliflower-like appearance. Genital warts infect an estimated
1 million Americans each year. Genital warts injections of a type
of interferon. If the warts are very large, they can be removed
by surgery.
Gonorrhea
Approximately 400,000 cases of gonorrhea are reported to the U.S.
Centers for Disease Control and Prevention (CDC) each year in
this country. The most common symptoms of gonorrhea are a discharge
from the vagina or penis and painful or difficult urination. The
most common and serious complications occur in women and, as with
chlamydial infection, these complications include PID, ectopic
pregnancy, and infertility. Historically, penicillin has been
used to treat gonorrhea, but in the last decade, four types of
antibiotic resistance have emerged. New antibiotics or combinations
of drugs must be used to treat these resistant strains.
Syphilis
The incidence of syphilis has increased and decreased dramatically
in recent years, with more than 11,000 cases reported in 1996.
The first symptoms of syphilis may go undetected because they
are very mild and disappear spontaneously. The initial symptom
is a chancre; it is usually a painless open sore that usually
appears on the penis or around or in the vagina. It can also occur
near the mouth, anus, or on the hands. If untreated, syphilis
may go on to more advanced stages, including a transient rash
and, eventually, serious involvement of the heart and central
nervous system. The full course of the disease can take years.
Penicillin remains the most effective drug to treat people with
syphilis.
Other diseases that may be sexually transmitted include trichomoniasis,
bacterial vaginosis, cytomegalovirus infections, scabies, and
pubic lice.
STDs in pregnant women are associated with a number of adverse
outcomes, including spontaneous abortion and infection in the
newborn. Low birth weight and prematurity appear to be associated
with STDs, including chlamydial infection and trichomoniasis.
Congenital or perinatal infection (infection that occurs around
the time of birth) occurs in 30 to 70 percent of infants born
to infected mothers, and complications may include pneumonia,
eye infections, and permanent neurologic damage.
What Can You Do to Prevent STDs?
The best way to prevent STDs is to avoid sexual contact with others.
If you decide to be sexually active, there are things that you
can do to reduce your risk of developing an STD.
- Have a mutually
monogamous sexual relationship with an uninfected partner.
- Correctly and
consistently use a male condom.
- Use clean needles
if injecting intravenous drugs.
- Prevent and control
other STDs to decrease susceptibility to HIV infection and
to reduce your infectiousness if you are HIV-infected.
- Delay having sexual
relations as long as possible. The younger people are when
having sex for the first time, the more susceptible they become
to developing an STD. The risk of acquiring an STD also increases
with the number of partners over a lifetime.
Anyone who is sexually
active should:
- Have regular checkups
for STDs even in the absence of symptoms, and especially if
having sex with a new partner. These tests can be done during
a routine visit to the doctor's office.
- Learn the common
symptoms of STDs. Seek medical help immediately if any suspicious
symptoms develop, even if they are mild.
- Avoid having sex
during menstruation. HIV-infected women are probably more
infectious, and HIV-uninfected women are probably more susceptible
to becoming infected during that time.
- Avoid anal intercourse,
but if practiced, use a male condom.
- Avoid douching
because it removes some of the normal protective bacteria
in the vagina and increases the risk of getting some STDs.
Anyone diagnosed as
having an STD should:
- Be treated to
reduce the risk of transmitting an STD to an infant.
- Discuss with a
doctor the possible risk of transmission in breast milk and
whether commercial formula should be substituted.
- Notify all recent
sex partners and urge them to get a checkup.
- Follow the doctor's
orders and complete the full course of medication prescribed.
A follow-up test to ensure that the infection has been cured
is often an important step in treatment.
- Avoid all sexual
activity while being treated for an STD.
Sometimes people are
too embarrassed or frightened to ask for help or information.
Most STDs are readily treated, and the earlier a person seeks
treatment and warns sex partners about the disease, the less likely
the disease will do irreparable physical damage, be spread to
others or, in the case of a woman, be passed on to a newborn baby.
Private doctors, local health departments, and STD and family
planning clinics have information about STDs. In addition, the
American Social Health Association (ASHA) provides free information
and keeps lists of clinics and private doctors who provide treatment
for people with STDs. ASHA has a national toll-free telephone
number, 1-800-227-8922. The phone number for the Herpes Hotline,
also run by ASHA, is 919-361-8488. Callers can get information
from the ASHA hotline without leaving their names.
Research
STDs cause physical and emotional suffering to millions and are
costly to individuals and to society as a whole. NIAID conducts
and supports many research projects designed to improve methods
of prevention, and to find better ways to diagnose and treat these
diseases. NIAID also supports several large university-based STD
research centers.
Within the past few years, NIAID-supported research has resulted
in new tests to diagnose some STDs faster and more accurately.
New drug treatments for STDs are under investigation by NIAID
researchers. This is especially important because some STDs are
becoming resistant to the standard drugs. In addition, vaccines
are being developed or tested for effectiveness in preventing
several STDs, including AIDS, chlamydial infection, genital herpes,
and gonorrhea.
It is up to each individual to learn more about STDs and then
make choices about how to minimize the risk of acquiring these
diseases and spreading them to others. Knowledge of STDs, as well
as honesty and openness with sex partners and with one's doctor,
can be very important in reducing the incidence and complications
of sexually transmitted diseases.
Sexually
Transmitted Diseases and the Organisms Responsible
Public Health Service
U.S. Department of Health and Human Services
July 1999
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