sexually transmitted diseases overview

8/3/2019 Sexually Transmitted Diseases Overview

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Sexually Transmitted Diseases Overview (STDs)

Sexually transmitted diseases (STDs, venereal diseases) are among the most common infectious

diseases in the United States today. STDs are sometimes referred to as sexually transmitted infections,

since these conditions involve the transmission of an infectious organism between sex partners. More

than 20 different STDs have been identified, and about 19 million men and women are infected each year

in the United States, according to the CDC (2010).

Depending on the disease, the infection can be spread through any type of sexual activity involving the

sex organs, the anus, or the mouth; an infection can also be spread through contact with blood during

sexual activity. STDs are infrequently transmitted by any other type of contact (blood, body fluids or tissue

removed from an STD infected person and placed in contact with an uninfected person); however, people

that share unsterilized needles markedly increase the chance to pass many diseases, including STD's

(especially hepatitis B), to others. Some diseases are not considered to be officially an STD (for example,

hepatitis typesA,C, E) but are infrequently noted to be transferred during sexual activity. Consequently,

some authors include them as STD's, others do not. Consequently, lists of STD's can vary, depending on

whether the STD is usually transmitted by sexual contact or only infrequently transmitted.

STDs affect men and women of all ages and backgrounds, including children. Many states require that

Child Protective Services be notified if children are diagnosed with an STD.

STDs have become more common in recent years, partly because people are becoming sexually

active at a younger age, are having multiple partners, and do not use preventive methods to lessen

their chance of acquiring an STD.

People can pass STDs to sexual partners even if they themselves do not have any symptoms.

Frequently, STDs can be present but cause no symptoms, especially in women (for example,

chlamydia, genital herpes or gonorrhea). This can also occur in some men.

Health problems and long-term consequences from STDs tend to be more severe for women than for

men. Some STDs can cause pelvic infections such aspelvic inflammatory disease(PID), which may

cause a tubo-ovarian abscess. Theabscess, in turn, may lead to scarring of the reproductive organs,

which can result in anectopic pregnancy(apregnancyoutside the uterus),infertilityor even death for

a woman.

Human papillomavirus infection(HPV infection), an STD, is a known cause ofcancer of the cervix.

Many STDs can be passed from a mother to her baby before, during, or immediately after birth.

Because the method of becoming infected is similar with all STDs, a person often obtains more than

one pathogenic organism at a time. For example, many people (about 50%) are infected at a single

sexual contact with both gonorrhea and chlamydia.

Sexually Transmitted Diseases (STDs) Causes

Depending on the disease, STDs can be spread with any type of sexual activity. STDs are most often

caused by viruses and bacteria. The following is a list of the most common STDs, their causes and other
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infections (see STDs with asterisk mark*) that may be transmitted on occasion by sexual activity, but are

frequently not considered primarily to be an STD by many investigators:

STDs caused by bacteria

Chancroid(Haemophilus ducreyi)

Chlamydia(Chlamydia trachomatis)

Gonorrhea(Neisseria gonorrhea)

Granuloma inguinale (Calymmatobacterium granulomatis)

Lymphogranuloma venereum(Chlamydia trachomatis)

Syphilis(Treponema pallidum)

STDs caused by viruses

Genital herpes(herpes simplex virus)

Genital warts(human papillomavirus virus [HPV])

Hepatitis Band D, and infrequently, A*,C*,E* (hepatitis viruses, types A-E)

HIV/AIDS(human immunodeficiency virus [HIV virus])

Molluscum contagiosum* (poxvirus)

STD caused by protozoan

Trichomoniasis(Trichomonas vaginalis)

STD's* caused by fungi

Jock itch(Tenia cruris)*

Yeast infections* (Candida albicans)

STD's caused by parasites

Pubic liceor crabs (Pediculosis pubis)

Scabies* Sarcoptes scabiei

Sexually Transmitted Diseases (STDs) Symptoms
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Common STDs have a variety of symptoms (if symptoms develop at all) and many different

complications, including death.

Symptoms of STDs caused by bacteria

ChancroidSymptoms

Are not common in the United States but common in developing countries.

Symptoms include painful ulcers on the genitals.

Can be confused with syphilis or herpes

Is treatable withantibiotics

Chlamydia symptoms

Most common of all STDs caused by bacteria.

Cause no symptoms in about 80% of women and 50% of men

When symptoms are present, commonly there is discharge from the vagina or the penis, and burning

or pain during urination.

Is transmitted through vaginal, oral, or anal sexual contact

Ectopic pregnancy and infertility for women are potential serious complications.

Is treatable with antibiotics

Gonorrhea symptoms

Discharge from the vagina or the penis

Over 50% of infected women have no symptoms, but they can still transmit the disease to others.

Painful urination

Ectopic pregnancy,pelvic inflammatory disease(PID), infertility for women, Fitzhugh-Curtis syndrome

(perihepatitis) and death are potential serious complications.


Granuloma inguinale (donovanosis) symptoms

Not common in the U.S.

Symptoms are painless genital ulcers in the groin area.
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Is treatable with antibiotics, usually for three or more weeks

Lymphogranuloma venereum

Not common in the U. S.

Symptoms are abscesses (buboes) in the groin, rectum or other areas; fistulas that drain pus may

occur and are treatable with antibiotics.

Syphilis

Symptoms are mild and often go undetected initially

Starts with a painless genital ulcer that goes away on its own

Rash,fever,headache, achy joints


More serious complications associated with later stages of the disease if undetected and untreated

Symptoms of STDs caused by viruses

Genital herpes

Recurring outbreaks of blister-like sores on the genitals

Can be transmitted from a mother to her baby during birth

Reduction in frequency and severity of blister outbreaks with treatment but not complete elimination of

infection.

Can be transmitted by a partner who has herpes even if no blisters are present.

Genital warts

Caused by a virus related to skin warts, human papillomavirus (HPV)

Small, painless bumps in the genital or anal areas (sometimes in large clusters that look like

cauliflower)

Various treatments available (for example, freezing or painting the warts with medication)

Vaccines are available against the most common types of HPV

Hepatitis

Hepatitis B and D are most often associated with sexual contact,hepatitis A, C, E are less frequently

transmitted by sexual contact.
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Both may be transmitted via contact with blood; for hepatitis B, sexual transmission is believed to be

responsible for 30% of the cases worldwide.

The hepatitis B virus can cause both an initial (acute) and a chronic form of liver inflammation. Only

50% of acute infections with the hepatitis B virus produce symptoms. The initial phase of infection lasts

a few weeks, and in most people (90%-95%), the infection clears.

Acute infection can causeyellowish skin and eyes, fever, achy, tired (flu-like symptoms).

Severe complications in some people, includingcirrhosisandliver cancermay occur in a small percent

of individuals infected with HBV.

Treatments are availableand remission is possible with some aggressive medications.

Immunizations are availableto prevent hepatitis B.

HIV/AIDS

Spread primarily by sexual contact and from sharing IV needles

Can be transmitted at the time a person becomes infected with other STDs

No specific symptoms or physical signs confirm HIV infection.

The average time from infection to the development of symptoms related to immunosuppression

(decreased functioning of the immune system) is 10 years.

Fatigue,night sweats, chills, or fever lasting several weeks,headaches, andcoughmay occur a few

weeks after contracting the virus initially.

Serious complications of AIDS include unusual infections or cancers, weight loss, intellectual

deterioration (dementia), and death.

No current cure but medications are available to slow disease progression.

Molluscum contagiosum

Small (2-5mm) raised areas (papules) on the skin

Contagious, usually by direct skin to skin contact

Self-limited over months to years; treated with some topical creams

Often cryotherapy (freezing) or surgical removal is performed

Symptoms of STDs caused by protozoan

Trichomonas
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Frothyvaginal dischargewith a strong odor

Treated with antibacterial/antiprotozoal medicines

Symptoms of STDs* caused by fungi

Jock itch (genital itching or Tenia cruris)* (not always an STD)

Itchy groin skin, sometimes has a reddish color

Is treated with topical antifungal medicines

Yeast infection (Candidiasis)* (not always an STD)

Cheese-like vaginal discharge or whitish exudates sometimes with a reddish hue to the skin; it may

occur around the foreskin of infected males; common symptoms are itching and burning sensation of

the vagina or penis.

Is treated with topical antifungal medicines in most cases

Symptoms of STDs caused by parasites

Pubic lice

Very tiny bugs that are found in pubic hair, sometimes referred to as "crabs"

Can be picked up from clothing or bedding

First noticed as itching in the pubic area

Are treatable with creams, anti-lice agents, and combing

Scabies

Skin infestation caused by a tiny mite

Highly contagious

Intense itching is the primary symptom, which worsens at night

Spread primarily by sexual contact or from contact with skin, infested sheets, towels, or furniture

Is treated with creams

When to Seek Medical Care

A medical examination may be necessary if a person believes he or she may have an STD or if he or she

may have been exposed to someone with an STD. Being seen by a doctor as soon as possible after
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exposure to an STD is important; these infections can easily spread to others and can have serious

complications.

Go to a hospital's emergency department in these circumstances if:

an STD problem worsens;

a fever develops with other symptoms; or

if it will be a couple of days before the individual can be evaluated by a doctor.

Exams and Tests

Some STDs can be diagnosed without any tests at all (for example, pubic lice). Other STDs require a

blood test or a sample of any unusual fluid (such as an abnormal discharge from the vagina or the penis

for gonorrhea or chlamydia) to be analyzed in a lab to help establish a diagnosis. Some tests are

completed while a person waits; other tests require a few days before a person may obtain the results (for

example, syphilis).

Sexually Transmitted Diseases (STDs) Treatment

Self-Care at Home

Home treatment of STDs is not recommended because prescription medications are usually necessary.

Medical Treatment

The treatment of an STD varies depending on the type of STD. Some STDs require a person to take

antibiotic medication either by mouth or by injection; other STDs require a person to apply creams or

special solutions on the skin. Often, reexamination by a doctor is necessary after the treatment to confirm

that the STD is completely gone.

Some STDs, such as genital herpes and HIV (which leads to AIDS), cannot be cured, only controlled with

medication.

For treatment of individual STD types, the reader is urged to click on the individual disease listed above.

Next Steps

Follow-up

Sometimes people with STDs are too embarrassed or frightened to ask for help or information. However,

most STDs are easy to treat. The sooner a person seeks treatment and warns sexual partners about the

disease, the less likely the disease will do permanent damage, be spread to others, or be passed to a

baby.

If diagnosed with an STD, follow these guidelines:

Seek treatment to stop the spread of the disease.


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Notify sexual contacts and urge them to have acheckup.

Take all of the prescribed medication, even if symptoms stop before all of the prescribed medication(s)

are taken.

Sometimes, follow-up tests are important so comply with the instructions given by the health care

practitioner.

Consult a doctor with specific needs and any questions about reinfection, sexual partner notification,

and prevention.

Avoid sexual activity while being treated for an STD.

Prevention

The best way to prevent STDs is to avoid sexual contact with others. If people decide to become sexually

active, they can reduce the risk of developing an STD in these ways:

Practice abstinence (refrain from sex entirely) or be in a monogamous relationship (both sexual

partners are each other's only sexual partner).

Delay having sexual relations as long as possible. The younger people are when they become

sexually active, the higher the lifetime risk for contracting an STD. The risk also increases with the

number of sexual partners.

Correctly and consistently use a male latex condom. The spermicide nonoxynol-9, once thought to

protect against STDs as well as to prevent pregnancy, has been proven to be ineffective for disease

prevention. Do not rely on it. In addition, condoms are only about 90% effective in preventing STDs

Have regular medical checkups even if you do not have symptoms of an STD.

Learn the symptoms of STDs.

Avoid douching because it removes some of the natural protection in the vagina.

Vaccines against HPV and hepatitis B are available and effective.

Outlook

Most of the common STDs can be cured with treatment.

In addition to the discomfort of the infection, some STDs can cause other, more serious, long-term

problems, including infertility and problems in newborns infected by their mothers during pregnancy

such as blindness, bone deformities, mental retardation, and infrequently, death.

HIV can only be slowed, not eliminated, and may cause death.
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Chlamydia Overview

Chlamydia is a bacterial infection disease transmitted when people have sexual relations. It is the most

commonsexually transmitted disease(STD) in the United States, with over 2.8 million affected individualseach year. Among adults, about 5% of the population is estimated to be infected. Among sexually active

adolescent females, about 10% are infected.

Infection with chlamydia is most commonly found among the following groups:

Young adults (24 years and younger)

People living in urban areas

African Americans

Those with lower social and economic status

Chlamydia Causes

Chlamydia is an infection caused by the bacteriumChlamydia trachomatis. The infection is transmitted in

2 ways:

From one person to another through sexual contact (oral, anal, or vaginal).

From mother to child with passage of the child through the birth canal. Chlamydia can

causepneumoniaor serious eye infections in a newborn, especially among children born to infected

mothers in developing countries.

What Are the Symptoms of Chlamydia in men and women?

Chlamydia is known as a "silent" disease because the majority of infected people have no symptoms. If symptoms do occur,

they usually appear within 1 to 3 weeks after exposure.

In women, the bacteria initially infect the cervix and the urethra (urine canal). Women who have symptoms might have an

abnormal vaginal discharge or a burning sensation when urinating. If the infection spreads from the cervix to the fallopian

tubes (tubes that carry fertilized eggs from the ovaries to the uterus), some women still have no signs or symptoms; others

have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods.

Chlamydial infection of the cervix can spread to the rectum.

Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also

have burning and itching around the opening of the penis. Pain and swelling in the testicles are uncommon.

Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum, which can cause rectalpain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected

partner.

ChlamydiaSymptoms in Women

No symptoms in 70% to 80% of cases (One study found that 3% of a sample of young adults 18 to 35

years of age had untreated chlamydia.)
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Bleeding after sexual relations or betweenmenstrual periods

Lowerabdominal painand burning pain during urination

Discharge from the vagina

ChlamydiaSymptoms in Men

Like women, men who are infected may not show symptoms. Estimates of those with no symptoms

range from 25% to 50% of infected men.

Discharge from thepenis

Pain, burning during urination

Inflammation or infection of a duct in the testicles,tenderness or pain in the testicles


Call your doctor if you experience any of the following:

Fever

Abdominal pain

Discharge from the penis or vagina

Pain with urination

Pain during intercourse

Frequent urination

Sexual contact with an infected person. Most often, a sexual partner is informed about a chlamydial

infection, and this is the first indication of the presence of the disease. All partners of an infected

person should be treated to prevent the spread of the infection back and forth.

When to go to the hospital

Chlamydial infections can develop into serious medical conditions if not treated.

Women: Pelvic inflammatory disease is a serious medical condition, which occurs in 10% to 15% of

untreated cases and can lead to sterility. Fever, abdominal pain, andvaginal dischargecan be

symptoms of this disease. Women with these symptoms need to go to a hospital's emergency

department immediately for treatment.
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Men: Fever, discharge from the penis, and painful urination may signal an infection, which may involve

inflammation of the testicles. Men with these symptoms need to go to a hospital's emergency

department immediately for treatment.

Chlamydia Diagnosis

The health care practitioner will conduct the following exams and tests.

Physical Examination

Tenderness for women in the area of the sex organs, pus from the vagina or penis, and fever could

indicate an infection.

Diagnostic Tests

Diagnostic tests may be ordered that may include looking at samples of the discharge under a

microscope or obtaining cultures to identify the disease-causing bacteria.

Some diagnostic tests may include obtaining cultures or sending urine to the laboratory to determine if

you are infected. You may also be tested for othersexually transmitted diseasesbecause many patients

with chlamydia also have other infections such asgonorrheaortrichomonas.

Chlamydia Treatment

Chlamydia Medications

The health care practitioner may prescribe a single-dose antibiotic, such asazithromycin(Zithromax),

taken as a pill. On the other hand, the doctor may choose an antibiotic, such asdoxycycline(Atridox, Bio-

Tab), to be taken as a pill twice a day for a week. Up to 95% of people will be cured after one course of

antibiotics.

Follow-up

Finish the entire course of antibiotics your doctor prescribes, even if you're feeling fine and symptoms

go away.

Notify any and all sexual partners of infection. They should be treated or tested so the infection is not

passed back and forth.

Be retested if your symptoms continue or you think you have been reinfected. Having the infection

once does not confer immunity to repeat infection.

Use latex condomsduring sexual intercourse.

Chlamydia Prevention

Use latex condoms when having sexual intercourse.
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Avoid sexual contact with high-risk partners.

Treat infected sexual partners or have them tested before having sexual relations. Up to one-fourth of

sexual partners will be reinfected because the partner wasn't treated.

Chlamydia Prognosis

Treated with antibiotics, chlamydial infections can be cured 95% of the time.

Complications if not treated:

o Ten percent to 40% of women will develop pelvic inflammatory disease;

5% of women with pelvic inflammatory disease will develop a form ofliver disease(perihepatitis).

o Women may develop chronic pelvic pain and become sterile due to blockage of the Fallopian tubes

that allow the egg to be transported from the ovary to the women's womb.

o More common in men, some may develop sexually acquiredreactive arthritisorReiter syndrome.

o Men may experience painful swelling of the testicles.

Genital Herpes Overview

Genital herpes is a common, highly infectious disease caused by a virus. It is transmitted from one

person to another during sexual activity. Genital herpes causes blisters or groups of small ulcers (open

sores) on and around the genitals in both men and women. Genital herpes cannot be cured; however,

there are medications that can be prescribed to treat outbreaks and minimize the symptoms.

Genital herpes is extremely widespread, largely because it is so contagious. Carriers can transmit the

disease without having any symptoms of an active infection.

At least 45 million Americans are infected with the genital herpes virus, with approximately one million

new infections each year. As many as 80%-90% of those infected fail to recognize genital herpes

symptoms or have no symptoms at all.

The highest rates of infection are seen among the poor, those with less education, those usingcocaine,

and those with many sexual partners.

Genital Herpes Causes

Genital herpes is caused by the herpes simplex virus (HSV). There are two types: HSV-1 and HSV-2.

Most genital herpes infections are caused by HSV-2. HSV-1 is the usual cause of what most people call

"fever blisters" in and around the mouth and can be transmitted from person to person through kissing.

Less often, HSV-1 can cause genital herpes infections through oral sexual contact. The genital sores

caused by either virus look the same.
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Genital herpes is spread by direct contact with an infected person. Sexual intercourse and oral sex are

the most common methods of spreading genital herpes. Any type of skin-to-skin contact, however, is

capable of spreading herpes.

Note:People with herpes may spread the disease even if they do not realize they have an infection.

Furthermore, there is strong evidence that people with herpes can transmit infection even while theirdisease appears to be inactive and no sores can be visibly seen.

Many people remember having an episode of genital herpes when it occurs. But as many as 90% of

those infected fail to recognize the symptoms or have no symptoms at all. It is not clear whether these

people never had an initial herpes outbreak or whether they never noticed a mild infection.

In these individuals genital herpes is still contagious, and they may have additional outbreaks,

nonetheless.

Genital Herpes Symptoms

Signs of genital herpes tend to develop within three to seven days of skin-to-skin contact with an infected

person. Genital herpes infections look like small blisters or ulcers (round areas of broken skin) on the

genitals. Each blister or ulcer is typically only 1 to 3 millimeters (1/32 inch to 1/8th inch) in size, and the

blisters or ulcers tend to be grouped into "crops." Usually the blisters form first, then soon open to form

ulcers. Herpes infections may be painless or slightly tender. In some people, however, the blisters or

ulcers can be very tender and painful.

Location of genital herpes

In men, genital herpes sores (lesions) usually appear on or around thepenis.

In women, the lesions may be visible outside thevagina, but they commonly occur inside the vagina

where they can cause discomfort orvaginal dischargebut cannot be seen except during a doctor'sexamination.

The ulcers or blisters may also be found anywhere around the genitals (theperineum) and in and

around theanus.

First outbreak of genital herpes

The first genital herpes outbreak is usually the most painful, and the initial episode may last longer than

later outbreaks. Symptoms may last for two to four weeks.

Some people develop other signs of genital herpes infection, particularly with the first episode including:

fever,

muscle aches,

headaches(may be severe),

vaginal discharge orpainful urination, and
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swollen and tender lymph nodesin thegroin(these swell as the body tries to fight the infection).

Later outbreaksof genital herpes

If the disease returns, later outbreaks generally have much less severe symptoms. Many people with

recurrent disease develop pain or a tingling sensation in the area of the infection even before anyblisters or ulcers can be seen. This is due to irritation and inflammation of the nerves leading to the

infected area of skin.

These are signs that an outbreak is about to begin. The condition is particularly contagious during this

period, even though the skin still appears normal.


With an initial outbreak, if an individual has signs or symptoms of a genital herpes infection, he or she

should seek the care of a doctor as soon as possible, particularly if the diagnosis of genital herpes has

not been previously diagnosed. Although genital herpes infections generally are not medical

emergencies, treatment is more effective when it is started within the first few days of the outbreak.

Later outbreaks rarely need immediate medical attention.

If an individual has had a genital herpes outbreak before, discuss options for preventing further

outbreaks with a doctor.

People with severe underlying medical problems (particularlyHIVor AIDS) are at higher risk of severe

illness if the disease is untreated. These individuals should contact a doctor immediately upon noticing

genital herpes sores.

Apregnant womanwith signs or symptoms of genital herpes must inform her doctor as soon aspossible. Prompt medical therapy may reduce the risk of transmitting the disease to newborn children

by exposure in the birth canal.

In otherwise healthy people, genital herpes outbreaks rarely require hospital visits. If an individual is

experiencing an initial episode of genital herpes and cannot be seen by a regular doctor within the first

few days of the illness, it is advisable go to a hospital'semergency departmentto have medical treatment

started.

Some people can become quite ill from genital herpes infections. If an individual has a high

fever,severe headache, shortness of breath, or extremefatigue, he or she should go to the hospital for

evaluation.

People with severe medical illnesses (particularly HIV or AIDS) may become very ill from genital

herpes infections. The herpes virus may quickly spread to thebrain,lungs, and other organs.

Individuals in this situation should seek prompt medical attention for genital herpes outbreaks and go

to a hospital if there is any sign of illness other than sores on the genitals.

Exams and Tests
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Many doctors will begin treatment based only on the appearance of the sores, if the sores seem typical of

herpes. Doctors may also take a swab of the sore and send the swab to the laboratory to see if the virus

is present. A number of types of tests may be ordered to establish the diagnosis, including:

a culture of the virus;

polymerase chain reactionto demonstrate the genetic material of the virus; and

using antibodies to the genital herpes virus to demonstrate the presence of the virus in clinical

specimens.

These types of tests generally require at least a few days. In some cases, blood tests to confirm the

presence of an immune response to the herpes virus may be ordered.

Genital Herpes Treatment

Self-Care at Home

Individuals infected with the genital herpes virus should:

avoid excessive heat or sunlight, which makes the irritation more uncomfortable;

not use perfumed orantibacterialsoaps, feminine deodorant, ordouches;

wear comfortable, loose fitting cotton clothing;

takeaspirin,acetaminophen(Tylenol and others), oribuprofen(Advil, Motrin, Nuprin, etc.) if helpful;

and

use cool cloths on the affected area if it soothes the pain.

Medications

Treatment with medication is effective in shortening the initial outbreak of the infection, lowers the chance

that the infection will come back, and makes any later outbreaks less severe.

There are similar antiviral drugs available for the treatment of genital herpes infection, These antiviral

medications vary in cost and how often they should be taken. All should be taken for 7-10 days. The

patient's doctor may extend the course of therapy if ulcers have not healed in 10 days. Examples of

these antiviral medications include:

o acyclovir(Zovirax),

o famciclovir(Famvir), and

o valacyclovir(Valtrex).
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For preventing later genital herpes outbreaks, people with recurring infections also may benefit from

the antiviral medications. Treatment is started when therecurrencefirst begins and continues for five

days.

For continuous prevention, a few individuals who have frequent outbreaks (generally over six

recurrences per year) can only control the outbreaks by taking medication every day. Acyclovir,famciclovir, and valacyclovir are all used to treat recurrent disease. This is known as suppressive

therapy. Suppressive therapy has been shown to decrease the frequency of genital herpes

recurrences by 70%-80% in those who have frequent recurrences, and many individuals taking this

treatment report no symptomatic outbreaks.

Next Steps

Follow-up

Anyone diagnosed with genital herpes must disclose their diagnosis with sexual partners. These partners

should be advised to seek medical attention if they develop any signs of the illness. Generally, nothing

needs to be done if the partner has no signs of developing a genital herpes infection.

Prevention

People with genital herpes outbreaks are highly contagious. Anyone with active disease should avoid any

sexual contact when sores are present. Even theuse of a condomdoes not prevent the spread of

disease because not all sores are covered by the condom.

Although the chance of spreading disease is greatest when sores are present, people who have had

genital herpes may always be contagious to some degree, even if they have received medical treatment.

The virus can become active and be transmitted to a sexual partner even when the skin appears

completely normal. For this reason,safe sexpractices (use of a condom) should be used betweendisease outbreaks to lessen the chance of spreading disease to a sexual partner.

Outlook

Treatment of genital herpes does not cure the disease. The virus usually lives (in an inactive form) in an

infected person throughout their lifetime. Most people (85%) with genital herpes will have recurring

outbreaks - sometimes 6 to 10 a year. Recurrences are likely to have less severe symptoms and sores

usually last a shorter period of time.

For More Information

People with genital herpes are naturally concerned about the implications of the disease and how it

might distress their sexual partner or partners. Some people with genital herpes find it difficult to cope

with a disease that tends torecurand interfere with their lifestyle.

Individuals with questions or concerns about living with genital herpes should be discussed with his or

her doctor. Seek further information and support from various health-serving organizations such as

these:


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o Centers for Disease Control and Prevention, National Center for HIV, STD & TB Prevention,Genital

Herpes

o National Herpes Hotline (919) 361-8488 (8:00 a.m. to 9:00 p.m. EST)

o American Social Health Organization, Herpes Resource Center

Genital Warts (HPV) Overview

Genital warts are flesh-colored or gray growths found in the genital area and anal region in both men and

women. Genital warts are sometimes referred to as condyloma acuminata or venereal warts. They

represent the most common sexually-transmitted disease caused by a virus. The warts are caused by the

human papillomavirus (HPV). Infection with genital warts may not be obvious.

Genital warts affect both men and women and can occur at any age.

Most patients with genital warts are between the ages of 17-33 years. Genital warts are highly

contagious. There is around a 60% risk of getting the infection from a single sexual contact withsomeone who has genital warts.

In children younger than three years of age, genital warts are thought to be transmitted by nonsexual

methods such as direct manual contact. Nevertheless, the presence of genital warts in children should

raise the suspicion forsexual abuse.

Up to 20% of people with genital warts will have othersexually transmitted diseases(STDs).

Genital Warts Causes (HPV)

Genital warts are caused by the human papillomavirus (HPV). Over 100 types of HPVs have beenidentified; about 40 of these types have the potential to infect the genital area.

About 90% of genital warts are caused by two specific types of the virus (HPV-6 and -11), and these

HPV types are considered "low risk," meaning they have a low cancer-causing potential. Other HPV

types are known causes of premalignant changes andcervical cancersin women. HPV-16, one of the

"high-risk" types, is responsible for about 50% of cervical cancers. HPV types 16, 18, 31, and 45 are

other known "high risk" virus types. High-risk HPV types are also referred to as oncogenic HPV types.

HPV is believed to cause 100% of cases of cervical cancer.

Common wartsare not the same as genital warts and are caused by different HPV types that infect the

skin.

The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in

the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet)

period of months to years may occur, during which there is no evidence of infection.

Generally, about two-thirds of people who have sexual contact with a partner who has genital warts

develop them within three months.
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Genital warts are indirectly associated with use of birth control pills due to increased sexual contact

without the use of barrier protection, multiple sex partners, and having sex at an early age.

Genital Warts Symptoms (HPV)

Although genital warts are painless, they may be bothersome because of their location, size, or due toitching.

The size may range from less than one millimeter (1 mm = 0.039 inches) across to several square

centimeters (1 cm = 0.39 inches) when many warts join together.

Men and women with genital warts will often complain of painless bumps, itching, anddischarge.

Rarely, bleeding or urinary obstruction may be the initial problem when the wart involves the urethral

opening (the opening where urine exits the body.)

Warts in more than one area are common.

There may be a history of previous or concurrentsexually transmitted diseases(STDs).

Specific descriptions

In men, genital warts can infect theurethra,penis,scrotum, andrectalarea. The warts can appear as

soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with many

fingerlike projections (anal warts). Others may appear pearly, cauliflower-like, or rough with a slightly

dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin

surface. Sometimes lesions may be hidden by hair or in the inner aspect of the uncircumcised foreskin

in males.

In women, genital warts have a similar appearance and usually occur in the moist areas of thelabia

minoraand vaginal opening. Lesions visible on the outer genitals warrant a thorough examination of

the vaginal canal, cervix, and anorectal area. Most vaginal warts occur without symptoms. Rarely,

women may experience bleeding after sexual intercourse, itching, orvaginal discharge.


If you have genital warts, see a health care practitioner and discuss treatment options.

Bleeding warts that cannot be controlled with direct pressure should be seen by a health care practitioner.

Warts that obstruct the urethral opening and don't allow you to urinate are an emergency and should be

treated as soon as possible.

Genital Warts Diagnosis

Diagnosis is often based on findings from the history and appearance of the genital warts.
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Sometimes, lesions are only visible with an enhancing technique called acetowhitening. This technique

involves the application of 5%acetic acidsolution to the area of suspicion for about 5-10 minutes.

Infected areas will turn white.

Magnification of the area (colposcopy) using a scope may be necessary to see the lesions. In females,

a colposcope may be used to look for lesions in the vaginal canal and on the cervix.

A routinePap smearshould always be done in order to look for evidence of HPV infection and

abnormal cells on the cervix.

A biopsy can be performed if the lesion appears unusual or recurs after treatment.

Special laboratory tests can also be used to confirm the presence of HPV infection.

Genital Warts Treatment (HPV)

Self-Care at Home

Because genital warts essentially have no symptoms other than their appearance, there is l ittle need for

home treatment. It is important, however, to recognize that the warts exist.

Take the necessary precautions to prevent trauma to the area, which can result in bleeding.

Be careful to prevent transmission to a sexual partner.

Because the warts themselves are infectious, avoid touching them. Do not pick or squeeze the warts.

Medical Treatment

There is no single effective cure for removal of genital warts. A number of treatment options exist;

however, no treatment is 100% effective in eliminating warts and preventing them from coming back in all

patients. It also is not possible to eliminate infection with human papillomavirus once it has occurred.

Genital warts may go away on their own in about 10%-20% of people over a period of three to four

months.

Cryotherapy: This technique freezes the wart using liquid nitrogen or a "cryoprobe." It is an excellent

first-line treatment because response rates are high with few side effects.

Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local,

regional, or general anesthesia. The laser physically destroys the HPV-induced lesion. Disadvantagesinclude high cost, increased healing time, scarring, and potentially infectious viral particles in the air

caused by the laser plume.

Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the

office with local anesthesia. Of note, the resulting smoke plume may be infectious.

Medications
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Several medications exist for treating genital warts and can be used as an alternative to other treatments.

Podophyllum resin(Pod-Ben-25, Podofin) is topically applied by a health care practitioner.

Podofilox(Condylox) can be topically applied at home and has a highercure rate than podophyllum

resin. Podofilox also is useful for prevention.

Trichloroacetic acid or bichloracetic acid is topically applied; however, the response is often incomplete

and recurrence is higher and it may cause pain and burning.

5-Fluorouracil(Efudex) is applied as a cream, has a long treatment time, can cause burning and

irritation, and has many side effects.

Interferon alpha-n3(Alferon N) is an injection used for warts that do not respond to other therapies;

however, it has many side effects.

Imiquimod(Aldara) is applied as a cream and local skin irritation is a common side effect.

Surgery

Cutting the warts away can be done as an office procedure with local anesthesia. It is usually done when

the warts are small in size and number. Surgical destruction or excision has been more effective in

eradicating genital warts than medical therapies, but it carries a relatively high recurrence rate of 25%-

55%.

Follow-up

Complete the necessary treatment as outlined by your health care practitioner. Women with genital warts

should see their doctor for a routine Pap smear and investigation for HPV infection of the vaginal canaland cervix. If the genital warts are not successfully treated with the initial therapy, the individual will need

to follow-up with a doctor or a dermatologist to discuss options for alternative treatment.

Genital Warts Prevention

In 2006, an HPV vaccine (Gardasil) was approved by the FDA. It is currently recommended for both

males and females aged 9 to 26 years. This vaccine has been shown to be safe and 100% effective in

preventing infection with the four most common HPV types (6, 11, 16, and 18) in women who have had

no previous exposure to the virus. However, it is less effective in those who have already been infected

with HPV, and it does not protect against all types of HPV infection. Studies are underway to determine

whether the vaccine is safe and effective in older women and in males.

Another vaccine against HPV types 16 and 18, Cervarix, has been approved by the FDA for females

aged 10 to 25 years.

Because no treatment is 100% effective, it is important to prevent the spread of HPV, which causes

genital warts and some cancers whenever possible. Transmission of genital warts can be decreased if

condoms are used and the infected individual refrains from sexual activity until therapy is completed.
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Genital Warts Outlook

In many cases, genital warts fail to respond to treatment or come back even after an removal.

Reappearance of abnormal cells on the cervix of women is not altered by treatment of their sexual

partners.

Recurrence rates of genital warts are greater than 50% after one year and have been attributed to the

following factors:

Recurrent infection from a sexual partner; infection with multiple HPV types is possible

Potentially long incubation time of HPV

Persistence of the virus in the surrounding skin, in the hair follicle, or in sites that are missed by the

treatment used

Deep lesions or lesions that cannot be detected

Genital warts often appear or increase in number duringpregnancy. Dormant infections may also become

activated. The presence of genital warts may make vaginal delivery difficult if they are in the cervix or

vagina, and warts in these locations tend to bleed easily. The warts often disappear on their own after

pregnancy. The real danger, however, is that newborns may become infected during passage through an

infected birth canal. HPV can cause a very serious condition in children called recurrent respiratory

papillomatosis (RRP). This is a life-threatening disease of the respiratory tract. The papillomas or warts

appear and spread quickly, sometimes dangerously blocking the child's airway.

Synonyms and Keywords

genital warts, venereal warts,condylomaacuminata, human papillomavirus, HPV,sexually transmitteddisease,STD,recurrent respiratory papillomatosis, RRP, Gardasil, HPV vaccine, Cervarix

Hepatitis B Overview

Hepatitis B is an infectious hepatitis caused by the hepatitis B virus (HBV). This infection has two possible

phases; 1) acute and 2) chronic.

1. Acute hepatitis B refers to newly acquired infections. Affected individuals notice symptoms

approximately 1 to 4 months after exposure to the virus. In most people with acute hepatitis,

symptoms resolve over weeks to months and they are cured of the infection. However, a small

number of people develop a very severe, life-threatening form of acute hepatitis called fulminant

hepatitis.

2. Chronic hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection

becomes chronic, it may never go away completely.
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Approximately 90% to 95% of infected adults are able to fight off the virus so their infection is cured. Only

about 5% to 10% of adults infected with HBV go on to develop chronic infection. Children are at much

higher risk for chronic infection. Up to 90% of infected young children will fail to clear the virus from their

bodies and go on to develop chronic infection.

About two-thirds of people with chronic HBV infection are chronic carriers. These people do not develop

symptoms, even though they harbor the virus and can transmit it to other people. The remaining one third

develop "active" hepatitis, a disease of the liver that can be very serious.

The liver is an important organ that filters toxins out of the blood, stores energy for later use, helps with

digestion, and makes substances that fight infections and control bleeding.

The liver has an incredible ability to heal itself, but long-term inflammation caused by HBV can result in

permanent damage.

Scarring of the liver is calledcirrhosis, a condition traditionally associated withalcoholismbut one that

is also caused by chronic active hepatitis B infection. When this occurs, the liver can no longer carry

out its normal functions and may fail completely. The only treatment for liver failure isliver transplant.

Chronic hepatitis B also can lead to a type ofliver cancerknown as hepatocellular carcinoma.

Any of these conditions can be fatal. About 15% to 25% percent of people with chronic hepatitis B die

of liver disease.

Hepatitis B is the most common serious liver infection in the world. Worldwide, about 350 million people

are chronic carriers of HBV, of whom, more than 620,000 die from liver-related disease each year.

In the United States, hepatitis B is largely a disease of young adults aged 20-50 years. About 800,000 to

1.4 million Americans are chronic hepatitis B virus carriers, and the disease causes about 3, 000 deaths

each year.

The good news is that infection with HBV is usually preventable because there is an effective vaccine.

Use of the vaccine has resulted in an 82% decrease in the number of new infections reported in the

United States each year.

Hepatitis B Transmission and Causes

The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to

another via blood or fluids contaminated with blood. Another important route of transmission is from an

infected mother to a newborn child, which occurs during or shortly after birth.

Direct contract with blood may occur through the use of dirty needles during il licit drug use, inadvertent

needle sticks experienced by healthcare workers, or contact with blood through other means. Semen,

which contain small amounts of blood, and saliva that is contaminated with blood also carry the virus.

The virus may be transmitted when these fluids come in contact with broken skin or a mucous

membrane (in the mouth, genital organs, or rectum) of an uninfected person.

People who are at an increased risk of being infected with the hepatitis B virus include the following:
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Men or women who have multiple sex partners, especially if they don't use a condom

Men who have sex with men

Men or women who have sex with a person infected with hepatitis B virus

People with othersexually transmitted diseases

People who inject drugs with shared needles

People who receive transfusions of blood or blood products

People who undergo dialysis forkidney disease

Institutionalized mentally handicapped people and their attendants, caregivers, and family members

Health care workers who are stuck with needles or other sharp instruments contaminated with infected

blood

Infants born to infected mothers

In some cases, the source of transmission is never known.

You cannot get hepatitis B from the following activities:

Having someone sneeze or cough on you

Hugging someone

Handshaking a persons hand

Breastfeedingyour child

Eating food or drinking water

Casual contact (such as an office or social setting)

Hepatitis B Symptoms

Half of all people infected with the hepatitis B virus have no symptoms and may never realize that they

have been infected. Adults are more likely to develop symptoms than children. For those who do get sick,

symptoms usually develop within 1 to 4 months after exposure to the virus. The initial symptoms are oftensimilar to the flu.

Common symptoms of hepatitis B include:

Appetite loss

Feeling tired (fatigue)


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Nausea and vomiting

Itching all over the body

Pain over the location of the liver (on the right side of the abdomen, under the lower rib cage)

Jaundice(a condition in which the skin and the whites of the eyes turn yellow in color)

Dark urine (the color of cola or tea)

Pale-colored stools (grayish or clay colored)

Many types of acuteviral hepatitissuch ashepatitis Aandhepatitis Chave symptoms that are

indistinguishable from hepatitis B.

Fulminate hepatitis is a severe form of acute hepatitis that can be life-threatening if not treated right away.

Fortunately, fulminate hepatitis is rare. The symptoms of fulminate hepatitis develop very suddenly and

may include:

Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic

encephalopathy)

Sudden collapse with fatigue

Jaundice

Swelling of the abdomen

Prolonged nausea and vomiting can causedehydration. Individuals with dehydration may notice these

symptoms:

Extreme weakness

Confusion or trouble concentrating

Headache

Lack of urination

Irritability

Symptoms of liver damage may include the following:

Fluid retention causing swelling of the belly (ascites) and sometimes the legs

Weight gain due to ascites

Persistent jaundice
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sexually transmitted diseases overview

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