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The ABCs of STDs

Genital Herpes About 1 in 5 Americans over age 12 -- approximately 45 million people -- are infected with HSV-2, the virus that causes genital herpes. The CDC estimates that up to 1 million new HSV-2 infections may be transmitted each year in the U.S.

Genital herpes is a highly infectious, chronic, and lifelong viral infection. Each year, there are about 500,000 new cases of symptomatic herpes, but there are even more newly infected people who have no symptoms. There is no cure for genital herpes.

What to look for:
During initial exposure, symptoms can appear in 2 to 20 days after contact, but sometimes they don't show up for months or years. First symptoms are itching, tingling, and aching around the genitals with flu-like symptoms. Then fluid-filled herpes blisters appear on or in the vagina, penis, anus, or mouth. They're very painful and may crack and become blistered. Sometimes these lesions bleed or ooze fluid.

The initial outbreak may last up to two weeks and go away never to return. But while the blisters heal, the virus still lives in the nerves at the base of the skull or the nerve cells throughout the body. A new outbreak can be triggered by stress, sickness, or if a person is run-down, tired, or has too much sun. Subsequent attacks are usually less severe.

How can you tell?
For testing, the doctor will collect a small amount of fluid from the sores and send it to a lab to see if the herpes virus is present. It may take up to 2 weeks to get the results. If no sores are present, testing may be difficult.

What is the treatment?
Although you can never "get rid of" herpes, you can treat the symptoms. Treatment of genital herpes outbreaks, especially when started early, shortens the duration of the outbreak and reduces the symptoms. The drugs used are acyclovir and, more recently, famcyclovir and valacyclovir.

How can I prevent it?
You can get and spread herpes through oral, anal, and vaginal sex. Remember that many genital herpes infections are spread by people with no noticeable symptoms. You can get the herpes virus from kissing, touching, and caressing infected areas.

Gonorrhea In this country, an estimated 650,000 cases of gonorrhea, caused by the bacteria Neisseria gonorrhoeae, occur each year. About half of all infections in women and men have no symptoms. If not adequately treated, 10 to 40 percent of women infected with gonorrhea develop pelvic inflammatory disease (PID), which can lead to infertility.

What to look for:
Symptoms may include discharge from the penis or vagina, the need to urinate often, burning or pain when urinating, and in women, bleeding between monthly periods.

How can you tell?
The only way to find out whether or not you have gonorrhea is to get tested. The test is simple: The doctor takes a sample of fluid from the penis or vagina and sends it to a lab.

What is the treatment?
Gonorrhea is treated with antibiotics, but incomplete treatment can result in serious problems later, such as chronic lower abdominal pain, sterility, tubal pregnancy, and painful joints.

How can I prevent it?
You can get and spread gonorrhea through oral, anal, and vaginal sex.

Trichomoniasis
Globally, an estimated 170 million people acquired Trichomonas vaginalis, a sexually transmitted parasite, in 1997. Approximately 5 million cases of trichomoniasis occur annually in the U.S. Trichomoniasis ("trich") is a common sexually transmitted disease (STD), attacking 2 to 3 million Americans every year.

What to look for:
Women may experience itching, burning, vaginal or vulval redness, unusual vaginal discharge, frequent and/or painful urination, discomfort during intercourse, and abdominal pain, worsening after menstruation. Mens' symptoms can include unusual penile discharge, painful urination, and tingling inside the penis, but many men have no symptoms for years.

How can you tell?
The healthcare provider will collect a sample of secretions from the penis or vagina and send it to a lab to see if trichomonas is present. It may take up to 2 weeks to get the result. Some providers can do a quick office examination of vaginal secretions.

What is the treatment
Trichomoniasis can be treated with antibiotics, usually a single dose of metronidazole (Flagyl).

How can I prevent it?
Trichomoniasis is spread through sexual contact. Using condoms (or another barrier method) provides some protection, as does knowing your partner's sexual history. Trichomonas can also survive on infected sheets and towels, and could possibly be transmitted by sharing them. It is especially important for the male partner to be treated -- even though he is almost always asymptomatic.

Syphilis
Syphilis is a serious disease that can be debilitating and even result in death if left untreated. There are an estimated 120,000 new cases of syphilis in the U.S. each year.

What to look for:
Syphilis has three stages. During the first stage, a painless sore may appear at the spot where the bacteria first entered the body (usually from 10 to 90 days after sexual contact with an infected person). This sore may appear around or in the vagina, on the penis, or inside the mouth or anus. Sores inside the vagina or anus are often unnoticed and may disappear on their own if not treated, but the bacterial infection remains.

The second stage occurs from 3 weeks to 3 months after the primary stage and includes flu-like symptoms and possible hair loss. Some people experience a rash on the palms of the hands and soles of the feet, as well as over the entire body. Although extremely rare, tertiary syphilis can appear 3 to 10 years or more after the first and second stages. Symptoms of this stage may include skin lesions, mental deterioration, loss of balance and vision, loss of sensation, shooting pains in the legs, and heart disease.

How can you tell?
A simple blood test can usually determine whether or not you have the disease. However, if you become infected 2 to 3 weeks prior to testing, the blood test might not be sensitive enough to pick it up.

What is the treatment?
Syphilis can be treated with proper antibiotics, such as penicillin injections.

How can I prevent it?
You can get and spread syphilis through oral, anal, and vaginal sex.

Hepatitis B
An estimated 77,000 cases of sexually transmitted hepatitis B infection occur annually in the U.S. Approximately 750,000 Americans are living with this infection of the liver, that is caused by a virus that is 100 times more infectious than HIV.

Most people recover, but a few become chronic carriers with increased risk of serious problems later, such as permanent liver disease and cancer of the liver.

What to look for:
Symptoms usually appear within 2 to 6 weeks after contact. They can include poor appetite; nausea; vomiting; headaches; general malaise; jaundice (yellowing of eyes and skin); dark, tea-colored urine; and light-colored stools. Even without symptoms, you can pass the virus to others. Chronic carriers carry the hepatitis B virus for the rest of their lives and may unknowingly pass it to their sex partners.

How can you tell?
Routine testing is not usually indicated unless the patient is symptomatic from jaundice or has had recent sexual exposure to someone with hepatitis. Sometimes, serological testing is done as part of a hepatitis B vaccination program. However, if you've already had hepatitis B, you don't need to be vaccinated. Remember that 90 to 95 percent of people who have hepatitis B will fully recover.

What is the treatment?
For acute hepatitis B, treatment includes rest and diet. There are some new treatments for chronic hepatitis, including interferon. If your sex partner or a member of your household is found to have hepatitis B, you should consult your doctor or health care provider and get immunized. Immunization may include hepatitis B immune globulin and hepatitis B vaccination series.

How can I prevent it?
Like AIDS, the hepatitis B virus is spread through contact with infected blood or body fluids. You can get hepatitis B from vaginal, oral, or anal intercourse. It also can be passed from an infected mother to her baby during childbirth.

To minimize your risk of contracting hepatitis B, do not share needles or syringes, or instruments used in ear-piercing, tattooing, or hair removal. Do not share toothbrushes or razors. If you have sex, reduce your risk by using condoms. If you are infected, avoid sex and other close contact, such as kissing, until your doctor says it's okay.

Hepatitis B is the only STD that can be effectively prevented by a vaccine. The CDC now recommends vaccination for all newborns in order to prevent infection of hepatitis B later on. Teens are urged to talk to their health-care provider and find out whether vaccinations are recommended.

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