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YOUNG PEOPLE'S GUIDE TO
SEXUALLY TRANSMITTED DISEASES (STDs)
AND AIDS/HIV Disease
1994

by Dr. Robert Taylor


Director: Health Awareness Connection
Research Fellow, Harvard Aids Institute 1993-95
Staff Physician, Boston City Hospital STD Clinic




Table of Contents

Introduction

The purpose of this online book is to help teenagers and anyone else who is interested to learn a little about themselves and hopefully to enable them to avoid getting a sexually transmitted disease including AIDS.

Sexually transmitted diseases have become a little less common in the general population of the United States during the past few years but they have remained epidemic among adolescents. One in seven US teens will get an STD by the time they graduate from high school. At the time this was written (1994), one in forty high school students in Washington DC are infected with the AIDS virus. Two and a half million teens will get a sexually transmitted disease this year.

The diseases that are shown in this book all have two things in common. The first is that they are all spread by unprotected sex. The other is that they are all preventable. If you are not having sex, you will not get or spread STDs. The exception to this is that certain diseases including AIDS and hepatitis can be spread by injecting drug users who share needles and from mother's to their newborn children..

One of the keys to prevention is caring.
Just learning about these diseases will not necessarily protect you from getting an STD including HIV disease but it can influence a young person not to have sex or to use a condom if she or he does.

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    A Message to Parents

    As a parent I have worried about my son's health and well being since before he was born. We all want our children to stay healthy. Our kids face problems that we did not have when we were young and they need to be prepared to face them.

    AIDS is a frightening disease that continues to spread in epidemic fashion. Adolescents make up a small percentage of people with AIDS but they are among the groups most at risk for HIV disease. The Washington Post reported in 1994 that one out of forty Washington DC high school students were HIV positive. One out of seven high school students gets a sexually transmitted disease(STD) before graduation.

    Getting the message of AIDS and STDs to our children is one of our foremost responsibilities. The message has to be clear, accurate and effective. This online book can only be part of a more comprehensive health program that should be taught in schools at the earliest possible grade and at home with a strong involvement of the parents. My personal belief is that STD/HIV education should be provided to children before they put themselves at risk. This means educating them before high school and in some cases before the junior high school level. Parents and teachers are probably the most sensitive to the teens (and sub-teens) developmental stages and cultural backgrounds. Our kids need a supportive environment. The lessons here are a result of teaching hundreds of classes in STD/HIV disease prevention since 1993 in the Boston area. (See Health Awareness Connection)

    Some of you will not like the explicitness of this message. My feeling is that our children have to learn what these diseases look like and how they are and are not transmitted. Some will not like the section on the use of condoms. I apologize to you but I feel we are in a crisis situation with this epidemic and we have to try bold and innovative measures to get the message out. This means that we may have to try techniques and strategies that at first may offend some. The message of abstinence is emphasized throughout this online book as the only true way of avoiding STDs and HIV disease but well over fifty percent of students have had sex before they graduate from high school and they must be taught to protect themselves. If a young persons life is saved because they learned something from this message, then I will consider my job well done. Our children's best protection against AIDS and STDs is knowledge.

    In the last sections of this online book, I have tried to stress strategies that will help young people take control of their lives and improve their decision making skills to reinforce healthy behaviors. Try as we may to shelter and protect our children, they will have to make important decisions on their own and they need to have information that will help them. The purpose of this message is to educate and to try to influence young people to prevent the diseases discussed.

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    Anatomy

    Q. What is anatomy and physiology and why study them?
    Anatomy is what the parts of the body look like and physiology is how the various parts of the body work. In medical school, one of the very first things that we study is how the body looks and works. After we learn what these parts look like normally, we then learn how they look and work when they become diseased. It is important that we all learn as much as we can about our own bodies as we will have our bodies for all our lives and if we don't take care of them, no one else will. Women and girls should know where their cervix and ovaries are and men and boys should know what the testicles do and where the urethra is.

    Anatomy of the genitals and reproductive tract
    The genitals are the body parts involved with sex and the reproductive tract includes those body parts that are involved in sex that are inside our bodies.

    Female

    External (What is visible from the outside)

    Even though these parts are on the outside, if a girl or woman wants to examine them she may want to use a mirror.

    Labia - There are two pairs of labia or lips, the outer lips and the inner lips. They help to protect the opening to the urethra and the vagina. The outer labia may have some pubic hair on them.

    Pubic Hair - Above the labia is the pubic hair which may be in a small area or may cover a large area on the lower abdomen. This hair develops during the teenage years and probably serves a protective function.

    Clitoris - A small bump at the top of external genitals where the labia meet in the middle. It enlarges during sexual excitement and its function is in sexual functioning. It is covered by a hood or fold of skin to protect it.

    Urethra opening - This lies below the clitoris and above the vaginal opening. It is where urine (pee) comes out of. The urethra is the tube inside from this opening to the bladder. The bladder is a collection area for urine inside our bodies.

    Rectum - The rectum is the last part of the intestines and it is from where solid body wastes leave our body. The actual opening to the outside is called the anus or the anal opening. Although it is not a part of the sex organs, it is included here because infections can happen here from leakage from the vagina or from having anal intercourse.

    Inside (Internal)

    Hymen - This is a ring of skin around the opening of the vagina that gets broken during sexual intercourse after which the women is no longer a virgin.

    Vagina - This is a tube-like opening that is moist most of the time because it has some glands that produce vaginal fluids. The tube ends a few inches inside at the cervix. This is where the penis fits during intercourse and it is through this tube that a baby goes through when it is being born.

    Cervix - This is the bottom end of the uterus. It has a small opening though which menstrual blood flows from the uterus. It is also the hole where semen can enter through and through which a baby comes out. This opening along with the vagina can expand greatly during childbirth to allow the baby to exit. When a doctor examines a woman, s/he will put a speculum (a tool to open the vagina) inside the vagina and look at the cervix for any abnormalities. The lining of the skin covering the cervix is different in young women who have not started to have their periods yet. This is important in the transmission of STDs since germs may be able to enter more easily in younger women.

    Uterus - This a muscular organ that has an inner lining with a lot of blood vessels. The inner lining builds up every month and if the woman does not get pregnant, it is washed out and renewed every month. The blood that a woman loses every month during her period is this inner lining of the uterus. This blood rich inner lining provides the necessary environment for a developing embryo and fetus. The uterus is where a baby develops from an embryo into a fetus. It stretches greatly to hold the developing fetus and the muscles tighten up when the baby is due to be delivered. The uterus also contracts during menstruation ( the period) which causes cramps that are familiar to most women. One of the openings of the uterus is through the cervix which opens into the vagina. The other openings are at the other end and open into the fallopian tubes.

    Fallopian Tubes - On each side of the uterus there is a narrow tube that reaches out towards the ovaries. It is through this tube that the egg travels from the ovary to the uterus. It is in this tube that fertilization takes place if the egg meets a sperm along the way.

    Ovary - Women have two ovaries which are about the size of a flattened walnut(1X1 _"). The ovaries contain eggs which develop and enlarge during the menstrual cycle and then pop out near the opening of the fallopian tube. The tube catches the egg and transports it towards the uterus. About 300 to 400 eggs are produced during a women's life from the time she starts her period until she stops(menopause). The other function of the ovaries are to produce the hormones estrogen and progesterone.

    Egg - The egg (also called an ovum or ova) is what gets together with a sperm to form a baby. If the egg travels down the tube without meeting a sperm, it doesn't get fertilized and it comes out with the menstrual flow of blood.

    Breasts - The breasts are fatty tissues with milk producing glands inside. The breasts may swell and become tender before the period starts and they may also swell during sexual excitement. The nipple can become firm in the cold or to a touch. Sometimes there is a bit of hair around the nipple. It is common to have one breast slightly larger than the other.

    Male

    External (Outside organs)

    Penis - this is the cylinder-like organ between males legs. It is normally hanging downward and when sexually excited, it becomes hard and enlarges.

    Shaft - filled with a sponge-like tissue that can get filled with blood during sexual excitement and become erect and stiff. It is not a muscle.

    Glans - the bulb-like area on the end of the shaft. This area is the most sensitive to sexual arousal. This is also called the head of the penis. In uncircumcised men it is covered by the foreskin.

    Foreskin - the covering over the glans, it is cut off during circumcism. It can be pulled back and it also comes back by itself during erection.

    Urethral opening - through this opening comes urine and semen. Germs can also enter into here.

    Scrotum - The sac or bag that contains the testicles. The testicles are outside the body because they have to be at the right temperature to produce sperm. When it is warm outside, the scrotum relaxes and the testicles drop down away from the body so as to not get too hot. When it is cold, the scrotum tightens up and brings the testicles close to the body to keep them warm.

    Pubic hair - appears after puberty and can be localized above the penis or can go up into the chest hair in some hairier men.

    Rectum - The rectum is the last part of the intestines and it is from where solid body wastes leave our body. The actual opening to the outside is called the anus or the anal opening. Although it is not a part of the sex organs, it is included here because infections can happen here. On occasion warts can spread from the front of a man to the back. Also many other STDs can be spread to the anal area by having anal sex.

    Internal

    Urethra - the tube inside the penis shaft. Urine and semen go through it. Just the opening is visible at the end of the penis. It is the place where such STDs such as gonorrhea and chlamydia can live.

    Prostate - This gland produces some of the semen that comes out when a man has an orgasm. The prostate can be infected with some of the germs that cause STDs such as gonorrhea or chlamydia. The germs are harder to get rid of when they get into the prostate and antibiotic medicine usually has to be given for a longer time. The prostate gland is examined by health providers by doing a rectal exam. In this exam, the doctor or health provider puts a gloved finger into the anus. The prostate can be felt under his or her finger.

    Seminal Vesicles - these glands produce some of the semen that comes out when a man has an orgasm.

    Vas deferans - this tube connects the testicles with the urethra and carries sperm.

    Testes (also called the testicles) - These are the 'balls' inside the scrotum. Their purpose is to make sperm and to produce the male hormone, testosterone.

    Epididymis - This is the area on top of the testicle that collects sperm and connects with the vas deferans. If some STDs such as gonorrhea or chlamydia are left untreated, the germs can get into the epididymis and cause them to swell up and become tender.

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    Physiology (How it works)

    The menstrual cycle

    The changes that go on in a women's body are very complicated but the main purpose is to prepare a women's body to get pregnant.

    The first day of the cycle is the first day of bleeding. Since pregnancy did not occur, the hormones(estrogen and progesterone) stop being produced and the lining of the uterus falls off and comes out of the vagina as blood and clots.

    During the first few days of the cycle, the ovary (on one side or the other) is producing follicles which contain an egg and are secreting estrogen. One of these eggs matures. The increase of estrogen that is being secreted by the maturing eggs signals the brain to release other hormones and it signals the uterus to develop. The hormones from the brain (actually the pituitary gland and the hypothalamus) signals the ovary to release its egg (called ovulation). After the egg is released, the left over follicle keeps on producing estrogen and also produces progesterone. There is a complex interaction between the hormones from the brain and those from the female sex organs.(see below)

    After ovulation, the egg travels down the tube on its way toward the uterus. If it meets a sperm along the way, they may join together (fertilization) and start to form an embryo which lands in the blood rich lining of the uterus and there it grows into a fetus.

    Hormones

    Estrogen - A chemical made by the ovaries that has many effects on women's bodies including:
    • development of the female reproductive organs (Vagina, uterus, breasts) during puberty.
    • signaling the brain and the reproductive organs during the menstrual cycle to have effects.
    • giving women their shape by regulating fatty layers.
    • Stopping the growth of bones (most girls do not grow much after puberty).
    • Many chemical functions in the body.
    Progesterone - made by the ovary in the second half of the menstrual cycle and during pregnancy. It, like estrogen, has many functions including:
    • preparing the uterus to accept a fertilized egg.
    • helping to regulate the menstrual cycle.
    • helping to maintain a healthy uterus during pregnancy.
    Vaginal secretions - the inside of the vagina is made a type of skin called mucus membrane. This type of skin, like the inside of our mouths, is normally moist or wet. When a woman is sexually excited, the lining of the vagina makes more wetness.

    Puberty

    This is a time in a young person's life when there sexual organs become mature. The hormones that affect sexual urges get active during this time and affect the different parts of the body.

    In girls, their bodies are changing to develop the curves of the hips and the breasts. Body hair in the armpits and in the genital area develops. The girls sex organs mature and the menstrual period begins. Puberty usually begins between the age of nine to fifteen.

    In boys the period of puberty usually begins later than in girls. Body hair starts to develop, their voice becomes lower and the sex organs get larger and they are able to make sperm.

    In both boys and girls the hormonal changes in the body make them have strong sexual feelings. Boys will get an erection easily by just thinking about sex. Both boys and girls will get a warm, tingling feeling in their bodies especially in their private parts. These feelings are very powerful and it is important to learn to handle them. All grownups get these feelings and they have learned to control them.

    How babies are made and prevented

    As mentioned in the discussion of the menstrual cycle, an egg gets released by an ovary each month in women and if it meets a sperm in the right place in the fallopian tube it becomes fertilized and starts to grow into a baby. Babies can be prevented by not allowing the egg and sperm to get together.

    Birth control methods

    Abstinence (not having sex) is the most effective way to avoid having babies or getting an STD. If you don't have sex, you can't get pregnant or get an STD. Even though it sometimes doesn't seem like it, many teens are not having sex. Many teens wait until they are older before becoming sexually active.

    The birth control pill is a very common and very effective form of birth control. The pill (also called oral contraceptives) stops an egg from being released from the ovary. The advantage of the pill is that it is very effective and the woman does not have to do anything else except take a pill once a day. Its disadvantage is that it does not protect the woman against STDs or HIV disease so a condom should be used along with taking the pill to avoid these diseases.

    Condoms ("rubbers") have been used to prevent women from getting pregnant for a long time. They are very effective if used properly and they have the added benefit of helping to prevent STDs and HIV disease. If you choose to have sex, condoms may be the most important thing you can do to protect yourself from an unwanted pregnancy and sexually transmitted diseases and HIV infection. When condoms were first invented over a hundred years ago, they were made of sheep's intestines and it is still possible to find lambskin condoms which are the same. These type of condoms will not fully protect you against STDs and should not be used. Instead, you should always use latex condoms which are made of a type of rubber.

    The diaphragm is an effective means of birth control. It is a round rubber shield-like barrier that is put inside the vaginal before having sex. It is filled with a jelly or cream that contains a chemical (called nonoxynol-9) that kills sperm. Although it has some protection against STD's, It is not very effective for this and condoms should be used along with the diaphragm for protection.

    A newer form of birth control is a hormone injection or implant that can prevent pregnancy. The injection is given every three months or it is placed under the skin where it is slowly released into the body.

    The IUD or intrauterine device is a piece of special wire that is placed into the uterus by a health provider where it can stay for years. It disturbs the environment inside the uterus making it not possible to have a fetus growing in it. There is a small string that dangles out of the cervix to allow for its removal. Its disadvantage is that it offers no protection against STDs and AIDS. It is no longer as commonly used as it used to be partially because having an IUD may make a woman more likely to get STDs because of the string that sticks out into the vagina.

    Some couples use a technique called withdrawal or the rhythm method to prevent getting pregnant. In this technique, the man withdraws or pulls out his penis from the vagina just before he has an orgasm (comes). Since no semen enters the vagina, the woman cannot get pregnant. This method has several problems. First of all it offers no protection against STDs. It is also very difficult to time the withdrawal properly when the couple is in the heat of passion and some semen may enter the vagina. Also, before a man comes, a small amount of fluid(called pre-ejaculatory fluid) is released by the penis and this enters the woman. This fluid, although it is only a small amount, may contain some semen and the woman may get pregnant.

    Although it is not a real birth control method, abortion is a way to end a pregnancy. In an abortion, the developing fetus is removed from the uterus and it cannot survive outside. If it is early in the pregnancy, the uterus is scraped with a tool that is pushed through the cervix. If it is late in the pregnancy, some water is injected into the uterus and this stops the pregnancy and the fetus is pushed out through the vagina as in a normal delivery of a baby. There is a lot of controversy about abortions since many people believe it is the same as killing a human being. Of course it is better to avoid getting pregnant than to have to be in the position of thinking about abortion.

    Sterilization is a means of permanently changing the normal anatomy so it is impossible to have a child. In women, the fallopian tubes are cut and the ends are sown up. This prevents an egg (or sperm) from traveling down the tube. In men, the vas deferens is cut and the ends sown up to prevent sperm from traveling from the testicles to the urethra. This is called a vasectomy. Although I said these were permanent changes, it is possible to reconnect these tubes in both men and women but it is a difficult operation and it doesn't always work.

    Male Physiology

    Testicular function - When a boy starts to get physically mature, the testicles start to produce more testosterone which is the male sex hormone. The testicles also become able to produce sperm .

    Testosterone - the male sex hormone gives boys and men the lower voice, the hair on the face and body, and the bulkier muscles. Since girls have much less of this hormone, they have higher voices, less body hair and less bulging muscles.

    Sperm production - Takes place in the testicles and is controlled by the hormone testosterone.

    Semen - this is the fluid that squirts out of the penis when a man has an orgasm. It is made of three fluids. Most of it (90-95%) comes from the prostate gland and the seminal vesicles and only a small part of it is actual sperm which comes from the testicles.

    Libido - this is the sex drive or urge that men (& women) have. A persons libido increases during the teen years since the hormones that control this increases during these years.

    Erection (include size of penis) - The penis increases in size during sexual excitement because it gets filled with blood. There usually seems to be a lot of concern with the size of the penis in boys (and men). There is a big difference in the size of the penis when it is erect or not erect. In adult men the erect size varies from five to seven inches but it may be smaller or bigger in some cases. Teenage boys can get an erection easily since they have a new increase in the sex hormone testosterone.

    Orgasm - During sex with another person or alone (called masturbation), a climax is reached where semen squirts out of the urethral opening. An intense feeling occurs which lasts for a very short time.

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    Sexually Transmitted Diseases

    These diseases used to be known as venereal diseases or VD and some people will still use these words. Venereal comes from Venus, the goddess of love. STDs are spread by having sex with an infected person. The germs that cause STDs are spread from one person to another during the act of making love. They can be spread by anal or oral sex too.

    General Questions

    What are sexually transmitted diseases?

    Sexually transmitted diseases or STDs as they are commonly called, are diseases that are spread by sex. That is, a person with one of these illnesses gives the illness to their sex partner during the act of having sex.

    What type of germs cause STDs?

    STDs(sexually transmitted diseases) are caused by bacteria, viruses and fungus germs and sometimes by other parasites.

    What is a bacteria?

    A bacteria is a type of germ that is very small but it can be seen easily under a microscope. The germ is like a complete little animal and they can live by themselves by feeding on their surroundings. They can usually move by themselves at least a small distance. They are fairly easy to treat with antibiotics. Examples of STDs that are caused by bacteria are gonorrhea, chlamydia and syphilis.

    What is a virus?

    A virus is a type of germ that is even smaller than bacteria germs and they cannot be seen under a microscope. They cannot live by themselves and they need to live inside another living cell to be able to reproduce themselves. Although they are much simpler than bacteria, they are much harder to treat. Examples of STDs caused by viruses are herpes, warts, and HIV infection.

    What is a fungus?

    A fungus is a germ that needs to live on another living thing. They particularly like to live on warm, wet areas. They are a bit like plants and they do not have any means of moving by themselves. A typical fungal infection is the yeast vaginitis that women can get. Athlete's foot and some types of jock itch are examples of fungal infections although they are not STDs.

    How are these germs spread from person to person?

    The germs live either directly on the skin or in body fluids such as semen, vaginal secretions and blood. When the germs on one body make contact with another body they may get transferred over to the other body. The basic way to protect yourself is to put a barrier or block between you and the germs. That is what a condom does. It is important to remember the STDs are not spread by casual contact. They are not spread by touching, coughing, shaking hands or sharing a glass with someone. These diseases are spread by direct contact with a sore or with contact with body fluids that contain the STD germs.

    Can you have an STD without knowing it?

    Yes, many sexually transmitted diseases (STDs) have little or no symptoms. Many people are infected without knowing it. In an STD such as gonorrhea or chlamydia, up to 90% of women infected with these germs have no symptoms at all.

    Is it possible to be exposed to an STD and not get the disease?

    Yes, In some cases a person may be exposed to the disease and not actually get the disease. There may not have been enough germs transferred to the other body or the person receiving the germs could have successfully fought them off before the germs were able to start the disease.

    Are STDs spread by public bathrooms?

    No. STDs are not spread by use of bathrooms (unless one were having sex there). STDs are spread through having sex. In an extremely rare case, pubic lice (crabs) can fall onto a toilet seat and may get on a future user of that seat. Some people who still worry about sanitation in toilets can wipe the seat or line the seat with toilet paper.

    Are STDs spread by sharing clothes? What about washed clothes?

    Again the only possible STDs that could possibly be spread by sharing clothes are crabs and scabies. Again this would be extremely uncommon and not usually a big worry. Washing clothes removes any of these little creatures.

    Can a person get more than one Sexually Transmitted Disease?

    Yes, it is certainly possible to get more than one STD at one time. The most that I have ever seen in my career as an STD specialist was a man with five different diseases at one time.

    Are there treatments for all the STDs?

    Yes, we can treat all the STDs(sexually transmitted disease) but we do not have a cure for all of them. Some of the STDs such as syphilis and gonorrhea can be totally cured fairly easily if treated properly and promptly. Others, such as herpes and hepatitis can be treated but not cured completely. In HIV disease, we can give some medicines that help these people a lot but we still do not have a cure.

    Where can a person get more information about STDs?

    There is a national STD hotline that is open from 8 AM to 11 PM Eastern time. The number is 1-800-227-8922

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    GONORRHEA & CHLAMYDIA (the 'clap' & 'Klamydia')

    Summary

    • Caused by bacteria germs; the infection starts 3 days to 3 weeks after having sex with an infected person.
    • In men it causes a liquid (pus) to come out of the opening in the penis.
    • Women usually don't have symptoms, but if untreated it can progress into a more serious disease and cause her not to be able to have babies in the future.
    • These diseases can be completely cured by antibiotics if treated early.
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    REMEMBER TO USE A CONDOM

    Gonorrhea is discussed first because it is one of the most common STDs with an estimated two to three million cases a year in the United States. It's been with us since ancient times with biblical references although there were more citations of syphilis in published history. A Greek physician in Rome in the year130 AD coined the term from Greek (gonos=seed, rhea=flow) believing it was an involuntary flow of semen. There was very little reference to women having this disease until the 1900's.

    Chlamydia (pronounced "Klamydia") is discussed along with gonorrhea because the symptoms that it causes are very similar to gonorrhea. In general, it tends to be a bit more milder of a disease but this is not always so and it can cause many complications too. Like gonorrhea, chlamydia is also very common with over a million new cases each year in the United States.

    These germs can be found in the genitals, throat, and the anal canal of an infected person. They can also affect the eyes but this is uncommon.

    The groups most likely to get gonorrhea and chlamydia are young adults from ages 15 to 29. There are more cases of gonorrhea and chlamydia in the 15 to 19 year old age group when you consider that 15 to 19 year olds are less sexually active than 20 to 29 year olds.

    The risk of spreading these diseases from a woman to a man following a single act of vaginal intercourse is said to be about 20 percent and it is likely that the rate of spread from men to women is even higher for each single act of sex. A big problem is that ten to fifteen percent of men and about seventy five percent of women do not have any symptoms. Most men and women who have symptoms will stop having sex and seek treatment. It is these individuals without symptoms who are spreading the disease more without even knowing it.

    What causes gonorrhea and chlamydia?

    Gonorrhea is caused by a bacteria that has an incubation period of from three to seven days but it may be as long as three weeks. The incubation period is the time from when the germ enters the body until it causes symptoms. Chlamydia is caused by a different bacteria germ whose incubation period is two to four weeks. It is possible to have the both germs at the same time.

    What are the symptoms of gonorrhea and chlamydia?

    When a person has gonorrhea, he or she will try to get rid of it by producing white blood cells that fight infections. The combination of the gonorrhea germs and the white blood cells are called pus. It is usually white but may be clear and at times it may be gray or greenish. Sometimes blood is present in the pus. It is this liquid pus that is the way it is spread. In men, the pus is in the urethra which is the tube in the penis. Most men with gonorrhea will have this pus coming out of the penis as a discharge. Since the urethra is where urine comes out, men will often have a burning feeling when they urinate("pee") and they may feel like they have to urinate often. When a man has an infection in the urethra, we call it a urethritis (itis=inflammation). These symptoms are usually dramatic enough that the men will go to a health provider for treatment but in about ten to fifteen percent of the time, a man with gonorrhea will have little or no symptoms. In these cases, the man could spread the disease to others without knowing he is doing so.

    In men infected with chlamydia, the symptoms are nearly identical but they are usually milder. The pus is usually clearer than in gonorrhea and it is usually less in quantity. Also with chlamydia, the pain while urinating is usually much less than with a gonorrhea infection. We call the infection of the urethra with chlamydia non-gonococcal urethritis (NGU) or non-specific urethritis (NSU). To further complicate matters, there are other germs that can cause NGU but this online book will not get into them. They are usually treated with the same medicines that work on chlamydia. Again, as with gonorrhea, ten to fifteen percent of men will not have any symptoms and they can spread the disease without knowing it.

    In women the gonorrhea and chlamydia germs do not usually live in the urethra but instead they live in the cervix. Since the cervix is way up in the vagina, women usually do not have many symptoms and when they do have symptoms, they are usually mild. Women do not feel pain on the cervix and even if pus is produced there, it usually is not much and it is hard to tell the difference from the woman's normal vaginal discharge. So, in about 85-90 percent of the time when a woman has gonorrhea or chlamydia, she has no symptoms. In the other ten or fifteen percent, the symptoms are pain urinating, vaginal discharge or discomfort or itching.

    In men and women who do oral sex without the protection of a condom(that is, they allow a penis into their mouth), these germs can infect the throat. Most of the time there are no symptoms when these germs are present in the back of the throat but sometimes the infected person may have symptoms of a sore throat. These diseases are not passed by kissing.

    In men and women who do anal sex that is not protected by a condom (that is, they allow a penis to enter the anus), these germs can infect the rectum. Again there are usually no or very little symptoms with anal gonorrhea and chlamydia. When symptoms are present, there may be pus that comes out of the anus. There may be pain or the infected person may feel like he or she has to go to the bathroom often.

    How is the diagnosis made?

    A cue-tip or cotton swab is taken of the discharge and looked at under a microscope. A culture is also done. If no discharge is present, the swab is put into the opening of the penis or in the cervix of females and a culture is done. A culture is where the gonorrhea or chlamydia germ is grown on a chemical that is put in a incubator for a day or two. A culture of the throat or rectum may be taken if oral sex or anal sex has been done. Actually, in women we often take a culture of the rectum too since the germs sometimes spread to it even without anal intercourse.

    How are these diseases treated?

    The two diseases have different treatments. Gonorrhea can be treated with an injection of an antibiotic or by a pill that just has to be taken once. Chlamydia is treated with an antibiotic that must be taken twice a day for a week or by four pills taken at once. A qualified health provider will be able to tell which medicine is best.

    Can these diseases cause serious problems?

    If left untreated these two germs can cause serious problems in the infected individuals. In women, the germs can travel up through the uterus into the fallopian tubes and cause a serious disease called Pelvic Inflammatory Disease or PID . PID is very serious because the women may become sterile from this, that is, she may not be able to have any children in the future. The fallopian tubes are very fragile and an infection inside them can permanently scar them.

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    HERPES

    Summary

    • Caused by a virus germ.
    • Appears 3 to 10 days after sex with person who already has the disease.
    • The herpes sores start as blisters, then they open up into little holes, and then they scab up.
    • By 5 to 15 days they heal and disappear.
    • The germs stay in your body and the sores may return in the future, sometimes often.
    • Women may not know they have herpes because the sores may be inside the vagina.
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    What is herpes?

    Herpes is a sexually transmitted disease that is caused by a virus (the herpes simplex virus or HSV). It is very common with over one million Americans infected each year. The herpes sores appear from three to twenty one days after contact with a herpes sore on a person who is infected by herpes. It is spread by direct contact with a herpes sore. Besides appearing on the sexual organs, it may also infect the mouth and lips. It is a bit more complicated disease than some other STDs because the disease looks like it disappears from your body but then it can reoccur in the future.

    What does herpes look like?

    The sores that the herpes virus cause go through several stages. They begin as a discolored and sometimes red area. Just before the sores begin to appear, the person may feel a tingling or discomfort in the area. The sores then swell up into fluid filled blisters. There are usually a few of them but they may be just one single sore. Usually within twenty four hours they break open and form holes or ulceration's in the skin. These holes are not usually very deep and sometimes have a clear or gray fluid in them. These ulcerations stay around for a few days and then they turn into scabs. These scabs stay for a few days and then they fall off and sometimes leave a light scar. The total time that the sores are present varies from five to fifteen days. The sores are not usually painful but they can be. Sometimes a person may feel pain when they urinate(pee) if the sores are near or in the urethra. (Remember that the urethra is the tube from where urine comes out of). A person may also have swollen lymph nodes in the groin area. These are enlarged, sometimes tender bumps in the crease where the legs join the body. The first time a person has a herpes outbreak, he or she may also have flu-like symptoms such as fever, muscle aches and headaches.

    In men, the sores can often easily be noticed on the shaft or the head of the penis. In women the sores may not be as easy to see and they may all be inside the vagina and completely out of sight. Similarly, in people who receive anal intercourse, the sores may all be inside and out of sight.

    What about herpes on the mouth?

    Herpes that occurs on or in the mouth(oral herpes) is basically the same as the herpes that people get on their genitals. It is caused by a similar virus and the sores look the same. A microbiologist may be able to tell the difference between type I herpes which is more likely to affect the mouth and type II herpes which is more likely to affect the genitals but is usually not important to the average person as the two types look and behave alike. Some people will call oral herpes cold sores or fever blisters. You should remember that not all sores that occur on the lips or in the mouth are herpes. Canker sores are another common mouth disease that look a lot like herpes and there are other mouth diseases that can look similar. A health provider will help you identify them. Remember that oral herpes is not usually spread by sex even though it can be. Many people get oral herpes as a child by having a relative or friend kiss them.

    Can herpes affect other parts of the body?

    Yes. Although it is very uncommon, herpes can affect the eyes. This should be treated by an eye specialist. Herpes can also rarely affect the skin such as on the hands or buttocks. This is uncommon because the skin is very thick compared to the thinner skin that is over the genital and in the mouth and the herpes virus has a harder time getting through it to cause the infection.

    What happens after the sores leave?

    The virus stays in the body but it goes into a sleep phase where there are no symptoms present. It may stay like this for a long time ( months or years) before the symptoms reappear.

    Are recurrences the same as the original outbreak?

    Recurrent episodes of herpes are similar to the original outbreak but they are often less intense and they may not last for as long a time.

    What triggers the virus to reappear?

    We don't really know why the body makes the virus come back again but we are pretty sure that it is associated with certain factors. These include: stress, heat (such as a fever or hot sun), trauma (a heavy sex episode may trigger it), being run-down and having another illness such as a cold or other virus. If a person is fortunate, they may not ever have recurrences of herpes but if they are less lucky they may have ten outbreaks during the first year that they have herpes. This is uncommon and it is more likely to have three or four outbreaks during the first year and less often as time goes on.

    What is so bad about herpes?

    Herpes can reappear many times during a persons life and it is more of a nuisance than anything else. A person can transmit it to a sex partner if there is an active outbreak. Also, it is possible to transmit it to another if there is even the slightest outbreak which may not even be apparent to the infected person.

    The other more important possible complication of a herpes infection is that an infected pregnant woman may transmit the herpes virus to her baby as the child is being born. A woman would have to have an active outbreak at the time of her delivery to pass it on to her child. It is possible for this herpes infection to cause brain damage to the child.

    If a woman has a history of having herpes outbreaks, the doctor who is assisting with the delivery of the child will simply look at the women's sex organs. If she has any herpes sores, the doctor will do a cesarean section which is an operation that gets the baby out without its having to go through the vagina where it may be infected by the herpes virus.

    How is herpes treated?

    Fortunately there are very effective medicines for herpes. They can be used in two different ways. First of all, they can be taken every time a person has an outbreak or reoccurrence. Although it is not a cure, it can help control the outbreak by limiting the time of the outbreak. Instead of having an outbreak for two weeks, a person can limit the outbreak to a few days. It is also possible to take the medicine daily, like a vitamin. This way, a person may be able to totally suppress an outbreak.

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    GENITAL WARTS

    Summary

    • Caused by a virus (the Human Papilloma Virus or HPV)
    • Appear as one or many raised lumps or bumps
    • They appear 1 month to 1 year after having sex with an infected person.
    • Often cannot be seen in women because they may be all inside the vagina. May also be too small in men and women to be easily seen.
    • More serious in women because they may change into cancer.
    image

    Genital warts are among the most common STDs. An estimated one million people get warts each year in the US.

    What causes genital warts?

    The warts are caused by a virus called the Human Papilloma Virus or HPV. The time from the exposure to the virus until symptoms show up is called the incubation period. The incubation period for the development of warts varies from one month to eighteen months with the most common incubation between three to four months.

    It is passed from person to person by direct contact. The virus is scraped off the skin during sex and is passed to the other person where it grows into a wart.

    What do they look like?

    The wart looks like a raised area or bump on the skin. There are often many bumps and they are usually flesh-colored. They may be on the penis, scrotum, vagina (inside or out), anus. They vary in size and may be so small that they can't be easily seen without special equipment.

    How are warts diagnosed?

    There is no good culture or blood test but a doctor or health provider who is experienced can usually make the diagnosis just by examining it. There is a test called an acid wrap that is sometimes helpful in making the diagnosis. In this test a piece of gauze or cloth soaked in vinegar (which is 5% acetic acid) is wrapped around the genitals and let stay in place for ten minutes. If warts are present, they usually turn white and they are easier to detect. In some cases, the warts are too small to be seen and in women, they may be inside the vagina and be hidden from view. A PAP smear which is normally used to detect cancer of the cervix may also detect the virus (HPV).

    How are they treated?

    There are no pills that will cure warts but they can be treated. There are several different possible treatments including: surgery, freezing, laser or destroying them by applying a chemical (podophyllum or bi or trichloro acetic acid) that kills the virus. It often takes several visits to the health provider to remove all the warts. It is important to return to the health provider after treatment to make sure they are all gone.

    Are there any complications of warts?

    If warts are untreated, you run the risk of transmitting them to any sex partner that you have unprotected sex with. In women, they may also progress into a cancer of the cervix. This type of cancer is detected by a PAP smear. Women should have a PAP smear whenever they change sex partners that they have unprotected sex with. A PAP smear is a test that checks for cancer of the cervix. Cancer of the cervix is a fairly common cancer in women and although it is serious, it is easily treated if found early.

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    SYPHILIS

    Summary

    • Caused by a bacteria (germ), sores appear 3 weeks to 3 months after having sex with an infected person.
    • The sores look like holes in the skin that have a raised edge. They are usually painless.
    • The sores disappear after a few weeks but the germ remains in the body and the disease reappears as a rash all over the body.
    • This rash disappears too but the germs can attack other parts of the body years later.
    • Syphilis can be completely cured at any stage.
    • In women the sores may be hidden in the vagina. Syphilis can be passed from a woman to her unborn child.
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    What is syphilis?

    Syphilis(pronounced sif'olis) is an infection caused by a bacteria germ, (Treponema pallidum).

    There are about fifty thousand reported cases of syphilis each year in the United States. The disease appears in stages.

    The first stage causes skin sores at the point where the germs entered the body. The second stage shows a generalized skin rash. Next it becomes without symptoms and is called latent syphilis where the only way it can be diagnosed is by a positive blood test. The third or tertiary stage can occur many years later when the germs attack another part of the body such as the heart or spinal cord. Syphilis can be completely cured in any stage by penicillin.

    What are the symptoms of the first stage of syphilis?

    The first stage is when a sore called a chancre (pronounced shanker) is present. In first stage syphilis, the chancre appears within ten to ninety days (with an average of three weeks) after direct exposure to the germ. The sore appears at the point of contact. It is a painless, open sore and can appear as just one or many sores . The entire sore is thick and its borders are raised. The sore or sores may be large or very small. The lymph nodes in the groin area are swollen but usually not painful. Chancres may appear anywhere on the body as they enter through small tears in the skin. Besides the genitals, they may also appear in other areas such as the mouth, tongue, eyes, fingers and buttocks. If untreated, the chancre will disappear by itself after two to eight weeks. Although the sores disappear, it does not mean that the syphilis germs have left the body.

    What are the symptoms of the second stage of syphilis?

    Without the proper treatment, about six weeks after the chancre appears, the second stage starts. During the incubation period and the primary stage, the syphilis germs have been multiplying and spreading throughout the body. The primary chancre may or may not still be present but soon a rash appears all over the entire body. The rash looks like many colored blotches and may even appear on the hands and feet. The rash is not-itchy and painless. It lasts from a few weeks to a year and then it disappears. This rash is contagious that is, you can get syphilis by touching it.

    In addition to the skin sores, the patient may have other symptoms and signs such as fever, sore throat, headaches, tiredness and joint pains. These are usually mild and don't last very long. Usually there is are swollen glands in the neck, the armpits and the groin area.

    Remember that the germs have invaded the blood and that other parts of the body may have been infected. The germs may infect the liver, the kidneys, the joints, the muscles and the brain.

    The blood tests are always positive during the second stage and remember that the lesions are full of syphilis germs.

    If untreated, even though the rash has disappeared, it does not mean that the germs have left the body. They stay in the body and may reappear many years later in the brain, heart or many other parts of the body. When the syphilis germs attack these other parts of the body, it is called tertiary syphilis (third stage syphilis).

    How is syphilis diagnosed?

    If a chancre is present, a scraping may be taken of it and examined under a special microscope. The syphilis germs can be directly seen. A blood test is also done and this is what is also done to diagnose syphilis in the later stages. The blood tests (there are many different ones for syphilis) can also be used to follow the infected persons treatment. After treatment the levels of the tests change and it is possible to see if the treatment was adequate.

    Can syphilis be passed to a unborn baby?

    Yes, if a pregnant women were to get syphilis, she may pass it to her unborn child. When the baby is born he or she would have congenital syphilis. A baby born with syphilis may have a variety of abnormalities.

    What is the treatment for syphilis?

    Syphilis in all stages can be fairly easily cured by penicillin injections.

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    PUBIC LICE ('Crabs')

    Summary

    • Very small (1/8th inch) gray to brown animals that live in the public hair and cause itching.
    • Easily treated with a medicine that is put directly on the pubic hair.
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    What are pubic lice?

    Pubic lice are very small (about 1/8th inch in diameter) creatures that live in the pubic hair and cause a lot of itching. They are not a serious sexually transmitted disease but they can cause a lot of discomfort. The little bugs have claws that hold on to the pubic hairs and they feed off the infected persons skin. If you have sex with a person who has pubic lice, some of the bugs may be spread to you. They can also fall off a person who is infected with them and land on towels, bed sheets or blankets, or clothes. Therefore, crabs may be spread by sheets, towels or by sharing clothes but it is most commonly spread by sex.

    How are they diagnosed?

    A person usually finds out that they have pubic lice by actually seeing them. Typically the person will have been feeling a lot of itching in the pubic hair area and they may have noticed some tiny red spots on their underwear. These are waste products from the crabs. The pubic lice are hard to see since they are small (about 1/16th to 1/8th of an inch in diameter) but they are visible to most people with good eyesight. If you pull one off the skin and place it on a white sheet of paper, they do look like little crabs. If you examine yourself very closely, a person may also see the pubic lice eggs which are very small lumps attached to the bottom of the pubic hair shafts.

    How are they treated?

    Pubic lice are treated with a shampoo or a lotion(lindane) that is applied directly to the pubic hair. The shampoo only has to be left on the hair for five minutes and then rinsed off. The lotion should be left on for about twelve hours before being rinsed off. After treatment, it is necessary to change clothes and bed sheets and towels as the bugs may live on these for a couple of days and re infect a person.

    Are there serious complications of pubic lice?

    There are usually not serious complications of crabs but occasionally they may become infected with other germs since the crabs live on the skin and cause small but open sores which may allow these other germs to enter. Public lice is an STD that may be spread from person to person even if condoms are used properly since they live in the pubic hair which is not protected by the condom.

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    SCABIES

    Summary

    • Similar to pubic lice but the bugs are too small to be seen and they live under the skin.
    • They cause very itchy small sores all over the body.
    • Treated with a lotion medicine that is applied all over the whole body.
    • Clothes, bed sheets and towels must be washed after treatment since the bugs can live in them.

    What is scabies?

    Scabies is a disease that is caused by very small bugs(called mites) that dig into the skin in little burrows. In these burrows they lay their eggs. They are usually very itchy(worse at night) and they can occur in many different parts of the body but especially on the hands, waist. arms and the trunk. They usually just look like small bumps or sores on the body but sometimes they can cause an allergic reaction and the sores can look very inflamed.

    Scabies is not so common these days because of good hygiene.

    How are scabies diagnosed?

    Usually a knowledgeable doctor or other health will be able to tell is you have scabies by examining the entire skin. He or she may also take a little sample of the skin sore with a little knife blade to look at under the microscope.

    How is scabies treated?

    It is easily treated with a lotion that is applied over the entire skin.

    Can there be serious complications of scabies?

    Not usually. It is more of a nuisance type of disease and only on occasion will the burrows become infected with other germs and cause a bigger problem.

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    YEAST INFECTION

    Summary

    • Caused by a fungus germ.
    • It causes an itchy redness under the foreskin in uncircumcised men.
    • In women it causes a thick white, itchy vaginal discharge.
    • Easily treated with an anti-fungal cream.

    What are yeast infections?

    These infections are not always spread by sex. The germ, a fungus called candida normally lives in the vagina without causing any symptoms. Sometimes it gets out of control and becomes an infection.

    What are the symptoms of yeast infections?

    In women it causes a thick, white, itchy cottage cheese-like vaginal discharge. In men who are not circumcised it can cause an itchy redness or discoloration under the foreskin. It also causes a skin rash that is commonly known as jock itch and also causes athlete's foot.

    Yeast infections are usually not serious but they can be a nuisance since they cause itching and discomfort.

    How are they treated?

    They are easily treated with a cream or more recently with pills.

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    HEPATITIS

    Summary

    • A serious virus disease affecting the liver.
    • May cause fever, abdominal pain, fatigue, yellowing of the eyes and skin, and darkening of the urine.
    • Treated by rest.

    What is hepatitis?

    Hepatitis is a disease that affects the liver. The liver is a body organ located in the abdomen and has many functions. It is like a little chemical factory and many of the bodies chemicals are made there. It is very useful in the digestion of food and also helps to get rid of waste products of the body. When the liver gets infected, many body functions become affected.

    What causes hepatitis?

    The are at least five viruses that cause hepatitis and it can also be caused by other factors such as poisons and alcohol. This online book will concentrate on the viruses that cause hepatitis and can be spread sexually. These viruses are hepatitis B and hepatitis C and possibly types D and E. It should be emphasized that these can also be transmitted by other means besides by sex.

    What are the symptoms of hepatitis?

    Hepatitis usually starts out with a fever, tiredness and muscle aches. Loss of appetite, nausea and vomiting, diarrhea and abdominal pain are common. The classic symptoms of hepatitis are a darkening of the urine and a yellowing of the skin and the whites of the eyes.

    When do symptoms appear?

    Depending on the type of hepatitis, symptoms may appear in 15 to 45 days (hepatitis A) or as long as six months (hepatitis B) after exposure to the virus.

    How is hepatitis diagnosed?

    There are blood tests that can show the inflammation of the liver and there are blood tests that can test for the presence of hepatitis antibodies. These antibodies are chemicals that your body makes to fight the hepatitis germs.

    Are there possible complications of hepatitis?

    Yes. First of all hepatitis itself can have a very intense course and people have been known to be very sick with it and die. Although hepatitis usually clears up by itself, it is possible to develop a chronic hepatitis which means that you will have it for years in your body. You are not usually sick with it for years but you may be able to infect others during this time. Having hepatitis B can also make a person more likely to get a cancer of the liver in the future.

    How is hepatitis treated?

    There is no medicine that will cure hepatitis but fortunately it is a self-limited illness and it resolves itself in a few days or weeks. There is currently a vaccine for hepatitis A and B and there are also other medicines that can be given to those exposed to hepatitis to help them prevent getting it.

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    VAGINITIS

    Summary

    • Infection of the vagina that usually causes a vaginal discharge. It is sometimes smelly or irritating.
    • Caused by one of many different germs such as gonorrhea, chlamydia, or yeast. Also can be caused by other germs such as trichomonas or gardnerella.
    • Found by examining the discharge under a microscope.
    • Treated by the right medicine depending on the germ that caused it.

    What is vaginitis?

    In medical language as with other words, you can figure out what a word means by breaking it down into sections. The first part of vaginitis means vagina and the second part, itis, means inflammation. Therefore vaginitis is an inflammation of the vagina. Inflammation means that the body is responding to something and that something is often a germ. In vaginitis, there are a number of different germs that can cause this vaginal inflammation. These include germs that we already discussed such as gonorrhea, chlamydia, and syphilis. There are also other germs that can cause vaginitis.

    What are the symptoms of vaginitis?

    One of the most common symptoms of vaginitis is an increased discharge from the vagina. A women usually has some amount of normal vaginal discharge and it is sometimes difficult to tell the difference between this and an abnormal discharge. The discharge of vaginitis can be of a different color or it may have an odor. There may also be a vaginal discomfort or itching.

    What germs cause vaginitis?

    As mentioned above, germs that have been discussed in earlier sections of this book such as gonorrhea, chlamydia and syphilis can cause vaginitis. Other germs include yeast, trichomonas('trick') and gardnerella. Each one of these produces a different type of discharge. For example, gardnerella produces a discharge with a fishy smell. Yeast makes a thick, white, cottage-cheese-like discharge.

    How is vaginitis diagnosed?

    A doctor or health provider will take a bit of the discharge and examine it under a microscope where s/he can actually see the germs or the change from what a normal discharge should look like. Sometimes a culture will be taken too. A culture is where the laboratory tries to grow the germ in an incubator to properly identify it.

    Is vaginitis a serious medical problem?

    In general it is not a serious problem and it is usually easily treatable but it can be caused by germs such as gonorrhea or chlamydia which can, if untreated, progress into very harmful problems such as PID or infertility.

    How is vaginitis treated?

    The treatment for vaginitis depends on the germ that caused it. For example, a yeast vaginitis would be treated by a cream that is put into the vagina while a vaginitis caused by gonorrhea or trichomonas would be treated by pills taken by mouth. The health provider would treat you with the proper medicine depending on the germ that was found on examination. It is necessary to have an examination in order to find out what particular germ is causing the infection.

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    MOLLUSCUM CONTAGIOSUM

    Summary

    • Uncommon disease that causes small, round, raised bumps in the genital area.
    • Easily treated
    • Few if any complications
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    What is Molluscum?

    Molluscum are named after mollusk shells because they are hard, small, flesh-colored round bumps that form in the genital region. The bumps may be from 1/16" to _" inches in diameter. There are usually a few to many of them present. They are small, dome-shaped, and they have a slight indentation in their center.

    What causes Molluscum?

    They are caused by a virus.

    How serious of a disease are they?

    They are more of a nuisance than anything and they rarely cause any complications. If they are scratched, they may be opened and become infected with other germs. Actually they may also occur non-sexually transmitted in children and in some adults such as wrestlers.

    How soon after contact do they appear?

    The time from contact to the appearance of the sores can be between one week to six months with the average being two to three months.

    What is the treatment for Molluscum?

    There is no medicine that a person can take for molluscum but they can be destroyed by physical means such a cutting them out with a small scalpel blade or putting an acid on them. If they are left untreated, they will go away by themselves within a year or two. We usually recommend treatment because they can be spread to others.

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    How to examine yourself for STDs

    It is important to be able to recognize whether you have a sexually transmitted disease or not. First of all, if you have never had sex with another person, then you will not have an STD. If you have ever had sex with anyone, then it is possible that you got an STD. The more sexual partners that you have had in your life, the better chance you have of having gotten an STD. You should check yourself out for STDs if you have ever had sex with another person.

    Remember that you are not a doctor and there are many conditions that can look like an STD but are not. If you see anything that you are not sure of, have it checked out by a health provider.

    How should men check themselves?

    First of all, it is important that you review the normal anatomy of yourself (see anatomy and physiology section). We will begin at the head of the penis. You may begin by looking into the urinary opening. A common symptom is a discharge coming out of this opening and sometimes it is a heavy discharge and sometimes it is very light. It may sometimes just cause a bit of staining on your underwear. If you are uncircumcised, you should pull the foreskin back so you can see the head of the penis. Look carefully at the head of the penis for any sores or bumps or change in color. Try to examine yourself in a way that starts at one point and continue around the shaft of the penis in a regular way so that no part of the penis is missed. An STD may be in any part of the penis so be sure to examine the underside too. After checking the penis, look carefully in the pubic area under your pubic hair. Again look for any lumps or sores or pimples. The pubic area is where pubic lice or crabs(see that section) may be.

    All young men should get into the habit of examining their testicles whether they are sexually active or not. A swollen testicle or a lump or tenderness may be a sign of an STD but it also may be a sign of cancer of the testicle. Testicular cancer is not an STD but it is something that all young men should be on the lookout for. This kind of cancer is not common but it the most common cancer in men between 15 and 35. Just as we try to get women to examine themselves for breast cancer, men should be examining their balls every couple of weeks for testicular cancer. If you notice any sores or any of the other symptoms that are talked about here, have it checked out by a health provider as soon as possible. Examine the scrotum and the skin around the genitals for any sores, rash, redness or discoloration.

    You should remember that you can have almost any of the different STDs with little or no symptoms and if you think you may have come in contact with a sexually transmitted disease, have yourself checked by a health provider as soon as possible. He or she may be able to do other tests to help diagnose the disease. You may also not have any symptoms of the STD until long after your sexual contact and you may want to consider getting checked out on a regular basis.

    How should women examine themselves?

    Women may have a harder time examining themselves than men because their sex organs are mostly inside their bodies but they can still check the parts that are outside. Review the normal outside anatomy before going on with this section. You may want to use a mirror to examine yourself.

    Its easiest to begin in the pubic hair area. Using your fingers to spread apart the hair, look for any sores, lumps, rash, redness or discoloration. You may also see crabs (pubic lice) in this area.

    Next you should spread apart the labia or lips and look over this entire area for sores, lumps, or discoloration. If you get in the habit of examining yourself, you will become familiar with what your body normally looks like and will be better able to see if there has been any change. Check the vaginal opening for any unusual discharge that is coming out. It is normal to have some vaginal discharge and it is important to check yourself to be able to recognize this. That way, you could more easily tell if any discharge is different. An abnormal discharge may also have an odor and it may be thick white or yellow.

    When should you get checked by a health provider for sexually transmitted diseases (STDs)?

    A person should certainly be examined in a clinic or health providers office if he or she feels they have any symptoms that could possibly be an STD. The symptoms may be very strong or they may be very slight. If you have any doubt, get yourself checked. A well known doctor in Boston advises her teenage patients to get a routine STD exam any time they have a new sexual partner. This is a good idea since so many STDs do not have visible symptoms.

    Are there any other things a Gay man should look for?

    Besides having a STD on or around the penis, a gay man may have an STD in the mouth or in the rectum if he practices oral or anal sex. Any unusual sores or discomfort may be a sign of an STD if you feel you may have been exposed.

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    AIDS/HIV Overview

    What is AIDS/HIV disease?

    AIDS stands for Acquired Immune Deficiency Syndrome.
    Acquired - you got the disease (instead of inheriting it or it developing like diabetes or heart disease.

    Immune Deficiency - something lacking or failing in your body's defense against disease system. The immune system is the part of the body that fights against germs and anything that invades our bodies.

    Syndrome - a group of symptoms. Symptoms are things that are abnormal in our bodies such as fevers, sores, headaches, pain, itching and any other sign that we feel or see that is not part of everyday normal healthy life.


    What is HIV?

    HIV stands for the Human Immunodeficiency Virus and it is the germ that causes AIDS.

    How long has AIDS been around?

    We don't know for sure when AIDS began as a disease or where it began but we first noticed it in 1981.

    How many people have HIV disease?

    In the United States there are an estimated one million people infected with the AIDS virus at present with over 600,000 already with the diagnosis of AIDS and over 300,000 already dead from the disease. It is estimated that there are about fourteen million people worldwide who have the HIV germ inside them and by the year 2000, there may be between twenty to forty million people infected.

    What is the difference between HIV and AIDS?

    AIDS is the end result of infection with HIV. When you first get infected, you will most likely not have any symptoms for years. During this time you are said to be HIV Positive and you can pass the virus to other people by various ways. As time goes on, an HIV positive individual will usually begin to have mild symptoms and eventually she or he will get sicker and progress to later stage HIV Disease or AIDS with more serious symptoms. This progression may happen quickly but it usually takes an average of ten years to get to AIDS.

    What is happening in the body during these ten years?

    The AIDS virus is growing in your body and is slowly but steadily destroying an important part of the immune system. The main part that is affected are the T-cells.

    What are T-Cells?

    T-cells are a type of white blood cell that is in your body to fight against any thing that attacks the body such as bacteria and viruses. A person normally has from 500 to 1500 of these cells in a small amount of blood. In HIV positive persons, the T-cell count eventually falls below 200 and in time it goes down to below fifty and even down to zero unless the person is treated.

    What happens when you lose your T-Cells?

    The T-cells, whose function is to help the immune system defend against germs and other foreign invaders, are some of the most important parts of the immune system. Without the right amount of T-Cells, your body cannot defend itself and you are more likely to get infections and other problems. In other words, a person is more likely to get sick if they don't have an intact immune system.

    Are there any medicines to help prevent this loss of T-Cells?

    There are now many drugs that are able to slow down the progress of the AIDS virus. These medicines are keeping HIV infected people alive much longer and it appears that we may soon be able to control this deadly illness. Unfortunately, these medicines are very expensive and only a small amount of all the HIV infected people in the world can afford them.

    What are the symptoms that occur first?

    Early in the disease, there are no symptoms but when they do develop they are usually mild but they may last a long time. These include weight loss, recurring fevers and night sweating (usually a lot), chronic tiredness, enlarged lymph nodes, and prolonged diarrhea and/or coughing. The symptoms may be vague and they are often like symptoms of many other diseases.

    What are the later symptoms?

    More serious infections can occur. A common one is pneumocystis pneumonia which can be life threatening. This disease is very common in AIDS but extremely rare otherwise. Fortunately, we now have several good treatments for this pneumonia. Pneumonia is an infection of the lungs and pneumocystis is a particular type of germ that affects persons infected with the AIDS virus. Another serious and common outcome of HIV disease is Kaposi's Sarcoma which is a cancer that causes purplish bumps on the skin. Other possible outcomes of HIV disease are infection with tuberculosis, infection in the brain and many others.

    How is the AIDS virus (HIV) spread from person to person?

    It is transmitted in three ways.
    1. By Sex
      The virus is present in semen(this is what comes out of a man's penis when he has an orgasm), and vaginal secretions. It can be spread by anal or vaginal sex. There is some risk of spreading AIDS by oral sex but it appears to be a lower risk than by anal or vaginal sex.

      It is not spread by kissing, touching, masturbation or hugging, being in the same room with an HIV infected person.

    2. By blood and blood products.
      Intravenous drug users who share needles to inject drugs may expose themselves to the AIDS virus.

      In the past, blood transfusions were unsafe and it was possible to get the AIDS virus by this means but since 1985 all blood products in the US have been tested and the blood supply is very safe.

    3. Mother to Child spread
      A pregnant woman who is HIV positive can transmit the AIDS virus to her baby.

    Can HIV disease be transmitted by other ways?

    NO, not by food, mosquitoes or other insect bites, bathrooms, coughing, sneezing, shaking hands, hugging, or kissing.

    Again, how is the HIV virus spread?

    It is spread by unsafe sexual behavior and by sharing needles.

    When was this disease first identified?

    In June 1981, five Gay men in Los Angeles were found to have a rare type of lung disease (called pneumocystis Pneumonia). Shortly afterward, a group of Gay men in New York City were found to have a rare type of cancer that affected the skin and other parts of the body. These men had abnormalities in their immune system but no one knew what was causing the breakdown of the immune system. By the end of 1981, about two hundred and fifty people had this new unnamed disease and no one knew what was causing it.

    By early 1983, the first cases of this disease in women were found when two women who were partners of IV drug users developed AIDS. By the end of 1983, the first cases of AIDS were discovered in Africa.

    In the United States, there were 50,000 cases of AIDS by July 1989 which was eight years after the first cases were discovered. It took only two years for the next 50,000 cases to be reported. It took ten years for the first 100,000 cases of AIDS to be reported and just 18 months for the second 100,000 cases. There are over 600,000 reported cases of AIDS at this time and an estimated one to one and a half million Americans with HIV disease. In the world there are an estimated thirty million people with HIV disease now. By the year 2000 there will be about one million children who will be orphaned because their parents will have died from AIDS.

    How many teenagers get HIV disease?

    About twenty percent of all the people in the United States who get AIDS are between the ages of twenty and twenty nine. This means that they got the AIDS virus in their bodies when they were teenagers. We do not have good statistics about the actual rate of HIV infection in teenagers since so few teens get tested.

    Where can one get more information about AIDS/HIV disease?

    There is a national AIDS hotline at 1-800-342-AIDS.

    Can AIDS and HIV Disease be treated?

    Yes. There are currently many medicines used in the treatment of AIDS but there is no cure for it yet. It is often fatal. We have many drugs that appear to slow the progression of AIDS somewhat and we have a lot of drugs that can treat the infections and cancers that people with AIDS get.

    TESTING

    What is the AIDS antibody test?

    When the HIV virus gets into your body, it stimulates your body's immune system to produce antibodies which are chemicals that fight the HIV virus. The blood test can detect these antibodies.

    Is the test accurate?

    The test is very accurate but it is possible to have the test read positive when there are not any antibodies in the blood. This is called a false positive test result. If the initial test is positive, the laboratory will repeat the test twice and if necessary do an another, totally different test to confirm it.

    It is also possible to have the test read out as negative when you are actually infected with the AIDS virus. This can happen when you get tested shortly after being infected with the virus. It takes a certain while for antibodies to build up in the blood and it is usually recommended that a person be checked for HIV antibodies six months after the risky contact. Most people who are infected develop antibodies within six to twelve weeks after contact with the virus.

    What does it mean if the test is positive?

    It means you have the HIV infection and after some time you will most likely progress to have the more serious symptoms of AIDS unless you receive treatment. We call someone infected with the AIDS virus HIV Positive. Currently there are several medicines to slow the progression of this disease such as AZT and DDC.

    What should a person do if they are positive?

    It's important to learn as much as you can about your disease and to find a knowledgeable health care provider to help take care of this infection. Your provider will examine you periodically and prescribe the proper treatments as necessary.

    Are there any special treatments or plans that HIV positive people should do?

    HIV positive individuals should live their lives in the same healthy ways that we all should, that is, we should watch our diet, get plenty of exercise and rest, cut back on alcohol and drugs and try to reduce stress. They should learn as much as they can about HIV disease and they should take an active part in the decisions that they and their health providers must make in their treatment.

    Can anyone make me take the test?

    No, in Massachusetts and in most every other state, a person must give written informed consent in order to be tested

    What do I do when a friend or relative has AIDS?

    As the AIDS epidemic continues, we will all most likely know someone with AIDS or HIV Disease. He or she may be someone close to us or they may be a less close acquaintance. The first important point to remember is you cannot get the disease through everyday routine contact. AIDS cannot be spread by touching, hugging, shaking hands or sharing the same bathroom. The next important point to remember is that people with AIDS and HIV Disease(sometimes called PWA) need all the help and support they can get. You should continue to be the friend that you were before they found out they were sick and you should offer to help them.

    Just because a person is HIV positive or has AIDS does not mean that they can't carry on a fairly normal life. They go to work, play sports and get involved in the same activities that non-infected people do. If the disease progresses, they may need more help if they become weaker and are unable to do certain activities easily by themselves.

    It is important that you do not intentionally avoid the person with HIV disease. It is okay to discuss the disease with him or her and you will learn a lot about life by getting involved in the care of HIV positive people. Learn as much as you can about this disease and you will see that you will be able to help your friend more. There are AIDS service organizations in most cities where you can get help.

    What if the person is dying of AIDS?

    Helping a person with AIDS who is dying is a very stressful situation. We do not learn to deal with death and dying very well in America and the whole subject is hardly ever talked about in our culture. It can be very frustrating to watch a person getting sicker and not being able to do much about it. With AIDS it is even more difficult to deal with since the persons infected with AIDS are usually young. Try to talk about your feelings of anger, sadness and uncertainty with others who you are close to. As you try to help the person with the disease, it is important that you think of yourself too. You cannot give the person dying of AIDS much support if you are too emotionally distressed yourself. There are many organizations that deal with AIDS and they should be used to your benefit.

    As the person with AIDS gets sicker, he or she will depend more and more on others to help them with basic needs such as shopping and house cleaning and eventually they may need help with eating and cleaning themselves. You may want to learn some basic nursing skills at a local AIDS support organization or the Visiting Nurse Association. You will learn to be careful with body fluids such as urine and vomit and you will learn to use rubber gloves to protect yourself. Again, you should not worry about getting the AIDS virus if you use simple careful handling.

    How do I deal with my feelings if someone close to me dies?

    As mentioned above, we do not learn to deal with death and dying very well. Death is a normal part of life but because of the uncertainty of what happens after death and because of the finality of it, we have many feelings attached to it. It is normal to grieve and feel sad when someone close to us dies. Its okay to cry but not everyone cries and it is okay not to cry. If you do not feel much after the death of a loved one, it may be that you are not ready to grieve and you may be denying the feelings as a way of coping at that time. Healing after losing a friend or relative takes time and it is a period that may take weeks or sometimes even years. It is said that time is the best healer. There are no rules for the right way to mourn the loss. It is always helpful to share your sadness with your friends and sometimes it is helpful to seek help with a minister or other clergy person or with a psychologist or other counselor. In time we accept the loss and the strong feelings we had become less strong.

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    How to prevent getting STDs and AIDS

    Basic goals for HIV/STD Prevention

    1. Abstinence

    Learn the necessary skills to have control over your life. If you don't really feel you are mature enough to handle having sex and the possible problems that it can bring(e.g.. possible pregnancy and STDs), then you should learn how to not get yourself into a situation where you are out of control. Learn how to say no.

    Don't have sex until you are old enough and smart enough to prevent getting these diseases. Abstinence is the only real way of not getting AIDS and STDs. Abstinence means not having sex. Just because it seems that all your friends are having sex does not mean that they are telling the truth. The fact is that at age fifteen, over 80% of girls have not had any sex and of all kids under seventeen, 40% of boys and 60% of girls have never had sex. If it doesn't seem like it is right to have sex then it may not be the right time.

    Learn how to communicate with your partner . This is not always very easy to do. In America we have a hard time taking about sex and it can feel awkward and uncomfortable. It is important to think about these important issues in advance and to practice dealing with them. Practice saying no. Learning to say no gives a person a lot of power in their lives and it is a very grown-up way of handling things.

    Get help with these issues wherever you can. Try your parents first. If they haven't already started to talk to you about these issues it is just because they also feel uncomfortable talking about them too. We are all in need of help when it comes to talking about these sensitive subjects. There are usually people at school who have a lot of experience talking about this and they are just waiting for you to come into their office. School guidance counselors and teachers are there only to help you and you may want to take advantage of this resource.

    In America there is a lot of pressure to have sex. We are shown sex on TV, in the movies and in advertisements. The changes that teenagers bodies are going through makes you think about it more than when you were a kid. Remember that having sex is a serious undertaking and you should think of the possible problems that it can bring. Having sex is not kid stuff. It is an adult activity and it is serious business in these times. Getting yourself or someone else pregnant is a problem but getting or giving a disease that will kill you is a much bigger problem.

    2. Use protection

    If you decide that you will have sex, you have to be protected. Always use protection if you do have sex. This means you should learn how to use condoms properly and how to refuse to have unprotected sex. Having sex is a mature activity and you must be responsible if you have chosen to do it. Latex condoms have been shown to be protective against STDs including AIDS. It should be noted that even condoms are not foolproof and they may break or they may not be used properly.(see section later on how to use a condom) They are very effective if used in the right way. In other words, using condoms will help to protect you but they are not an absolute guaranteed foolproof method of being safe. They will most definitely help to protect you but the only 100% method to avoid getting any sexually transmitted disease(STD) is by not having sex. Using condoms properly and consistently will have the added benefit of preventing an unwanted pregnancy. Remember that over one million teenagers get pregnant every year in the United States.

    3. Limit the number of sex partners you have.

    It is just common sense that the more partners that you have sex with, the higher chance there is of meeting someone with these diseases. If you have already had sex in the past with someone, and you are not currently in a relationship, it does not mean that you should be having sex with someone now. It is perfectly normal not to be having sex with anyone at any given time. In the old days, it was common to have sex with just one person in a lifetime. Actually, it is still practiced in our society and in others but it is not well known. It is okay not to be having sex with anyone and it is okay to be saving yourself for that one special someone if you want. Abstinence (not having sex) is okay.

    4. Avoid getting STDs(sexually transmitted diseases) and treat them promptly if you do get one.

    If you get one STD then you could have just as easily have gotten another including AIDS. Also if you have an STD it makes an opening in your skin or an inflammation that may make it more likely for the AIDS virus to get into your body.

    5. Keep control of your life and what you do.

    Don't get yourself into situations that you may lose control (e.g.. getting drunk or using crack or other drugs that may affect your judgment). Without being able to make wise decisions, a fatal mistake may be made.

    Although some teenagers don't think a lot about living to an old age (I didn't when I was younger), you just may make it to thirty or forty years or older and your body has to stay in shape to do it. Taking care of your body is important and that means avoiding unnecessary diseases if possible. A disease that you catch as a teenager can affect you for the rest of your life. Be smart! Don't let yourself get into a situation that you will regret someday. You will someday decide to have sex even though you know you are not yet ready to have a child or to get a sexually transmitted disease. You have to know how to avoid getting pregnant or get an STD.

    Get help if you are having trouble dealing with growing up and the changes that it brings. We all go though adolescence and it was not easy for any of us. Life is not easy and we can all use all the help we can get. Do not be afraid to look and to ask for help. Your parents may be the first ones to look to or maybe a teacher or guidance counselor at school. There is usually a friend or relative or someone at your school that you can talk to. Try to think about what can happen to you before you get yourself in an uncomfortable situation. If you don't let yourself get into a tight spot you will not have to think about how to get yourself out of it. If you have already made some mistakes and you do have problems, you have to be strong enough to get help. There are people out there who care. You just have to look for them.

    Talking more freely about sex, birth control and how to protect yourself from STDs can be learned. It is not easy for anyone but it can be done.

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    HOW TO USE A CONDOM

    Summary

    • Use a new condom each time.
    • Squeeze air out of the condom tip and place it on end of penis. Penis should be hard first.
    • Roll condom down over penis.
    • After the man comes, he should hold the penis and the condom while taking them out of the vagina to prevent the condom from slipping off and to avoid a spill.
    • Condom should be thrown away and not reused.
    • Both partners should wash their sex parts with soap and water.

    How do I talk to my partner about using condoms?

    First of all, it is best to talk about using condoms before having sex and not just at the last minute even though it is not easy to do. Wanting to use a condom means that you care about your partner and yourself. It is best to be honest with your partner. If you find it impossible to talk about, it may be an indication that you may be too immature to be having sex after all. There is nothing wrong with waiting until you are a bit older and more mature to have sex .

    What kind of condom should be used?

    You should always use latex condoms since they offer more protection than the natural ones. Natural skin condoms are made of sheep intestines and some germs can pass through them. The natural skin condoms are much more expensive and are not as easy to find in the stores these days anyway and the newer latex ones are more sensitive than them. The brand of condom is not that important since all condoms sold in the US are required to pass an inspection. Condoms come in different sizes and colors and some are lubricated and some have a coating that contains a chemical (called nonoxynol-9) to kill sperm. You will find which condom you like the best by trial and error. You can ask your friends which ones they like and try different ones. Condom packages have an expiration date on the that you should check to see if they are fresh. Also you should store condoms in a place where they won't be damaged by heat or pressure. This means not keeping them in your wallet in your back pants pocket where they may become crushed and damaged.

    What is the little bulge at the end of most condoms?

    Most condoms have a little bulge at the tip that acts as a reservoir to collect semen. You should pinch this tip to get the air out of it while you are putting it on. The reason you do not want air inside the condom once it is on your penis is that it will make more friction which will make it easier to break. The most common reason for condoms breaking is air bubbles inside them. It also makes the man feel a little less too. Another reason for condoms breaking is lack of lubrication.

    Should lubrication be used with a condom?

    A woman will produce a natural lubrication but it is not always enough and using an artificial lubricant can be helpful. A lubricant is the liquid that makes the sex parts(vagina and penis) slippery. It is important to use a water-based lubricant and never use a fat-based one. Oils including baby oil and Vaseline should never be used as they will actually dissolve the condom. KY Jelly or any lubricant specifically made for this purpose are the best. You can also put a little lubricant on the head of the penis before putting on the condom to increase the sensitivity during sex. Many condoms come with a lubricant covering them. Although it is not the best, many people use saliva (spit) as a lubricant.

    When should the condom be put on?

    The penis should be erect(hard) before putting on the condom. The condom should be put on before it gets near the vagina. Some guys will say that they want to start sex without the condom and stop before they come and put one on then. This is unsafe because you are both being exposed to germs if they are present. After pinching the reservoir tip with one hand, use the other hand to roll the condom down over the erect penis while taking care to smooth out any air bubbles that may form while you are doing this.

    When should the condom be removed?

    After the man has an orgasm (comes), the penis starts to gets smaller and the condom may slip off. Of course this could be dangerous so the man should withdraw the penis out of the vagina while at the same time holding on to the condom and the penis to prevent it's slipping off and spilling the semen. Hold on to the ring at the end of the condom as the penis is removed from the vagina. The condom should slide off easily. It should be thrown away and never reused. Don't flush it down the toilet but put it in the trash instead. When you flush it down the toilet it has a good chance of winding up in a river or the ocean as pollution.

    What about oral sex?

    Oral sex is safer than unprotected sex in the vagina or anal sex but that does not mean it is safe. There have been cases of AIDS that have been spread by oral sex and it is certainly possible to spread STDs such as herpes, gonorrhea, syphilis and others by oral sex. A condom should be used on a man's penis if someone is going to put their mouth on it. There are unlubricated and flavored condoms available. If someone was going to perform oral sex on a woman, a piece of plastic wrap such as Saran Wrap should be used to cover the vagina. It may sound strange but it could prevent you from getting a disease. It is important to keep semen and vaginal fluids out of the mouth since it is these fluids that can contain the AIDS virus and the germs of other sexually transmitted diseases. Remember that using protection such as a condom shows that you care about your partner.

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    TEENAGERS GUIDE TO SEXUALLY TRANSMITTED DISEASES AND AIDS 1994

    BY DR. ROBERT TAYLOR

    RESEARCH FELLOW, HARVARD AIDS INSTITUTE
    STAFF PHYSICIAN, BOSTON CITY HOSPITAL STD CLINIC

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    (c) 1998 Robert Taylor, M.D.