Each Tuesday, I’ll be posting information around a monthly theme. These are short thoughts or articles design to give you more useful information around this topic that you can take with you into your daily lives.

April was Sexually Transmitted Infections (STI) Awareness Month, but there are more than 4 STIs so I’m continuing on that topic to give you information to help keep you safe and healthy.

Topic Tuesday: Crabs/Pubic Lice

What Are They?

Pubic lice are tiny insects that can crawl from the pubic hair of one person to the pubic hair of another person during sexual contact. People can also catch pubic lice from infested clothing, towels and bedding. Once they are on a person’s body, the insects live by sucking blood from their host. Pubic lice are sometimes called “crabs” because when seen under a microscope they look like tiny crabs. They are the size of a pinhead when fully grown.

Do They Only Live in Pubic Hair?

They are found in pubic hair around the scrotum, anus, vagina and penis. But they can also be found anywhere you have body hair. This includes the hair of the beard, moustache, eyelashes, eyebrows armpits, and sometimes the chest and abdomen, but not in hair on the head.

Crabs feed on blood, but they cannot pass on HIV. The lice can live away from the body for 24 hours so they could survive that long on clothes, bedding and towels.

What Are the Symptoms?

Someone who has been exposed to pubic lice may not notice symptoms for 2-3 weeks but those symptoms include:

  • Intense itching in genital areas or anus, especially at night. This is caused by an allergic reaction. When a lice bites the skin to feed on a person’s blood, their saliva from these bites causes this result.
  • Inflammation and irritation in the infected areas, due to scratching.
  • A skin reaction that is bluish-grey in color, from the bitesThese will be small, flat marks (maculae cerulea) that look like bruises. These can still exist months after the lice have been killed.
  • Lesions (sores) in the genital area, due to bites and scratching.
  • Black “powder” in your underwear. (Excrement from the lice.)

If you’ve been exposed to pubic lice, you may notice tiny tan to grayish-white insects crawling in the pubic hair. Lice are visible to the naked eye using a strong light. They look pale gray in color; they darken when swollen with blood. You may also see tiny oval-shaped, yellow to white blobs called nits clinging to the hair. Nits are about the size of a pinhead, and are the louse eggs. Nits can’t be easily removed from the hair with the fingers — “nit combs” made especially to remove the eggs are sold at drugstores and many grocery stores.

What Can Happen?

It’s unusual for pubic lice to create any serious health problems, but the itching can be very uncomfortable, and it’s easy to transmit pubic lice to others. The female louse survives an average of 25 to 30 days and each can lay 20 to 30 eggs. Lice can also live away from the body for 1 to 2 days. So it’s important to get properly diagnosed and treated, or it can take a while to get rid of them.

If a case of Public Lice is left untreated, it can lead to severely infected skin. When you scratch, you break skin, and that broken skin can be infected by bacteria, particularly that found in the refuse of the Pubic Lice themselves.

Additionally, you may also experience matted and foul-smelling pubic hair and infected blisters in the pubic area.

Interesting fact: if you have Pubic Lice and shave off your pubic hair, the lice will simply relocate to another areas of the body that Pubic Lice infest. If your personal desire is to shave the area, you could keep a closer watch on the success of your Rx. However, if you don’t plan to keep the area shaved then it’s a lot of needless effort that won’t help you heal faster.

How Is It Treated?

If you think you may have pubic lice or if you have had a partner who may have pubic lice, see a doctor or gynecologist right away. If the doctor diagnoses pubic Lice, you may be prescribed medication or told to buy an over-the-counter medicine that kills the lice and their eggs.

There are over the counter drugs such as RID, A-200 and InnoGel, will that eliminate lice. Put the lotion all over your body and leave it on for 24 hours.

Topical creams or lotions containing permethrin (for example, Lyclear cream or Quellada lotion) and applied to the affected area are the most commonly recommended treatment.

However, Permethrin should not be applied to the eyelashes. If this area is affected, discuss an alternative treatment such as petroleum jelly.

Water-based treatments are also available for those with allergies and sensitive-skin.
Pubic lice can sometimes develop resistance to certain treatments. Your doctor or pharmacist can advise you on suitable alternatives if this occurs.

The important thing to remember is that the treatment you use may need to be repeated after 7 to 10 days to kill any lice you didn’t get the first time. And anyone who is treated for Pubic Lice should be tested for other STIs as well.

You will also need to dry clean or use very hot water and a hot dryer cycle to wash and dry all your bedding, towels or recently worn clothing to properly kill the lice and their eggs. Don’t forget about your luggage!

Anyone with whom you’ve had sexual contact in the last month should also check for Pubic Lice immediately.

Although condoms help protect against other STIs, a partner could still get Pubic Lice because the condom does not cover the entire pubic area.

Treatment for public Lice will be much more effective if few simple guidelines are consistently followed:

  1. The instructions on the medication you receive should be carefully read.
  2. The treatment should be repeated after one to two weeks. No treatment is effective against unhatched eggs. These Eggs hatch in 6–10 days, so a repeat will be necessary to prevent re-infection.
  3. Typically, the entire body from neck to toes should be treated, including the perineum and the anal area.
  4. Wash clothing, towels and bedding at the same time as treatment.
  5. The skin should be cool, clean and dry when the cream is applied.
  6. Avoid close personal intimate contact with partner(s) until you both are free of infection.

Topic Tuesday: Trichomoniasis

Fun fact: The Pap smear is named after the physician George Papanicolaou, who introduced this technique in 1949.

This week’s STI topic is dedicated to Mr. Pap, because his technique is used as a way to diagnose trichomoniasis.

Trichomoniasis, one of the most common STIs, and often excluded from STD education, is caused by a protozoan parasite called trichomonas vaginalis. That’s why it’s sometimes given the name “TV.”

It’s more often referred to as “trich” — pronounced “trick.”

This parasite can live in the urogenital tract of males and females and infect any sexually active person, especially those who are not using protection or who have multiple partners.

How Common is Trichomoniasis?

Trich is considered the one of the most common curable STIs. Over 180 million cases of trichomoniasis occur worldwide per year. In the United States, an estimated 3.7 million people have the infection, but only about 30% develop any symptoms of trichomoniasis.

The highest number of cases are seen in women between the ages of 16 and 35. Infection is more common in women than in men, and older women are more likely than younger women to have been infected.

How Do People get Trichomoniasis?

The parasite is passed from an infected person to an uninfected person during sex. In women, the most commonly infected part of the body is the lower genital tract (vulva, vagina, or urethra), and in men, the most commonly infected body part is the inside of the penis (urethra). During sex, the parasite is usually transmitted from a penis to a vagina, or from a vagina to a penis, but it can also be passed from a vagina to another vagina. It is not common for the parasite to infect other body parts, like the hands, mouth, or anus because the parasite cannot survive in the mouth or rectum.

It is unclear why some people with the infection get symptoms while others do not, but it probably depends on factors like the person’s age and overall health. Infected people without symptoms can still pass the infection on to others.

What are the Symptoms?

Symptoms of trich can appear as early as 5 days after sex with an infected partner. Some people with symptoms get them up to 28 days after being infected, but others do not develop symptoms until much later. Symptoms can come and go. Trichomoniasis often goes undiagnosed because about 70% of infected people do not have any signs or symptoms.

In females, symptoms can include:

  • abundant or frothy vaginal discharge ranging in color from gray to green to yellow, with a watery to milky consistency
  • foul smelling vaginal discharge
  • itching and tenderness in or around the vagina
  • pain during sex
  • bleeding after sex
  • blood spotting in discharge
  • frequent urination and pain during urination
  • soreness or itching of the labia and inner thighs and groin area
  • swollen labia

If you’re a female, it’s important for you to recognize both a normal vaginal discharge (it’s usually clear or whitish, has no bad odor, and causes no irritation) and one that might signal a problem.

Normal vaginal discharge has several purposes: cleaning and moistening the vagina, and helping to prevent and fight infections. Although it’s normal for the color, texture, and amount of vaginal fluids to vary throughout a girl’s menstrual cycle, some changes in discharge may indicate a problem.

Symptoms in men:
Trich is not very common in men, and males who have trichomoniasis often don’t show any symptoms, but if they do, symptoms can include:

  • mild urethral itching
  • mild burning after urination or ejaculation
  • painful or difficult urination
  • inflammation of the prostate gland
  • pain and inflammation of the scrotum

Men may also be treated if they have ongoing symptoms of urethral burning or itching despite treatment for gonorrhea and chlamydia. The infection in men usually goes away on its own in a few weeks.

Occasionally, some men with trichomoniasis may develop prostatitis (swelling and irritation of the prostate gland) or epididymitis (swelling of the epididymis, the tube that connects the testicle with the vas deferens) from the infection.

How Can You Prevent Trich?

Because trichomoniasis is an STI spread through sexual contact, the best way to prevent it is to abstain from having sex. Sexual contact with more than one partner or with someone who has more than one partner increases the risk of contracting any STI.

When properly and consistently used, condoms decrease the risk of STIs. Latex condoms provide greater protection than natural-membrane condoms. The female condom, made of polyurethane, is also considered effective against STIs.

Using douche can actually increase a female’s risk of contracting STIs because it can change the natural flora of the vagina and may flush bacteria higher into the genital tract.

A teen being treated for trich also should be tested for other STIs, and should have time alone with the doctor to openly discuss issues like sexual activity. Not all teens will be comfortable talking with parents about these issues. But it’s important to encourage them to talk to a trusted adult who can provide the facts.

How is Trichomoniasis Diagnosed?

Fun fact: Trich is easily visible under the microscope. It paddles around using flagellae like oars.

It is not possible to diagnose trichomoniasis based on symptoms alone. For both men and women, your primary care doctor or another trusted health care provider must do a check and a laboratory test to diagnose trichomoniasis.

Your doctor can determine whether there is a trichomoniasis infection by performing a pelvic or genital examination and by testing a sample of vaginal or urethral discharge. In females, the infection also may be detected on a Pap smear.

Treating Trich

Trichomoniasis can be cured with a single dose of prescription antibiotic medication, either metronidazole or tinidazole, which can be taken by mouth. Both sexual partners should be considered infected and treated at the same time, even if one has no symptoms. People being treated should not have sex until they have finished their treatment and no longer have symptoms.

People who have been treated for trich can get it again. About 1 in 5 people get infected again within 3 months after treatment. To avoid getting re-infected, make sure that all of your sex partners get treated too, and wait to have sex again until all of your symptoms go away (about a week). Get checked again if your symptoms come back.

Because many STIs might not cause obvious symptoms, teens often don’t know when they’re infected. It’s important for all teens who have had sex to get screened regularly for STIs so that they don’t lead to other more serious health problems.

If a patient has trichomoniasis, a doctor usually will also test for other STIs like gonorrhea and chlamydia because these STIs sometimes occur together.

How Can Trichomoniasis Be Prevented?

It’s better to prevent trichomoniasis than to treat it, of course. The only way to completely prevent infection is to not have any type of sexual intercourse. Second to that, it’s recommended that you limit the number of sexual partners. Finally, using latex condoms correctly every time you have sex will help reduce the risk of getting or spreading trichomoniasis. However, condoms don’t cover everything, and it is possible to get or spread this infection even when using a condom.

Condoms are the only birth control method that will help prevent trich.

Key Points To Remember
  • Trichomoniasis is considered one of the most common curable STIs.
  • It is caused by Trichomonas vaginalis, a motile, flagellate protozoan
  • Symptoms occur more often in women than in men, although both women and men may be asymptomatic
  • Older women are more likely than younger women to have been infected.
  • The disease is also recognized as a potential cause of adverse pregnancy outcomes, male and female infertility, and atypical pelvic inflammatory states.
  • The only sure way to prevent sexually transmitted infections is to avoid having sex entirely.
  • Trichomoniasis can be uncomfortable and can make someone who has it more susceptible to HIV, the virus that causes the Acquired Immune Deficiency Syndrome (AIDS).
  • To avoid getting re-infected, make sure that all of your sex partners get treated too, and wait to have sex again until all of your symptoms go away (about a week).

Topic Tuesday: Hepatitis

The word hepatitis means an inflammation of the liver. It can be caused by one of many things — including a bacterial infection, liver injury caused by a toxin (poison), and even an attack on the liver by the body’s own immune system. However, hepatitis usually is caused by a virus. The three most common hepatitis viruses are hepatitis A, hepatitis B, or hepatitis C. Two other types of hepatitis virus, D and E, are rare in the United States.

Hepatitis A (HAV)

Hepatitis A is usually the least serious of the three main types of hepatitis, but can make you very ill. Unlike some other hepatitis viruses, hepatitis A rarely leads to permanent liver damage. Within a few weeks, the symptoms will have gone away on their own and the virus will no longer be in your system. Once someone has recovered from a hepatitis A infection, that person has immunity to the virus, meaning he or she will probably never get it again. People are also protected against hepatitis A if they’ve been vaccinated against it.

How Do You Get Hepatitis A?

Hepatitis A is found in fecal matter, even in microscopic amounts. Infected individuals shed large amounts of the virus in their stool, starting about two weeks before symptoms present, and continue shedding the virus in their stool for one to three months.

So how exactly does a person get microscopic amounts of fecal matter in their system during sex? One obvious answer is anal sex without a condom. But here are some less obvious things to consider:

  • Rimming: the act of using one’s tongue on the anal rim of another person in order to gain and/or give sexual pleasure.
  • Anal fingering: the act of sticking one’s finger (or, in some cases, the fist) in the anus and start to move in and out like people do during sex.
  • Handling used condoms and dildos.

And here are the non-sexual routes of transmission:

  • The hepatitis A virus also may be spread by ingestion of food or water that is contaminated by infected individuals;
  • or by eating food or drinking water that’s been contaminated with feces. As disgusting as that sounds, though, hepatitis A is actually considered less destructive than some other hepatitis viruses.
  • People traveling in countries with poor hygiene risk getting it too.
What are the Symptoms of Hepatitis A?

Here’s the thing about the symptoms of Hepatitis A: you are most infectious before your symptoms appear. Once those symptoms do appear, they can be so mild that you may not realize you have it. In addition, people with hepatitis A may not show any symptoms, so the infection can go undiagnosed.

Any hepatitis infection causes inflammation of the liver, which means that the liver becomes swollen and damaged and begins losing its ability to function. People with hepatitis often get symptoms similar to those caused by other virus infections, such as weakness, fatugue, and nausea. Because the symptoms of hepatitis are similar to those from other conditions, it’s easy for someone who has it to confuse it with another illness.

Even when infected people don’t have any symptoms, they can still pass the disease on to others.

The incubation period for hepatitis (how long it takes from when someone is infected to when symptoms first appear) varies — some people might not feel any different, while others may notice symptoms anywhere from 15 days to 4 months after getting the disease, depending on the type of hepatitis.

Symptoms of hepatitis A include:

  • yellowing of the skin and eyes, known as jaundice
  • mild flu-like symptoms
  • fever
  • diarrhea
  • fatigue
  • nausea, vomiting, and lack of appetite
  • abdominal pain (on the upper right side)
  • light-colored bowel movements
  • dark-colored urine
  • weight loss
  • may feel sick around tobacco smoke, alcohol and fatty foods.

The illness can last many weeks and take many months before you get your strength back.

How Do You Prevent Hepatitis A?

There is a vaccine for Hepatitis A. Hepatitis A does not cause chronic or persistent infection of the liver. Once a person has recovered from hepatitis A, he or she is immune to reinfection with hepatitis A for life. This is true because effective antibodies are developed against the hepatitis A virus. After infection with hepatitis A, these antibodies provide life-long protection against the virus. The ability of the body to make protective antibodies after infection with hepatitis A led researchers to develop vaccines against the disease.

The hepatitis A vaccine is made of killed hepatitis A viruses and causes the body’s immune system to produce antibodies against the hepatitis A virus. In most vaccine recipients, antibodies start to develop immediately after the first dose but do not reach protective levels for 2 to 4 weeks. A second dose of the vaccine is recommended at least six months after the first dose to provide prolonged protection.

Two hepatitis A vaccines are currently available in the United States; these vaccines are hepatitis A vaccine injections of Havrix or Vaqta. The vaccine is given as an injection into the deltoid muscle of the arm. Both Havrix and Vaqta provide high-level protection against hepatitis A. There is also a combination vaccine called hepatitis-b-hepatitis-a-vaccine injection (Twinrix) that protects against both hepatitis A and hepatitis B. The dosing schedule for Twinrix is different from the other hepatitis A vaccines and requires three doses over six months.

In the United States, hepatitis A vaccination is recommended for all children at one year of age. Vaccination also is recommended for individuals in high-risk settings. Examples include:

  • travelers to developing countries,
  • men who have sex with men,
  • users of intravenous drugs,
  • persons needing frequent blood products, and
  • people who have chronic liver disease.

Side effects of the hepatitis A vaccine usually are mild. Soreness at the site of injection is common. Less commonly, recipients may complain of a headache or fatigue. Serious allergic reactions are possible, but are rare.

A blood test before being vaccinated shows if you’ve picked up the virus already. If you have, you already are immune and don’t need the vaccine. Hepatitis vaccines are safe if you have HIV, but can briefly affect your viral load.
After 10 years, a booster is needed.

Hepatitis B (HBV)

Hepatitis B (HBV) is a more serious infection that also attacks the liver. It may lead to a condition called cirrhosis (permanent scarring of the liver) or liver cancer, both of which cause severe illness and even death.

There’s no effective cure for hepatitis B, although people who have had the hepatitis B vaccine are protected against it. In most cases, teens who get hepatitis B will recover from the disease and may develop a natural immunity to future hepatitis B infections. But some people will have the condition forever. Medicines can help some people with hepatitis B get rid of the virus.

How Do You Get Hepatitis B?

Hepatitis B is extremely contagious. Listen up, here’s what you need to know:

Hepatitis B virus (HBV) is transmitted from person to person through five body fluids: semen (including pre-cum), vaginal fluid, urine and saliva.

In the United States, the most common way people get infected with HBV is through unprotected sex with someone who has the disease. In other words, contact of mucous membranes with an infected person’s fluids: as you read above – semen (including pre-cum), vaginal fluid, urine and saliva.

Another way to explain it is:

  • Kissing, anal, oral and vaginal intercourse, rimming and watersports.
  • People who share infected needles are also at risk of becoming infected because it’s likely that the needles they use will not have been sterilized.
  • Inadvertent exposure to infected blood or body fluids may also occur during tattooing, body piercing, or when sharing razors or toothbrushes (blood particles) with an infected person.
What are the Symptoms of Hepatitis B?

At first, people are usually asymptomatic; they can have the virus for between one and six months before showing any symptoms. In some cases, symptoms can appear within 4 weeks. It’s a flu-like illness characterized by:

  • extreme fatigue
  • headache
  • fever
  • nausea and vomiting
  • loss of appetite
  • yellowing of skin and whites of eyes (jaundice)
  • clay-colored stool
  • very dark urine
  • abdominal pain

The majority of people infected with Hepatitis B recover from their symptoms, suffer no lasting damage and stop being infectious. In most cases, the infection clears in 4-8 weeks. However some people (1 in 10) remain contagious (carriers) for life, which means they feel fine but stay infectious to others. Carriers run a small risk of getting cirrhosis, liver cancer or liver failure. One in 100 die from it.

How Do You Prevent Hepatitis B?

Vaccination has reduced the number of new cases of hepatitis B by more than 75% in the United States. The hepatitis B vaccine contains a protein (antigen) that stimulates the body to make protective antibodies. Examples of hepatitis B vaccines available in the United States include hepatitis B vaccine-injection Engerix-B and Recombivax-HB. Three doses (given at 0, 1, and 6 months) are necessary to assure protection.
There are also combination vaccines on the market that provide protection against hepatitis B and other diseases. For example:

  • Hepatitis-b-hepatitis-a-vaccine injection (Twinrix), which provides protection against both hepatitis A and hepatitis B;
  • Haemophilus B/hepatitis B vaccine – injection (Comvax) provides protection against hepatitis B and Haemophilus influenzae type b (a cause of meningitis; and
  • Pediarix provides protection against hepatitis B, tetanus, pertussis and polio.
    Hepatitis B vaccines are effective and safe. Most vaccinated individuals develop protective antibodies when they get the vaccine and are protected from infection with hepatitis B.

A blood test for hepatitis B antibodies is recommended after vaccination is completed to ensure that antibodies have been produced. For the few who do not form antibodies, revaccination may improve the response, especially in infants. The vaccine works for about 95% of people. However, a small proportion of individuals will never respond to hepatitis B vaccination. The older you are, or if you have HIV, the less effective it can be. (If you’ve read this far, I’m one of those people.)

Side effects from the vaccine usually are mild, primarily soreness at the site of injection. The risk of serious allergic reaction is less than one per million doses.
In the United States, hepatitis B vaccination is recommended for all infants at birth. Older children and adolescents should receive the vaccine if they did not receive it at birth. Adults in high-risk situations also are advised to receive hepatitis B vaccine.
Some countries have a high prevalence of hepatitis B in their population. Travelers who visit these countries for a prolonged period of time (usually 6 months or longer) and those who may be exposed to blood or semen should consider vaccination.

After five years, you’ll need a booster injection.

Hepatitis C

Hepatitis C is the most serious type of hepatitis. Like hepatitis B, hepatitis C can lead to cirrhosis or liver cancer. An estimated 4.1 million Americans are currently infected with the virus. It’s now one of the most common reasons for liver transplants in adults. Every year, thousands of people in the United States die from HCV. And there’s no cure and no vaccine.

How Do You Get Hepatitis C?

The hepatitis C virus (HCV) is transmitted from person to person through blood.

  • The most common way people become infected is through sharing drug paraphernalia such as needles.
  • People also get hepatitis C after having unprotected sex with an infected partner.
  • Also anal sex without a condom if there is blood.
  • A lesser known fact is that you can Hepatitis C from fisting, if blood is present.
  • Inadvertent exposure to infected blood or body fluids may also occur during tattooing, body piercing, or when sharing razors or toothbrushes (blood particles) with an infected person.
  • Before July 1992, many people got HCV through blood transfusions, but better blood screening and handling procedures now mean that this rarely happens.
  • Or if you were treated for clotting problems with a blood product made before 1987.
  • Sometimes, mothers with hepatitis C pass the virus along to their babies during birth.
How do you diagnose Hepatitis C?

A doctor will test for antibodies, which can take up to 6 months to appear in the blood. Sometimes, a doctor will take a liver biopsy.

How Do You Treat Hepatitis C?

The medicines currently used to treat hepatitis C (6 – 12 months of Alpha Interferon and Ribavirin) are effective in controlling the disease in some people. However, hepatitis C treatments are not very easy to take, especially because some require frequent injections.There is no vaccine for Hepatitis C.

Key Points to Remember

The hepatitis A virus (HAV) is transmitted through the feces (poop) of infected individuals. Unlike some other hepatitis viruses, hepatitis A rarely leads to permanent liver damage.

The hepatitis B virus (HBV) is transmitted from person to person through five body fluids: semen (including pre-cum), vaginal fluid, urine and saliva.

The hepatitis C virus (HCV) is transmitted through blood and sharing infected needles. It is not as easy to get through sex as A and B.

Even when infected people don’t have any symptoms, they can still pass the disease on to others.

Get Vaccinated. Vaccinations can protect you from A and B. Today, all kids in the United States are routinely vaccinated against hepatitis B at birth and against hepatitis A when they’re between 1 and 2 years old.

A blood test for hepatitis B antibodies is recommended after vaccination to ensure that antibodies have been produced.

In addition to getting vaccinations against hepatitis A and B, here’s how to protect yourself against hepatitis virus infection:

  • Don’t have unprotected sex.
  • Avoid intravenous drug use and sharing of drug paraphernalia.
  • Wash your hands before handling food and after using the bathroom.
  • Be sure tattoo or piercing shops sterilize needles and other equipment properly.
  • Don’t share toothbrushes or razors. Hepatitis can be transmitted through sores or cuts.
  • Avoid eating raw shellfish (such as clams or oysters). You could put yourself at risk for hepatitis A if the shellfish was harvested from contaminated water.

DISCLAIMER: The information contained in this post is intended to inform readers and is not intended to replace specific advice from a health care professional.

Topic Tuesday: HSV-2

Herpes is a common and usually mild recurrent skin condition caused by a virus: the herpes simplex virus (HSV). Here’s some good news: herpes is not life-threatening nor does it destroy your immune system

HSV is in a family of viruses called “herpesviruses.” There are eight human herpesviruses. (I know it looks like a typo, but actually medical texts refer to herpesvirus as one word.) Also, every animal species that has been studied has its own herpesvirus: cat, carp, elephant, horse. What these viruses all have in common is the ability to hide in the body without causing symptoms, and then reappear at a later time.

The human herpesvirus family includes the Epstein-Barr virus, often abbreviated to EBV (the cause of mono), the varicella virus (the cause of chicken pox) and zoster (the cause of shingles).

Although there are several viruses in the herpesvirus family, each is a separate virus and each is different. Having one virus does not mean you will have another.

There are two types of herpes simplex viruses: herpes simplex virus type-1 (HSV-1) and herpes simplex virus type-2 (HSV-2).

The majority of oral herpes cases are caused by HSV-1 and the majority of genital herpes cases are caused by HSV-2; however, type-1 or type-2 can occur in either the genital or oral area.

Genital Herpes

Genital herpes is a sexually transmitted disease. It can cause sores in the genital area and is transmitted through vaginal, oral or anal sex, especially from unprotected sex when infected skin touches the vaginal, oral or anal area. Occasionally, it can cause sores in the mouth and can be spread by secretions in saliva. Because the virus does not live outside the body for long, you cannot catch genital herpes from an object, such as a toilet seat.

How Do You “Catch” It?

HSV-2 is spread by direct skin-to-skin contact, including vaginal, anal and oral sex. The virus can be passed whenever it is present on the skin, even right before an outbreak when no symptoms are present. Simplex-1 can be passed to the genitals and simplex-2 can be passed to the mouth during oral sex.

What Are the Signs and Symptoms of Genital Herpes?

While some people realize that they have genital herpes, many do not. It is estimated that one in five people in the United States has genital herpes; however, as many as 90% are unaware that they have the virus. This is because many people have very mild symptoms that go unrecognized or are mistaken for another condition or no symptoms at all.

A person may show symptoms within days after contracting genital herpes or it may take weeks, months or years. Some people may have a severe outbreak within days after contracting the virus while others may have a first outbreak so mild that they do not notice it. Because of these possibilities, it can be difficult for people to know when and from whom they may have contracted the virus.

Someone with genital herpes may first notice itching, tingling or burning and pain or soreness in the buttocks, legs and groin areas. This is followed by small red bumps that appear at or near where the virus entered the body. These bumps turn into blisters or open sores a few hours to a few days later. The “classic” symptoms that most people associate with genital herpes are these sores, vesicles, or ulcers – all of which can also be called “lesions.” (The scientific literature on herpes uses the term “lesion” to describe any break or irregularity in the skin.) These classic lesions of genital herpes often resemble small pimples or blisters that eventually crust over and finally scab like a small cut. These lesions may take anywhere from two to four weeks to heal fully. Here’s the good news: they eventually do scab over and heal without leaving any scars.

The sores, which may appear on the vagina, penis, scrotum, buttocks or anus, start out as red bumps that soon turn into red, watery blisters. The sores might make it very painful to urinate. They may may open up, ooze fluid or bleed. The entire genital area may feel very tender or painful and there may be flu-like symptoms including fever, headache and swollen lymph nodes.

More good news:

If future outbreaks occur, they tend to be less severe and shorter in duration, with sores healing faster. The future outbreak can also include swollen glands, muscle aches, headache, fever, painful or difficult urination and nausea. Although symptoms can be so mild that people do not notice their future outbreaks at all.

For many people, herpes lesions can so mild that they may be mistaken for:

  • insect bites
  • abrasions
  • yeast infection
  • “jock itch” and other conditions
How Long Until Symptoms Appear?

When a person is first infected, the immune response is not well developed and the virus is able to multiply more rapidly and in more places than it can later. Signs and symptoms during a first episode can be quite pronounced. Someone who has been exposed to genital herpes will notice genital itching and/or pain about 2 to 20 days after being infected with the virus. The sores usually appear within days afterward and may last for 2 to 4 weeks.

During this time, some people will experience a second crop of lesions, and some will have flu-like symptoms including fever and swollen glands, particularly in the lymph nodes and groin.

However, some people with genital herpes do not get symptoms or have a first episode so mild they don’t even notice it. In other cases, the first outbreak may happen years after the virus is picked up. Or, it may be a later episode, known as “reactivation,” that is first noticed months or years later.

Herpes is different from other common viral infections in that it sets up a lifelong presence in the body, called “latency.” The virus can travel the nerve pathways in a particular part of the body and hide away, virtually sleeping, in the nerve roots for long periods of time. This means that even though HSV may not be causing “cold sores” or genital signs and symptoms at a given time, it can still cause symptoms later.

Does It Recur?

It does. But if you have recently made it through a first episode that consisted of full-blown symptoms, you know something about signs and symptoms already. The good news is that the first episode is almost always the worst that HSV throws your way. Signs and symptoms of recurrent episodes (when they occur) tend to be milder and heal much more quickly, typically within two to twelve days.

If the first episode produced fairly mild symptoms, then subsequent recurrences will not usually increase in severity. But, as noted earlier, the first episode doesn’t always cause recognizable signs and symptoms. Some people have recurrent outbreaks with the so-called “classic” blister-like herpes lesions that crust over, or with painful sores. More good news: In recurrent herpes, however, this process usually takes about half the time it does in first episodes. In addition, many people have very subtle forms of recurrent herpes that heal up in a matter of days. And lastly, herpes is capable of reactivating without producing any visible lesions (asymptomatic reactivation).

Research suggests that reactivation is influenced by HSV type and how long one has been infected. People with a marked first episode caused by HSV-2 can expect to have several symptomatic recurrences a year. The average is four or five. Some may not be recognizable. In most cases, the first year has the most viral activity.

HSV-1 behaves quite differently in the genital area. People with HSV-1 in the genital area may have a marked first episode but are much less likely to have outbreaks in the first year. Their average number of symptomatic recurrences is closer to one per year and their rates of unrecognized recurrences are lower as well.

What Triggers a Herpes Outbreak to Recur?

Herpes “triggers” (determining exactly what leads to an outbreak) are highly individual, but with time, many people learn to recognize, and sometimes avoid, factors that seem to reactivate HSV in their own bodies.

It occurs on the same part of the body but is not as severe. It may simply be a temporarily itchy area. What one can say with confidence is that, in general, recurrent attacks become less frequent and less severe as time goes by.

As for the reasons for recurrences, it is not really known, but based on research, there is agreement on some predisposing factors associated with outbreaks:

      • Prolonged exposure to strong sunlight or ultra-violet light can trigger (usually) oral herpes.
      • Trauma: surgical trauma and steroidal medication (such as asthma treatment)
      • Friction in the genital area: some people (and this is pretty rare) find that they get recurrences following sex.
      • Stress (emotional or physical): enough people with herpes believe that stress is involved to give it credence as a provoking factor.
      • High fever and illness
      • Poor diet

The frequency of outbreaks can often be managed through effective stress management and getting adequate rest, nutrition and exercise. For people with frequent outbreaks, suppressive (daily) therapy with any one of the antiviral treatments can reduce outbreaks by as much as 80%.

What Are the Warning Signs of a Reactivation Outbreak of Genital Herpes?

In the early phase of genital herpes reactivation (also called an outbreak) many people experience an itching, tingling or painful feeling in the area where their recurrent lesions will develop. This sort of warning symptom is called a “prodrome” and often comes a day or two before lesions appear. To be on the safe side, it’s best to assume that the virus is active (and, therefore, can be spread through direct skin-to-skin contact) during these times.

Where Do These Symptoms Appear?

When a person has genital herpes, the virus lies dormant (sleeps) in the bundle of nerves at the base of the spine. When the virus reactivates (wakes up), it travels nerve paths to the surface of the skin, sometimes causing an outbreak. The nerves in the genitals, upper thighs and buttocks are connected; therefore, a person can experience outbreaks in any of these areas. Such areas include the vagina or vulva, penis, scrotum or testicles, buttocks or anus, or thighs.

Genital herpes, regardless of whether it is HSV-1 or HSV-2, does not cause symptoms on the mouth or face.

But What if You Don't See Any Lesions or Have Other Symptoms?

In some studies, people with herpes were completely unaware of lesions about one-third of the time that the virus was found to be active in the genital area. While recognizing lesions and other symptoms is important, this cannot always tell you when the virus is active.

Confusingly, someone who was unknowingly infected in the past may suddenly develop symptoms for the very first time, maybe years later. This resembles a recurrence, rather than a primary attack, that is not as bad.

It used to be thought that all of HSV’s active times were marked by “outbreaks” such as a sore, blister or some kind of symptom like an itch. Then researchers learned that the virus could become active without causing signs or symptoms. This phenomenon has been called a number of things, including “asymptomatic shedding” and “subclinical shedding.” But the best term for it might simply be “unrecognized” herpes. Even if you’re a person with recurring signs and symptoms that you can usually recognize as herpes, there are almost certainly days when you won’t be aware that the virus has reactivated and traveled to the skin or mucous membranes.

How is Genital Herpes Treated?

Since herpes is a virus, there is no cure. There are however treatments which can decrease the pain and length of the outbreaks. There are two types of treatments: episodic and suppressive.

Episodic therapy means taking medication during an outbreak to speed healing. That means you would begin taking medicine at the first sign of a prodrome and continue for five days. It doesn’t suit everybody but, for those with a reliable warning of an attack, it works well and avoids continuous suppressive therapy. But listen up, once a recurrence has started, and the outbreak appears, acyclovir or other anti-herpes drugs have no significant effect on the severity or length of the attack.

Suppressive therapy means taking antiviral medication every day to hold HSV in check so that it’s less likely to flare up and cause symptoms. It is designed to stop recurrences. This greatly reduces the number of outbreaks for most people and can prevent outbreaks altogether for some. It can also greatly reduce asymptomatic shedding (the recurrence of virus on the skin). Studies are underway to find out whether antiviral medication can help prevent transmission. People have taken it for many years without side effects or complications. However, most people with herpes don’t feel the need to take medication because their outbreaks are relatively mild. The virus is killed with soap and water.

In the old days, Acyclovir (Zovirax) use was limited by cost, but when the patent ran out in the ‘90’s, copies of acyclovir became available at a greatly reduced price allowing for much more widespread use, in particular for suppressive therapy.

Valacyclovir (Valtrex) uses acyclovir as its active ingredient but is better absorbed by the body and can be taken less often.

Famciclovir (Famvir) works much the same way acyclovir does but is also better absorbed and can be taken less often.

All three are effective. All three drugs work by disrupting the virus’ ability to reproduce. All are safe and have virtually no side effects.

No vaccines against herpes have been shown to be effective.

How is It Diagnosed?

If an active sore is present, the virus can be cultured or seen using an electron microscope. Specific herpes DNA tests may differentiate between HSV-1 and HSV-2. Finally, blood tests can detect whether an infection has been caught in the past and whether it is type-1 or 2, or both. However, unless the infection is really very recent, when a different and transient sort of antibody is found, the blood test cannot tell for how long the infection has been present.

How Likely are You to Pass on Herpes?

If someone who already has HSV-1 is exposed to their sexual partner’s herpes virus, as long as it is also type-1, no reinfection will occur. You cannot catch the same virus twice! It is true that there exists a small minority of people who are infected with both 1 and 2, but they remain a small minority.

How Is It Prevented?

The only surefire way to prevent genital herpes is abstinence. Those who do have sex must properly use a latex or polyurethane condom every time they have any form of sexual intercourse (vaginal, oral, or anal sex).

Genital Herpes and Pregnancy

There is a risk of transmission to the newborn if the mother suffers a primary attack. The attack needs to be primary and in the last few weeks of pregnancy. A recurrent attack is not an equivalent risk at childbirth.

Probably the most important factor is in the transfer of antibodies from the mother to the baby across the placenta. Along with oxygen and nutrients, the placenta also transmits a ready-made immune package full of antibodies to all the infections the mother has ever suffered from, including this year’s common cold, last year’s flu and most importantly, her HSV-1 or 2. This passive immunity is quite enough to prevent any serious infection taking hold in the baby. Secondly, there are fewer virus particles in a recurrent episode than a primary attack.

There have been several studies showing that even when there are genuine herpetic sores on the vulva at the time of delivery, the baby does not develop infection. Most authorities agree that caesarean section is not necessary under these circumstances.

Some Interesting Facts
  • Women are more likely to be infected than men;
  • Gay men more than straight;
  • American more than British;
  • African more than European;
  • European more than Indian subcontinent.
  • Type-1 has a better outlook, in terms of genital recurrences, than type-2.
  • There are one million new infections per year.
  • 45 million people are currently living with it.
  • By the age of 25, at least 80% of people worldwide have been infected with either 1 or 2.
  • Herpes is not life-threatening nor does it destroy your immune system.

DISCLAIMER: The information contained in this post is intended to inform readers and is not intended to replace specific advice from a health care professional.

Topic Tuesday: HSV-1

Is it a cold sore?
Is it a fever blister?
Is it herpes?

It’s actually all of the above.

Oral herpes is commonly referred to as “cold sores” and “fever blisters” typically caused by herpes simplex virus type 1 (HSV-1). More than 50% of adults in the United States have oral herpes. Most people get it when they are children by receiving a kiss from a friend or relative.

The information in this week’s Topic Tuesday comes from one of my favorite Internet sites for sexual health and wellness information, www.kidshealth.org.

Here’s the link:


What's a Cold Sore?

Cold sores, which are small and somewhat painful blisters that usually show up on or around a person’s lips, are caused by herpes simplex virus-1 (HSV-1). But they don’t just show up on the lips. They can sometimes be inside the mouth, on the face, or even inside or on the nose. These places are the most common, but sores can appear anywhere on the body, including the genital area.

Genital herpes isn’t typically caused by HSV-1; it’s caused by another type of the herpes simplex virus called herpes simplex virus-2 (HSV-2) and is spread by sexual contact. But even though HSV-1 typically causes sores around the mouth and HSV-2 causes genital sores, these viruses can cause sores in either place.

What Causes a Cold Sore?

HSV-1 is very common. If you have it, chances are you picked it up when you were a kid — most likely from close contact with someone who has it or getting kissed by an adult with the virus.
Although a person who has HSV-1 doesn’t always have sores, the virus stays in the body and there’s no permanent cure.

When someone gets infected with HSV-1, the virus makes its way through the skin and into a group of nerve cells called a ganglion (pronounced: GANG-glee-in). The virus moves in here, takes a long snooze, and every now and then decides to wake up and cause a cold sore. But not everyone who gets the herpes simplex virus develops cold sores. In some people, the virus stays dormant (asleep) permanently.

What Causes the Virus to "Wake Up" or Reactivate?

The truth is, no one knows for sure. A person doesn’t necessarily have to have a cold to get a cold sore — they can be brought on by other infections, fever, stress, sunlight, cold weather, hormone changes in menstruation or pregnancy, tooth extractions, and certain foods and drugs. In a lot of people, the cause is unpredictable.

Here’s how a cold sore develops:

  • The herpes simplex virus-1, which has been lying dormant in the body, reactivates or “wakes up.”
  • The virus travels toward the area that was originally infected (like a person’s lip) via the nerve endings.
  • The area below the skin’s surface, where the cold sore is going to appear, starts to tingle, itch, or burn (called a “prodrome”).
  • A red bump appears in the area about a day or so after the tingling.
  • The bump becomes a blister.
  • The blister dries up and a yellow crust appears in its place.
  • The scab-like yellow crust falls off and leaves behind a pinkish area where it once was.
  • The herpes simplex virus travels back to the ganglion (nerve cells), where it goes back to “sleep.”
How Do Cold Sores Spread?

Cold sores are really contagious. If you have a cold sore, it’s very easy to infect another person with HSV-1. The virus spreads through direct contact — through skin contact or contact with oral or genital secretions (like through kissing). Although the virus is most contagious when a sore is present, it can still be passed on even if you can’t see a sore. HSV-1 can also be spread by sharing a cup, eating utensils, or lip balm or lipstick with someone who has it.

Listen up, this one is important

If you or your partner gets cold sores on the mouth, the herpes simplex virus-1 can be transmitted during oral sex and cause herpes in the genital area.

Herpes simplex virus-1 also can spread if a person touches the cold sore and then touches a mucous membrane or an area of the skin with a cut on it. Mucous membranes are the moist, protective linings made of tissue are are found in certain areas of the body (like the nose, eyes, mouth, and vagina). So it’s best to not mess with a cold sore — don’t pick, pinch, or squeeze it.

Actually, it’s a good idea to not even touch active cold sores. If you do touch an active cold sore, don’t touch other parts of your body. Be especially careful about touching your eyes — if it gets into the eyes, HSV-1 can cause a lot of damage. Wash your hands as soon as possible. In fact, if you have a cold sore or you’re around someone with a cold sore, try to wash your hands often.

Cold sores can actually be dangerous for people whose immune systems are weakened (such as infants and people who have cancer or HIV/AIDS) as well as those with eczema. For people with any of these conditions, an infection triggered by a cold sore can even be life threatening.

How Are Cold Sores Diagnosed and Treated?

Cold sores normally go away on their own within 7 to 10 days. And although no medicines can make the infection go away, prescription drugs and creams are available that can shorten the length of the outbreak and make the cold sore less painful.

If you have a cold sore, it’s important to see your doctor if:

  • you have another health condition that has weakened your immune system
  • the sores don’t heal by themselves within 7 to 10 days
  • you get cold sores often
  • you have signs of a bacterial infection, such as fever, pus, or spreading redness

To make yourself more comfortable when you have a cold sore, you can apply an ice pack wrapped in a towel or anything cool to the area. You also can take an over-the-counter pain reliever, such as acetaminophen or ibuprofen.

Reviewed by: Mary L. Gavin, MD
Date reviewed: February 2014
You can learn more about oral herpes here:


DISCLAIMER: The information contained in this post is intended to inform readers and is not intended to replace specific advice from a health care professional.

Topic Tuesday: What is HPV?

And the winner for the most common STI is…

HPV stands for human papillomavirus, which is a virus from the papillomavirus family that affects human skin and the moist membranes that line the body, such as the throat, mouth, feet, fingers, nails, anus and cervix. There are at least 120 types of HPV. Some of them cause the kind of common warts you see on people’s hands and some of them cause plantar warts on the feet.

About 40 types of HPV, however, can infect the genital area — the vulva, vagina, cervix, rectum, anus, penis, or scrotum.

Genital HPV infections are very common. HPV is so common that about half of all men and more than 3 out of 4 women have HPV at some point in their lives. But most people who have HPV don’t know it.

For the purposes of understanding HPV better, let’s group it into two categories: low risk and high risk.

Low Risk Type of HPV

Here’s how it works: the papilloma viruses infect cells just beneath the skin which, like normal skin cells, move toward the surface, reach the upper layer, die and slough off, quite unnoticed by anyone. Papilloma is a fancy word for “raised bump,” so occasionally, the HPV-infected cells form lumps, which can be seen and felt. In reality, these are benign tumors. They are more commonly called genital warts.

Genital warts are warts that are located near or on the genital areas. In a female, that means on or near the vulva (the outside genital area), vagina, cervix, or anus. In a male, that means near or on the penis, scrotum, or anus.

Genital warts can look like bumps or growths. They can be flat or raised, single or many, small or large. They tend to be whitish or flesh colored. Sometimes, if left untreated, they can be shaped like a cauliflower. They are not always easy to see with the naked eye, and many times a person with genital warts doesn’t know that they’re there.

The warts can show up weeks or months after exposure to an infected sexual partner.

The types of HPV that can cause genital warts are NOT the same as the types of HPV that can cause cancer. Low-risk HPV strains, such as HPV-6 and 11, cause more than 90% of genital warts, which rarely develop into cancer. These, along with HPV-42, 43 and 44 are LOW risk for cancer of the cervix.

In the majority of cases, infected young females are not infected for long and there is no long-term consequence. The CDC says that over 70% of young female infections clear up within 12 months, while 90% do so within 24 months.

High Risk Type of HPV

Not all of the 40 sexually transmitted HPV viruses cause serious health problems. But there are some types of HPV that may cause cell changes, which sometimes lead to cervical cancer and certain other genital and throat cancers. These are called high-risk types.

Very few warts are of the high-risk type. High-risk HPV strains include HPV-16 and 18, which cause about 70% of cervical cancers. Other high-risk HPV strains include 31, 33, 35, 39, 45, 51, 52, 58, and a few others.

Although most HPV infections go away within 8 to 13 months, some will not. HPV infections that do not go away can “hide” in the body for years and not be detected. That’s why it is impossible to know exactly when someone got infected, how long they’ve been infected, or who passed the infection to them.

In somewhere between 5% to 10% of cases, the infection persists and leads to high-risk type of HPV. This persistent long-term HPV infection raises the risk of developing precancerous lesions of the cervix. These can eventually, over a period of five to ten years, develop into cervical cancer. During this period, the progress can be treated and reversed with treatment for the pre-cancerous lesions. In some cases, treatment can lead to loss of fertility. However, in the majority of cases, cancer can be prevented.

As mentioned earlier, in 90% of cases the body’s own immune system destroys all the HPVs within 24 months. It is impossible to tell who might go on to develop health problems, including cancer.

How Does Someone Get HPV?

These sexually transmitted HPV viruses are spread through contact with infected genital skin, mucous membranes, or bodily fluids, and can be passed through vaginal intercourse, anal intercourse and oral sex.
HPV can infect skin not normally covered by a condom, so using a condom does not fully protect someone from the virus.

You can get it from touching (hand to genital or genital to genital) an infected person’s lesions, which can transmit cells containing the virus.

Here’s an interesting fact regarding transmission of HPV: for many people, HPV is transmitted during their first 2 to 3 years of sexual contact.

Experts believe that when a wart is present, the virus may be more contagious. But HPV can still spread even if you can’t see warts. Many people don’t realize they’re infected with HPV and may have no symptoms, so neither sexual partner may realize that the virus is being spread.

In some rare cases, genital warts are transmitted from a mother to her baby during childbirth.

When Do Symptoms Start?

Warts can appear any time from several weeks to several months after a person has been exposed to them. Sometimes they might take even longer to appear because the virus can live in the body for a very long time before showing up as warts.

What Exactly are the Symptoms?

A few weeks or many months after infection, small groups of the genital warts, the size of a pinhead to begin with, appear on their own or in groups. They grow mostly on the head of the penis or anus. Occasionally, they appear in mouth, on the tongue or other parts of body or face, including the urethra and peri-anal area. Untreated, they can spread and get bigger to cauliflower-like warts.

External lesions may itch. A lesion on the skin may be either papillary (standing up from the skin) or flat. Lesions on the cervix can be seen only with the use of 5% acetic acid and magnification.

Not all warts look the same. They can be flat or raised above the surrounding skin. In moist areas, they have a softer surface and are known as exophytic warts. On skin that’s exposed to the air, the wart has a harder, “keratinized” surface. These are known as sessile or popular warts. Warts can be as small as a pinhead or as large as a sprout.

How Common Is HPV?

About 20 million people in the U.S. are infected with HPV at any time, according to the CDC. And three-fourths of sexually active people between ages 15 and 49 have been infected at some point in their lives, according to estimates from the American Social Health Association.

You’re more likely to get HPV if you:

  • Have sex at an early age
  • Have many sex partners
  • Have a sex partner who has had multiple partners

While many people think HPV is mostly a problem for teens or young adults, HPV can infect men and women of any age. In fact, the latest statistics from the CDC found that:

  • 19% of women 50 to 59 were infected with HPV virus
  • 27% of women 20 to 24 were infected with HPV virus
  • 45% of women 14 to 19 were infected with HPV virus
How Do You Get a Diagnosis for HPV?

This has already been stated, but it’s important to read it again. Most HPV infections have no signs or symptoms. So someone can be infected and pass the disease on to another person without knowing.

Some people do get visible warts. Although warts might hurt, itch, or feel uncomfortable, most of the time they don’t. This is one reason why people may not know they have them.

Doctors can diagnose warts by examining the skin closely (sometimes with a magnifying glass) and using a special solution to make them easier to see.

Your doctor may take a tissue sample, (biopsy) and then examine it under the microscope (histology).

A common way to diagnose HPV in females is with a Pap smear (routine cervical cytology). This is a test that is performed during a gynecologic exam. In college-age females, probably no more than 10% of cervical lesions are truly pre-cancerous. It is extremely unlikely in college age women that HPV turns out to be malignant.

A colposcopy enables the operator to examine the surface of the cervix under magnification. Biopsies can be taken and if the labs show suspicious cells, it’s a simple matter to remove the offending tissue by freezing, burning or cutting off or a combination of these.

What is the Treatment for HPV?

So here’s the thing about HPV: you can treat the symptoms but rarely get rid of the virus. The good news is that the lesions and warts can be eliminated. For many people, the virus is cleared from the body by itself! For others, viral particles remain in a latent form after treatment. However, (more good news), it is doubtful that simple presence of latent viral particles can result in transmission.

It is not possible to predict how long treatment will be needed. In some, two or three ‘shots’ of cryo-therapy suffices, while in others the warts just go on and on. Approximately 25% of cases return within 3 months.

However, in this particular lottery, everyone is a winner. Warts always eventually go away!

Here’s some really technical stuff about HPV treatment. Your doctor might use one or more of these procedures to remove the warts:

  • LEEP (loop electrosurgical excision procedure): uses a metal prong, which literally burns the wart away.
  • Freezing (cryotherapy) with liquid nitrogen: most commonly used. A jet of liquid nitrogen freezes the wart until it turns white. This is repeated at weekly intervals until the warts are gone. Freezing destroys the skin cell in which the virus resides. The cell dies; the virus dies. There are two theories to freezing warts: one freezes the wart and a small area around it, whereas the other limits the white frozen area to the wart.
  • Aldara is a topical cream which is very effective.
  • Laser is useful when there are many warts.
  • Liquid N, TCA/BCA (tri and bichloracetic acid), and interferon: burns away the wart.
  • Podophyllin: a plant extract, stops cells dividing, which means that the virus dies out. It has been replaced by podophyllotoxin. This is the first home treatment. It’s easy for the patient to apply as a cream or lotion – three times weekly, for 4 weeks.
  • Imiquimod: an immune modulator is applied 3x a week, for 4 weeks (can be up to 16 weeks).
  • 5-flouorocytosine is useful for warts that are difficult to reach, for example inside the urethra in the male.
  • Proctoscopy: passing a metal cylinder through the anus to get at the warts. Not highly effective.
Does HPV Cause Cancer?

Yes, high-risk types of genital HPV can cause cancer of the cervix, vagina, vulva, anus, penis, and throat. The type of cancer HPV causes most often is cervical cancer.

Up to 50% of sexually active women develop HPV on their cervix. But as already stated, infection persists in up to only 10%. Perhaps 1 in five of those will need further treatment to prevent development of cancer.

Most HPV infections go away by themselves and don’t cause cancer. But abnormal cells can develop when high-risk types of HPV don’t go away. If these abnormal cells are not detected and treated, they can lead to cancer.

Most of us recover from HPV infections with no health problems at all. It is not fully known why some people develop long-term HPV infection, precancerous abnormal cell changes, or cancer. But we do know that women who have diseases that make it difficult for them to fight infections are at higher risk of cervical cancer. We also know that cigarette smoking increases the risk of cervical cancer.

What’s the Scoop on the Vaccines?

There are two vaccines that have been shown to stop infection.

Although the vaccines were primarily designed to reduce the risk of cervical cancer in women, they also reduce the likelihood of genital warts in general and have some effect even on those already infected.

<b>Gardasil</b> protects against HPV type-16 and 18, and as we learned earlier, those are the high-risk strains, which cause 70% of cases of cervical cancer. It also protects against HPV types-6 and 11, the low-risk strains, which cause 90% of cases of genital warts.

<b>Cervarix</b> is another type of HPV vaccine that protects only against HPV types-16 and 18, the high-risk strains.

A patient’s prior exposure to HPV and age are two very important things to consider before s/he receives three doses of the vaccine. Unfortunately, Gardasil does not cure HPV. Gardasil does not work for a person who has already been exposed to the strains of the virus in the vaccine. As far as age goes, the vaccine is recommended for women and men between the ages of 9 and 26. Vaccinating a person before his or her first sexual encounter is thought to be most effective, although the vaccine can also be administered to someone who is sexually active.

If you choose to get the Gardasil vaccine, it is recommended that you have someone with you as you leave. It has been found that some people faint 20 minutes after the shot.

What Different Kinds of HPV Warts Are There?

There are at least 120 types of HPVs. Below is a list of HPV virus types and what signs and symptoms or diseases they are linked to:

  • 2, 7 – Common warts. Rough, raised bumps that generally affect the fingers, hands and around the nails. In the majority of cases their only problem is their appearance; however, they may sometimes bleed. Some patients may experience pain, but this is unusual.
  • 1, 2, 4, 63 – Plantar warts. Small lesions that appear on the soles of the feet; they usually look like a cauliflower, with very small hemorrhages (petechiae) under the skin. When scratched they may bleed. Patients may feel pain when walking or standing. They can be similar to corns or calluses.
  • 3, 10, 8 – Flat warts. Slightly raised, flat-topped lesions, which are darker than the skin around them. They may appear on the knees, elbows, wrists, hands, neck or face. Young adults, teenagers and younger children are usually affected.
  • 6, 11, 42, 44 and some others – Anogenital warts. Small, flat cauliflower-like bumps, some may have stem-like protrusions. In females, the warts will usually appear on the vulva, but may also be found in the vagina, on the cervix, and near the anus. In males, they may appear on the penis, around the anus, and on the scrotum. They are rarely painful and do not typically cause discomfort.
  • 6, 16, 18, 31, 53, 58 – Anal lesions
  • Genital cancers

- 16, 18, 31, 45 are the highest risk
- 33, 35, 39, 51, 52, 56, 58, 59 are high or medium-risk
- 26, 53, 66, 68, 73, 82 – are probably high-risk
  • 6, 7, 11, 16, 32 – Oral papillomas
  • 16 – Oropharyngeal cancer
  • 6,11 – Laryngeal papillomatosis
What If It’s Not HPV? What’s That Growing on Me?

All sorts of lumps or bumps in the genital area get mistaken for warts and there are six other diagnoses that regularly cause confusion.Sebaceous cysts are pockets of secretion from sebaceous glands in the skin and occur almost anywhere. They vary in size from a small ballbearing to a billiard ball or larger.Folliculitis is literally an inflammation of a hair follicle. Any bit of skin that has hair follicles can develop folliculitis, which when infected becomes a boil.Skin tags are little extra bits of skin near the entrance to the vagina or around the anus.Molluscum contagiosum is sometimes mistaken for HPV.

Fordyce tubercles or ‘pearly papules’ appear as a ring of small, whitish bumps less than a millimeter across, encircling the glans penis just where it joins the shaft. They are normal variations but are often misdiagnosed as warts.

Vulval papillosis, a woman’s equivalent to Fordyce tubercles, are little fleshy bumps, also smaller than 1 mm across on the inside of the labia. Both vulval papillosis and Fordyce tubercles will not go away if subjected to anti-wart treatment.Any condition that can cause lumps or bumps on the skin will be confused with warts.

However, the conditions described above will account for 95% of the “warts” that turn out not to be warts.

HPV and Pregnancy

In pregnancy, the immune system becomes less aggressive so as not to harm the unborn child, allowing warts to surface. Those who know they’ve had warts in the past and those with latent HPV infection may develop warts when they become pregnant. The good news is that the warts tend to regress, even without treatment, after the baby is born.The anogenital HPV types are usually confined to the nether regions. Very rarely, a mother with genital infection can pass this on during birth leading to laryngeal warts in her child.

Key Points to Remember

Because HPV is so common and such a popular topic these days, there are a lot of key points to remember:

  • Most HPV infections have no harmful effect at all.
  • Most HPV cures itself without any medical intervention.
  • There are more than 120 types, half of which cause genital warts.
  • Approximately 3 out of 4 people will get them after having any kind of genital contact with someone who is infected.
  • While there are 40 types of HPV that affect the genital area, some are low risk and some are high risk that cause most of the HPV-related diseases.
  • Low risk strains are types-6 and 11 and cause about 90% of genital wart cases in males and females.
  • High risk strains are types-16 and 18 and cause about 75% of cervical cancer cases, 70% of vaginal cancer cases, and up to 50% of vulvar cancer cases in females.
  • If you have HPV, you should not be ashamed or afraid. Most people who have had sex have HPV at some point in their lives. And most infections go away on their own.
  • The warts are actually (and properly) called ano-genital warts because they favor the back as well as the front. Warts can occur around the anus in both sexes without anal intercourse.
  • It is the most common STI in the US.
  • More than 5 million people are infected with it each year. 20 million people are currently living with it.
  • The highest rates of genital HPV infections are found in adults between the ages of 18 to 28.
  • Up to 80% of women will have been infected by the age of 25.
  • At least 80% of sexually active women have been infected.
  • Less than 5% of women aged 50 or older are still infected.
  • HPV may be less common in young men but will infect well over 50%.
  • Most of these men and women are unaware and unless they develop actual warts, will go their graves unaffected and oblivious.
  • By the age of 50, only a small number, less than 5%, still carry the virus, unless they are still having many sexual partners. This statistic tells us that we eradicate it ourselves eventually.
  • You cannot catch genital warts from towels or sheets.
  • Keep in mind that a healthy immune system is usually able to clear the HPV virus, or at least suppress it, over time.
  • Most men who contract HPV (of any type) never develop any symptoms or health problems.
  • Unfortunately, there are no blood tests clinically available to diagnose a person for HPV prior to vaccination. Most of the time, patients are diagnosed when visible genital warts appear.

DISCLAIMER: The information contained in this post is intended to inform readers and is not intended to replace specific advice from a health care professional.

Topic Tuesday: Syphilis

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Who remembers where this quote is from?

“You gave me syphilis?”

Answer: Grey’s Anatomy – Season One, Episode 9. George discovers he has syphilis, and it soon emerges that the disease is rampant among the hospital staff.

Well, just last week, the CDC (U.S. Centers for Disease Control and Prevention) announced that syphilis has returned with a vengeance to the gay community. Once almost eliminated in the United States, cases of syphilis have more than doubled among gay and bisexual men since the year 2000.

If you’re a numbers kind of person, this might interest you. In 2013, there were more than 16,000 cases of syphilis, 91% of these in men – up from 84% in 2012.

So this week’s STI topic is all about syphilis.

What Is It?

Syphilis is caused by a type of bacteria known as a spirochete, called treponema pallidum that lives in warm, moist parts of the body such as the mouth, anus and penis. If you were to look at it through a microscope, you’d see something that looks like a corkscrew or spiral. It’s extremely small and can live almost anywhere in the body.

How Is Syphilis Spread?

These spirochetes can be passed from one person to another through direct contact with a syphilis sore (infectious lesion). That contact can be genital intercourse, anal intercourse or oral intercourse. Yes, that means that you can get syphilis from oral sex. The bacteria pass through intact mucous membranes and abraded (just a fancy word for scraped) skin. The treponeme needs a small cut or abrasion in the skin to cause infection which may be one of the reasons it is common among MSM (men having sex with men), since anal intercourse is more traumatic than vaginal sex. The spirochetes are then carried by the bloodstream to every organ in the body. The infection can also be passed from a mother to her baby during pregnancy. But listen up…you cannot catch syphilis from a towel, doorknob, or toilet seat.

In its early stages, syphilis is easily treatable. However, if left untreated, it can cause serious problems — even death. So it’s important to understand as much as you can about this disease.

How Long Until Symptoms Appear?

A person who has been exposed to the spirochetes that cause syphilis may notice a chancre from 10 days to 3 months later, though the average is 3 weeks. If the syphilis is not treated, the second stage of the disease may occur anywhere from about 2 to 10 weeks after the original sore (chancre).
It’s important to keep in mind that many people never notice any symptoms of syphilis. This means it is important to let your doctor know that you are having sex, so that he or she can test you for syphilis even if you don’t have any symptoms.

So How Is It Diagnosed?

So this is where it gets interesting. Syphilis is divided into three stages, each with different signs and symptoms.

Primary Stage: Syphilis usually appears first as a red, firm, painless and sometimes wet ulcer or open genital sore, which disappears without a scar. “It can appear in the back of the throat and be missed entirely,” according to Dr. Demetre Daskalakis, an infectious disease expert at Mount Sinai Hospital in New York City. This first phase is the most infectious stage.

This chancre (pronounced: SHANG-ker) appears 3 weeks to 90 days (up to 12 weeks) after infection either on the penis, scrotum, mouth, back of the throat or anus. It’s often misdiagnosed as a herpes sore. It then scabs over and heals. Also, the glands nearest to the sore (neck or groin) may swell. Treatment of the sore with antiseptics or antibiotic creams has no effect since the treponeme has already infected the nearby lymph nodes. The sore is usually painless (as are the swollen nearby lymph glands) and feels like a small hard button just below the skin surface. It varies between barely visible to the size of a small fingernail.

The primary chancre is usually a single ulcer that is hard to miss when found on the penis but difficult when on the vulva, vagina or cervix, or in either gender when near the anus. A chancre can be found on the lips, nipples, tongue or other sites. One unlucky site is the base of the penis (called a “condom chancre”) when a sore on the vulva has come into contact with the lower part of the penis NOT covered by the condom.

The chancre will disappear on its own in 1-6 weeks (3 weeks average) but the disease doesn’t go away. In fact, if the infection hasn’t been treated, the disease will continue to get worse.

The primary sore is still present in perhaps 15% of secondary stage cases.

Secondary Stage: About 3-8 weeks after infection, the bacterium has spread throughout the body. A rash appears in most people on hands, palm and the soles of the feet. It might seem like this rash is the most important problem. But the treponeme can be found affecting all the parts of the body, from the liver to the lungs and the brain to the bones. People with secondary syphilis feel generally unwell, with a temperature, aches and pains, and loss of appetite. Half have enlarged lymph glands. Other symptoms are condylomata lata (fancy term for wart growths), lymph node enlargement, spotty baldness/hair loss, mild fever, fatigue, ulcers in the mouth and anus, and weight loss. There is an involvement of the central nervous system in 20% of cases, with nothing more than a slight headache.

Sometimes the rashes associated with syphilis can be very faint or look like rashes from other infections and, therefore, may not be noticed. Remember, sores sometimes appear on the lips, mouth, throat, vagina, and anus — but many people with secondary syphilis don’t have sores at all.
Secondary symptoms may last 2 to 6 weeks (4 weeks average) and may recur. The symptoms of this secondary stage will go away with or without treatment. But if the infection hasn’t been treated, the disease can continue to progress. Syphilis is still contagious during the secondary stage.
After some weeks, the rash and other complications disappear and the disease enters its next stage.

Early latent stage: If syphilis still hasn’t been treated, the person will have a period of the illness called latent (hidden) syphilis. This means that all the signs of the disease go away, but the disease is still very much there. Even though the disease is “hiding,” the spirochetes are still in the body. This stage can last for 2 years without signs or symptoms although infectious bacteria are still present in the tissues. Syphilis can remain latent for many years. Chancres or rashes may recur in this early latent stage.

Late latent stage or Tertiary Stage: If the disease still hasn’t been treated at this point, some develop tertiary (or late-stage) syphilis. This means the spirochetes have spread all over the body and can affect the brain, the eyes, the heart, the spinal cord, and bones. Symptoms of late syphilis can include difficulty walking, numbness, gradual blindness, and possibly even death. One third of people reach this stage, also called neuro-syphillis. It can appear up to 30 years after infection. The good news is that there is no chance of syphilis being passed on in this stage. It’s also been found that many who have reached this stage can look forward to no further trouble from their infection and may die of old age or an unrelated condition. The lesion in tertiary syphilis is known as the gumma. A gumma results from blockage of small arteries and can cause spots and lumps or nodules in skin, tongue, bones, muscles and internal organs. These later manifestation of syphilis are very uncommon in the western world today. If untreated, there can serious damage to the nervous system, heart, brain and other organs. Sometimes no clinical signs, but vascular and neurological damage may be occurring.

There is something called a dark-ground or dark-field microscope examination that looks at a little fluid from the primary sore of the secondary rash. Also, serological tests measure the presence of antibodies in the blood.

– Treponemal antibody tests, TPHA, TPPA, FTA or EIA stay positive forever even after successful treatment. These continuing positive results simply say that the person has had the infection in the past.

– Non-treponemal antibody tests, VDRL and the RPR tell us whether the syphilis is still active, depending on how strongly positive the test is. This distinguishes between a positive treponemal test owing to older treated infection or a new infection.

How Is It Treated?

If you think you may have syphilis or if you have had sexual contact with someone who might have syphilis, see your doctor or gynecologist right away. It can sometimes be difficult to spot chancres. So it’s important to get checked on a regular basis, especially if you have had unprotected sex and/or more than one sex partner.

Early stages of syphilis are easily cured with antibiotics. The most common treatment is penicillin or doxycycline once a week for three weeks in alternate buttocks. Other antibiotics, including tetracyclines and macrolides are used when there is penicillin allergy. Here’s some good news: these antibiotics respond promptly. Also, the treponeme shows no signs of developing resistance to penicillin or any other antibiotics.

Someone who has been infected for a while will need treatment for a longer period of time. Unfortunately, damage to the body from the late stage of syphilis cannot be treated. However, even in the late stage, it is important to get treatment. This can prevent further damage to the body. Anyone with whom you’ve had unprotected sex also should be checked for syphilis immediately.
Being treated for syphilis does not make you immune. You CAN catch it more than once.

How Is It Prevented?

The best way to prevent any STD is to not have sex. However, for people who decide to have sex, it’s important to use protection. Latex condoms are effective against most STDs; however, if there are any sores or rashes, avoid sex until the person has seen a doctor for treatment.

Fun Facts!

If you’ve read this far, here’s some fun facts on the origins of syphilis.

Where did syphilis come from?
In David Barlow’s book, Sexually Transmitted Infections (The Facts), he explains that there are a few views as to the origins of syphilis in Europe. Some blame Columbus (actually probably his crew) for bringing it to Barcelona from North America in 1493. The siege of Naples took place the following year when some infected Spaniards joined France. By the spring of 1495 a dreadful plague had broken out. The English called it the French disease. The French called it the Italian disease; the indecisive Italians called it the French and Spanish disease, while the Spanish called it the disease of Hispaniola. Neopolitan soldiers labeled it Mal Franzoso, the French disease, in 1495. Their French opponents called it “the Neapolitan disease.” The Russians dubbed it “the Polish sickness.” The Poles attributed it to Germany. The Japanese named the sores “Chinese ulcers.” And it was known for centuries as “the great” (as opposed to the “small”) pox.

Medieval cities banished syphilitics outside their gates or “cured” them with mercury ointments that made their bodies shake and teeth fall out before they died. The pre-Columbians school argues that it was around in Europe in pre-Christian day. There are many references in the Old Testament to conditions with signs and symptoms that could be syphilis. One translation, from Psalms, threatens ‘…the Lord shall smite you in the knees and in the legs with a sore botch that cannot be healed from sole of thy foot to the top of thy head.’

Pope Julius II, Henry VIII, Ivan the Terrible, George Washington and Nietzsche were all syphilitics.

Key Points to Remember
  • You CAN get syphilis from oral sex.
  • This first phase is the most infectious stage characterized by a red, firm, painless and sometimes wet ulcer or open sore.
  • The second phase occurs 3-8 weeks after infection and is characterized by a flu-like condition. This is also an infectious time.
  • If you want to get a blood test for syphilis, ask your doctor for an RPR. That’s the code, so you can keep the results more hidden.
  • African Americans are 34 times more likely to have syphilis than whites.
  • Being treated for syphilis does not make you immune. You CAN catch it more than once.

DISCLAIMER: The information contained in this post is intended to inform readers and is not intended to replace specific advice from a health care professional.

Topic Tuesday: Gonorrhea

This week’s STI topic is PACKED with many fun tidbits of trivia, so if you have the stamina to read the entire post, I promise to make it worth your time. You may just stumble upon some great stuff that I’ve thrown in. Here goes…
Gonorrhea is hard to spell! Maybe that’s why there are so many slang words for it. It’s also called the ‘clap’, ‘a red hot poker in the pipe,’ ‘pissing broken glass or like razor blades.’ Gonorrhea is caused by a bacteria that lives on warm, moist parts of the body such as the anus, vagina, penis, mouth, throat and urethra.
But first, here’s some interesting info for the next time you play ‘Trivial Pursuit: The STD Version”
The Old Testament, Leviticus, Chapter 15, devotes several verses to what is almost certainly gonorrhea!
“When any man has a running issue out of his flesh; because of his issue he is unclean…then he shall number to himself seven days for his cleansing and wash his clothes and bathe his flesh in running water and shall be clean.”
And here is a suggestion that the myth of the catching something from a toilet seat happened in Biblical times, from the same chapter!
“He that sitteth on anything whereon he sat that hath the issue shall wash his clothes, and bathe himself in water.”
So gonorrhea seems to have been around a long time! In fact, it was recognized by sages and historians such as Hippocrates, Plato and Aristotle for many centuries before Galen named it gonorrhea in 1526 from the Greek = seed and flow.  (Back in those days, mucous discharge was mistaken for semen.) 353 years later, in 1879, scientist Albert Neisser obtained experimental evidence about the pathogen for gonorrhea so the full name is Neisseria Gonnorrhoeae.
It kind of rhymes!
What Is It?
Gonorrhea (pronounced: gah-nuh-REE-uh) is a sexually transmitted disease (STD) caused by bacteria called Neisseria gonorrhoeae. Easy to see using a microscope’s high magnification, the gonococci are pink, kidney-shaped bacteria inside white cells, arranged in pairs that can be passed from one person to another through vaginal, oral or anal sex, even when the person who is infected has no symptoms.
How Is It Transmitted?
The bacteria can be spread by the exchange of sexual fluids (semen and vaginal secretions) through vaginal, anal (most common) and oral intercourse. Mouth-to-mouth transmission between adults is theoretically possible but it’s unlikely. It has sometimes been found in the throats of women or gay men who perform fellatio (oral sex), but it is unusual in men who have oral sex with infected female partner, cunnilingus. Doctors have never come across a case of direct mouth-to-mouth transmission.
No one really knows how infectious it is. A man with gonorrhea might have a 95% chance of passing it on from one episode of vaginal sex.  If the woman has gonorrhea, the risk of her passing it on may be lower.
The usual sites for infection are the urethra, throat and rectum in men, and cervix, urethra, rectum and throat in women. Rectal gonorrhea in men is mostly the result of bottoming, (being the receiving partner) although an infection can be passed by vibrators or through digital insertion (fingers). In 40% of women with gonorrhea, the infection is found in the rectum, not necessarily as a result of rectal intercourse. Gravity can allow the secretions to come into contact with anal tissue during intercourse.
You cannot catch gonorrhea from a towel, a doorknob, or a toilet seat.
But if you really want to stump someone with information about catching it from a toilet seat, read this:
Gonoccocus rapidly dies away from the warmth and moisture of a human being. So the only way to catch it from a toilet seat would be for a man’s penis to leave a little discharge on the seat while sitting, and a second man’s penis coming into contact with that discharge. That’s highly improbable and no single case has ever been recorded this way. The gonococcus cannot infect ordinary skin surfaces; it needs mucous membrane or internal tissue. It is therefore unlikely that a woman could either infect a toilet seat or bring an infect-able part of her anatomy into contact with one.
That settles that!
How Does a Girl Know She Has It?
A female who has gonorrhea may have no symptoms at all or her symptoms may be so mild that she doesn’t notice them until they become more severe. In some cases, females will feel a burning sensation when they urinate, or they will have a yellow-green vaginal discharge. There also may be vaginal bleeding between menstrual periods. Some experience frequent urination and abdominal pain, as well. Remember: 50% of women show no signs.
If the infection becomes more widespread and moves into the uterus or fallopian tubes, it may result in an infection called pelvic inflammatory disease (PID), which can cause abdominal pain, fever and pain during sexual intercourse, as well as the symptoms above.
How Does a Guy Know He Has It?
Guys who have gonorrhea are much more likely to notice symptoms, although a guy can have gonorrhea and not know it. Guys often feel a burning sensation when they urinate, and yellowish-white or greenish discharge may ooze out of the urethra (at the tip of the penis).  A guy may feel like he wants to urinate but can’t or only can a little.  Discharge in acute gonorrhea starts as a slight bit of mucus, developing into full-blown pus after a day or two – off-white and staining the underwear.
Here’s more trivia for you: clinic workers recognize the “tissue paper” sign – when a man attends with a piece of toilet paper on the inside of his underwear, the diagnosis is gonorrhea until proven otherwise.
Dysuria (which is a fancy word for “painful burning during urination”) is a classic symptom of gonorrhea but we rarely see patients complaining of the really severe discomfort mentioned in the old textbooks.  50% do not mention any discomfort at all.
How Long Until There Are Symptoms?
The incubation period, the time between infection and the development of symptoms, has progressively lengthened since the 1930s. In that pre-war era, an infected person noticed something wrong within 2 or 3 days. By the 1990s, the average time had increased to a few more days.
Symptoms usually appear 2 to 7 days after a person has been exposed to gonorrhea, and in females they may appear even later. In some cases, they can appear up to 14 days after the initial infection. No one knows how soon you are infectious, but there have been anecdotes of transmission within an hour or two of catching gonorrhea.  It is best to wait at least three days and some say a week, for detection.
Remember, many people experience no symptoms, especially with gonorrhea of the throat. However, a sore throat can be a symptom of the infection there.
Infection of the throat is not associated with any particular symptoms, although it seems that men or women who practice oral sex are more prone to sore throats than others.
Gonorrhea of the rectum tends to produce no symptoms in more than 80% of men or women infected there. Some notice pus on their feces and others may complain of a little dampness or itching around the anus, but most are unaware of their infection.
How Is It Detected?
Gonorrhea can be very dangerous if it is left untreated, even in someone who has mild or no symptoms. In females, spread of infection inwards to the uterus can give rise to endometritis, followed by involvement of the Fallopian tubes, salpingitis, and into the pelvis to cause pelvic peritonitis. Chlamydial and gonococcal salpingitis share the same signs and symptoms; both infections may be found together in the same patient and both may lead to ectopic pregnancy, scarring or infertility. Gonorrhea infection during pregnancy can cause problems for the newborn baby, including meningitis (an inflammation of the membranes around the brain and spinal cord) and an eye infection that can result in blindness if it is not treated.
And, if you’ve read this far, here’s some more trivia for you:
A woman’s ovaries are as sensitive as a man’s testicles and are normally protected within the bony pelvis; but there are certain occasions during sex when the erect penis will bang the ovary. This is known as ‘anvil syndrome’ after the metal block on which a blacksmith fashions a horseshoe.
In guys, gonorrhea can spread to the epididymis (the structure attached to the testicle that helps transport sperm), causing pain and swelling in the testicular area, known as epididymo-orchitis.  This can create scar tissue that might make a guy infertile.  Guys are less likely to develop blood-borne complications but may develop infection of the various glands in the genital area, including the Littre’s glands inside the urethra and Cowper’s, Tyson’s and the prostate gland.
In both males and females, spread of infection internally can give rise to the Fitz-Hugh-Curtis syndrome, a condition in which the lining outside the liver becomes inflamed, a ‘peri-hepatitis.’  Rarely, gonorrhea spreads via the bloodstream to elsewhere in the body, usually the skin and the joints. It can affect other organs and parts of the body including the throat, eyes, heart, brain, although this is less common.
What Can Happen?
At the beginning of the 20th century, gonorrhea could be seen using the microscope and a diagnosis made in this way was very likely to be correct. It was possible to grow (culture) the gonococcus, the bacterium, in a laboratory. But this sort of “horticulture” is time-consuming. It takes a good 48 hours for gonococcus to grow and it is expensive in labor and equipment. Now it’s a NAAT – nucleic acid amplification test (more trivia!!) which detects part of the bacterium rather than the whole organism. The tests tend to be highly sensitive; if the infection is there, they will find it.
If you think you may have gonorrhea or if you have had a partner who may have gonorrhea, you need to see your doctor or gynecologist. He or she will do an exam which may include checking a urine sample, or for a female, swabbing the vagina or cervix for discharge, which will then be analyzed. Talk to your doctor about which test is best for you. The doctor may also test for other STDs, such as syphilis or chlamydia. Let the doctor know the best way to reach you confidentially with any test results.
In more understandable terms, a diagnosis can be performed in days simply on a sample of urine, if it’s a urethral infection. A doctor will need to take a culture from the back of throat, if it’s an oral infection and from the anus, if it’s an anal infection – whether or not there are symptoms.  Blood tests are discounted; none are reliable.
How Is It Treated?
If you are diagnosed with gonorrhea, your doctor will prescribe antibiotics to treat the infection. Anyone with whom you’ve had sex should also be tested and treated for gonorrhea immediately. This includes any sexual partners in the last 2 months, or your last sexual partner if it has been more than 2 months since your last sexual experience.
If a sexual partner has gonorrhea, quick treatment will reduce the risk of complications for that person and will lower your chances of being re-infected if you have sex with that partner again. (You can become infected with gonorrhea again even after you have been treated because having gonorrhea does not make you immune to it.)
It’s better to prevent gonorrhea than to treat it, and the only way to completely prevent the infection is to abstain from all types of sexual intercourse. If you do have sex, use a latex condom every time. This is the only birth control method that will help prevent gonorrhea.
Key Points to Remember
  1. You cannot catch gonorrhea from a toilet seat.
  2. One in ten men and half of women with gonorrhea have NO symptoms.
  3. Although most men have a discharge, only 50% have pain during urination.
  4. Gonorrhea and chlamydia are like 1st cousins: if you test positive for one, you will most likely be treated for the other, as well.
Additional Resources

DISCLAIMER: The information contained in this post is intended to inform readers and is not intended to replace specific advice from a health care professional.

Topic Tuesday: Condoms

I got infected with HIV because I didn’t use one.
Below is a great post from goaskalice.columbia.edu about the different types of condoms.
Oh, and if you’re looking for the safest condoms on the market, check out this link to Consumer Reports’ most recent survey:
Happy reading.
Condoms are made from different materials — latex, lambskin, polyurethane, and also a new material called polyisoprene. Latex condoms are some of the most widely available and among the least expensive. The market offers several brands, each coming in a variety of sizes, colors, textures, shapes, and even flavors. Some are already coated with the spermicide Nonoxynol-9 (N-9), but this slight amount has been found to be inadequate in protecting against pregnancy. Additionally, research no longer promotes the use of N-9 as it may facilitate HIV transmission.
Polyisoprene condoms are the newest condom option on the market. Ideal for people allergic to latex or polyurethane, polyisoprene condoms have a soft natural feel that conforms to the skin similarly to latex. Some claim polyisoprene condoms are more comfortable than latex; you’ll have to experiment as a couple to find which material suits your groove the best. Right now polyisoprene condoms are sold in the United States by LifeStyles (SKYN) and Durex (Avanti Bare) brands.
Polyurethane condoms have long been the go-to for those with latex allergies. But even with the new polyisoprene condom on the market, polyurethane may still be a great choice for lots of couples. Compared to latex, polyurethane condoms are thinner and stronger, and tend to have a less constricting fit. Polyurethane condoms also transfer heat more efficiently, which some say increases pleasure.
Unlike other condoms, the non-latex variety are available in male and female versions. Worn by women, the female condom is a nitrile (synthetic rubber) sheath that’s inserted into a vagina up to eight hours before intercourse. Adding extra water-based lube helps increase comfort and decrease noise. (Note: female condoms should not to be used together with male condoms.) Check out What is a female condom? in the Go Ask Alice! archive for more information about this method. Both latex and non-latex condoms provide comparable protection against sexually transmitted infections (STIs). And while they also offer comparable pregnancy protection, non-latex are pricier than latex condoms.
Lambskin condoms, in contrast, are made from the oldest material on the market — the intestinal membrane of a lamb. Small pores make lambskin condoms ineffective in protecting against viruses that cause STIs. But they do protect against pregnancy, since the pores are too small for sperm to pass through. Lambskin supposedly has a more “natural” feel than latex and polyurethane, although the verdict is still out on how they stack up to polyisoprene condoms in this department.
All four male condom types offer the same statistical effectiveness against pregnancy, which is your primary concern. Contraceptive Technology estimates that only two percent of couples who consistently and correctly use male condoms will experience failure in the first year of usage. Female condoms have a probability of pregnancy of five percent, which still makes them quite an effective method of pregnancy prevention. The safest route in avoiding an unexpected pregnancy is to use a combination of hormonal birth control and a backup method, such as using male condoms. When using condoms alone, correct and consistent use will maximize their intended efficacy to keep you from getting pregnant. Check out How to Use a Condom Properly in the Go Ask Alice! archive for refreshers on expert condom protocol.
All five condom options — male latex, polyisoprene, polyurethane, and lambskin condoms as well as the female condom — offer similar protection against pregnancy. Other factors that could figure into your choice might include your budget, availability, how they feel, willingness to experiment, and animal rights convictions. Have fun trying them out!

DISCLAIMER: The information contained in this post is intended to inform readers and is not intended to replace specific advice from a health care professional.

Topic Tuesday: What’s Chlamydia?

I was recently asked to present at a conference of teens teaching other teens about STIs. While I was impressed with the few students who led the workshops, I was saddened to see the lack of basic STI knowledge in the rest of the student body.
Many of you have told me that you don’t have health classes in school. Some of you who have taken health have told me that you’re not learning enough facts that will keep you safe. With the absence of comprehensive sexual health education in too many schools today, some teens search for answers online.
Please beware: some of what’s out there may not be correct or useful information.
BUT…I’m here to help guide you in the right direction!
Here’s a great post on chlamydia that IS useful! It’s from KidsHealth.org. And here’s the full link, if you want to search through their site:
What is it?
Chlamydia (pronounced: kluh-MID-ee-uh) is a sexually transmitted disease (STD) caused by bacteria called Chlamydia trachomatis. Although you may not be familiar with its name, chlamydia is one of the most common STDs. Because there often aren’t any symptoms, though, lots of people can have chlamydia and not know it.
The bacteria can move from one person to another through sexual intercourse, and possibly through oral-genital contact. If someone touches bodily fluids that contain the bacteria and then touches his or her eye, a chlamydial eye infection (chlamydial conjunctivitis) is possible. Chlamydia also can be passed from a mother to her baby while the baby is being delivered. This can cause pneumonia and conjuntivitis, which can become very serious for the baby if it’s not treated. You can’t catch chlamydia from a towel, doorknob, or toilet seat.
How Does a Girl Know She Has It?
It can be difficult for a girl to know whether she has chlamydia because most girls don’t have any symptoms. Because of this, it’s very important to see a doctor at least once a year if you are sexually active. Your doctor can tell you about how to test for chlamydia, even if you don’t have any symptoms.
Much less often, symptoms are present and may cause an unusual vaginal discharge or pain during urination. Some girls with chlamydia also have pain in their lower abdomens, pain during sexual intercourse, or bleeding between menstrual periods. Sometimes a chlamydia infection can cause a mild fever, muscle aches, or headache.
How Does a Guy Know He Has It?
A guy can also have a difficult time recognizing that he has chlamydia and should be tested by a doctor at least once a year if he is sexually active.
When symptoms are there, guys may have a discharge from the tip of the penis (the urethra — where urine comes out), or itching or burning sensations around the penis. Rarely, the testicles may become swollen. Many times, a guy with chlamydia may have few or no symptoms, so he might not even know he has it.
When Do Symptoms Appear?
Someone who has contracted chlamydia may see symptoms a week later. In some people, the symptoms take up to 3 weeks to appear, and many people never develop any symptoms. 75% of women and 50% of men will show no symptoms.
What Can Happen?
If left untreated in girls, chlamydia can cause an infection of the urethra (where urine comes out) and inflammation (swelling and soreness caused by the infection) of the cervix. It can also lead to pelvic inflammatory disease (PID), which is an infection of the uterus, ovaries, and/or fallopian tubes. PID can cause infertility and ectopic (tubal) pregnancies later in life.
If left untreated in guys, chlamydia can cause inflammation of the urethra and epididymis (the structure attached to the testicle that helps transport sperm).
How Is It Treated?
If you think you may have chlamydia or if you have had a partner who may have chlamydia, you need to see your family doctor, adolescent doctor, or gynecologist. Some local health clinics, such as Planned Parenthood, can also test and treat people for chlamydia.
If the infection occurs through vaginal or anal intercourse, doctors usually diagnose chlamydia by testing a person’s urine or taking a tissue sample from the anus or the vagina. If the infection occurs through oral sex, doctors will take a culture from the back of the throat, whether or not there are symptoms.
If you have been exposed to chlamydia or are diagnosed with chlamydia, the doctor will prescribe antibiotics, which should clear up the infection in 7 to 10 days.
Anyone with whom you’ve had sex will also need to be tested and treated for chlamydia because that person may be infected but not have any symptoms. This includes any sexual partners in the last 2 months or your last sexual partner if it has been more than 2 months since your last sexual experience. It is very important that someone with a chlamydia infection abstain from having sex until they and their partner have been treated.
If a sexual partner has chlamydia, quick treatment will reduce his or her risk of complications and will lower your chances of being reinfected if you have sex with that partner again. (You can become infected with chlamydia again even after you have been treated because having chlamydia does not make you immune to it.)
It’s better to prevent chlamydia than to treat it, and the only way to completely prevent the infection is to abstain from all types of sexual intercourse. If you do have sex, use a latex condom every time. This is the only birth control method that will help prevent chlamydia.
Reviewed by: Nicole A. Green, MD
Date reviewed: March 2013

DISCLAIMER: The information contained in this post is intended to inform readers and is not intended to replace specific advice from a health care professional.