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Sexually Transmitted Diseases 101

February 2001

Syphilis

Syphilis is a highly treatable disease in which a single painless lesion (chancre) will develop over three to four weeks at the site of entry into the body. As the lesion may be painless and occur in the rectum, it can go unnoticed, and be easily spread.

Infection is detected by blood test, examining fluid produced by the lesions, and spinal fluid testing. Antibiotics are successful in treating syphilis. Damage caused by untreated syphilis, however, cannot be undone.

Even without treatment, the lesion will heal in about three weeks. The patient will then develop secondary syphilis, often characterized by a body rash. Without treatment, the rash will remain for about four weeks and will also eventually disappear.

Because of a relatively long incubation period, the spread of syphilis can be stopped by testing individuals who suspect they may be infected, and then treating them before the infection can be spread to others.

For people living with HIV, co-infection with HIV and syphilis may complicate the treatment of both diseases. The risk of syphilis treatment failure increases in the presence of HIV. People with HIV may also be at higher risk for neurosyphilis.

STDs also may increase the risk of HIV transmission since there is a two- to five-fold increased risk of acquiring HIV infection when syphilis is present. A person already infected with syphilis, who has sexual contact with another infected person, also infected runs the risk of an additional syphilis infection. Testing for syphilis at least every four to six months is suggested for sexually active people.

Symptoms of Syphilis

Diagnosing syphilis and treating the disease is especially complex among people with HIV. Untreated, the syphilis organism, called "spirochete," can remain in the body for life and lead to disfigurement, neurologic disorder or death.

Syphilis occurs in phases that may overlap, and do not always follow in the same sequence. Symptoms vary with each phase. In the primary phase, painless sores or open, wet chancres appear, often from three weeks to 90 days after infection. They last three to six weeks. They appear on the genitals, in the vagina, on the cervix, lips, mouth, or anus. Swollen glands may also occur during the primary phase.

Other symptoms occur in the secondary phase, which begins between three and six weeks after the sores appear. These symptoms include body rashes that last from two to six weeks, often on the palms of the hands and the soles of the feet. Other symptoms include mild fever, fatigue, sore throat, hair loss, weight loss, swollen glands, headache and muscle pains.

Latent phases of syphilis are characterized by no symptoms. This phase may occur between other phases or at the same time. When syphilis is untreated, it can reach a late phase. Serious damage to the nervous system, heart, brain, or other organs occur, and death may result.

How Syphilis Is Spread

Syphilis may be contracted through vaginal, anal or oral intercourse, kissing, and by a fetus from its mother. When sores are present early in the disease, syphilis is especially contagious. Liquid that oozes from the chancres is very infectious.

People are usually not contagious during the latent phases of the first four years of syphilis infections. Untreated syphilis remains latent for many years or a lifetime, but can be spread from a pregnant woman to her fetus.

If untreated, the risks of stillbirth or serious birth defects from syphilis infection are high. Birth defects include damage to the heart and brain as well as blindness. It is very important for pregnant women to consider testing for syphilis early, and, sometimes, throughout their pregnancies. Pregnant women with syphilis can be treated to prevent damage to the fetus.

Chlamydia

Chlamydia is the most common STD in the United States, and also the most invisible. Chlamydia is a microscopic parasite that can cause sterility in women and men. Four million American men and women become infected every year.

In women, chlamydia infects the cervix and can spread to the urethra, Fallopian tubes and ovaries. It can cause bladder infections and serious pelvic inflammatory disease (PID), sterility and ectopic pregnancy, which occurs when a fertilized egg implants in tissue outside of the uterus, and the placenta and the fetus begins to develop there. Up to 40 percent of women with untreated chlamydia will develop PID. Of those with PID, 20 percent will become infertile. In men, chlamydia infects the urethra and may spread to the testicles, causing epididymitis, which can cause sterility.

Chlamydia can also lead to Reiter's syndrome, especially in young men. Reiter's syndrome involves eye infections, urethritis and arthritis.

Symptoms

Symptoms of chlamydia include the following:

Seventy-five percent of women with chlamydia have no symptoms. Many women discover they have chlamydia only because their partners are found to be infected. Other women discover that they must have had it for some time when they are treated for the infertility that it can cause.

If symptoms appear, they do so in seven to 21 days. If your partner is a man, and he has a urinary tract infection, you may have chlamydia. Only one in four men with chlamydia have no symptoms.

Chlamydia is spread by vaginal and anal intercourse or from the birth canal to the fetus. In rare cases, it can be spread from the hand to the eye. Condoms offer very good protection against chlamydia. Chlamydia can be confused with gonorrhea and other conditions. Examination of tissue samples or urine is necessary for correct diagnosis.

Chlamydia can be treated successfully with antibiotics.

Cytomegalovirus

Cytomegalovirus (CMV) is a virus transmitted through many bodily fluids. No cure for CMV is known. CMV is also sexually transmitted. It is the most common infection in America that is spread from women to the developing fetus. CMV is also very dangerous for people with weakened immune systems. It can cause blindness and mental disorders. Like many other viruses, CMV can remain in the body for life.

Symptoms of CMV

No symptoms are generally associated with a person's initial infection with CMV. But re-infection with CMV, or infection with other STDs such as HIV and hepatitis B, may reactivate the virus and cause illness. Symptoms of CMV include:

CMV is spread by saliva, semen, blood, cervical and vaginal secretions, urine, and breast milk. It is spread through:

Adults usually become re-infected through sexual activity. Women who want to become pregnant and who suspect they may have the virus should consider testing for CMV. CMV infection can be detected through a blood test.

Condoms can provide protection against CMV during vaginal, anal and oral intercourse, but kissing and other intimate touching can spread the virus.

Gonorrhea

Gonorrhea cases in the U.S. are reported at a rate of more than one million every year. Gonorrhea is a bacterium that can cause sterility, arthritis and heart problems. In women, gonorrhea can cause pelvic inflammatory disease (PID), which can result in ectopic pregnancy or sterility. During pregnancy, gonorrhea infections can cause premature labor and stillbirth.

To prevent serious eye infections that can be caused by gonorrhea, drops of antibiotics are routinely put into the eyes of newborn babies immediately after delivery.

Symptoms of Gonorrhea

Gonorrhea symptoms for women include:

Symptoms for men include a pus-like discharge from the urethra or pain during urination. Symptoms appear in men in one to 14 days.

Eighty percent of the women with gonorrhea and 10 percent of the men with the hepatitis B disease show no symptoms. If they appear, they appear in women within 10 days.

Gonorrhea is spread by vaginal, anal and oral intercourse. It can be detected by a microscopic examination of urethral or vaginal discharges. Cultures are taken from the cervix, throat, urethra or rectum. Both partners can be successfully treated with oral antibiotics. Often people with gonorrhea also have chlamydia. They must be treated for both infections at the same time.

Condoms offer very good protection against gonorrhea.

Hepatitis B

Hepatitis B virus (HBV) is the only STD preventable with vaccination.

Despite the availability of a vaccine, about 1.5 million people in the U.S. have HBV. Because they have not been vaccinated, about 200,000 people each year get HBV. While as many as 95 percent of adults with HBV recover completely, the virus can cause severe liver disease and death.

Unless they are treated within an hour of birth, 90 percent of the infants born to women with HBV will carry the virus. Pregnant women who may have been exposed to HBV should consider being tested before giving birth so that their babies can be vaccinated at birth or treated if they become ill. Like many other viruses, HBV may remain in the body for life.

Symptoms of HBV

Early symptoms of HBV include:

Later symptoms of HBV include:

HBV is very contagious, and may show no symptoms during its most contagious phases. If symptoms appear, they appear within four weeks.

HBV is spread in semen, saliva, blood and urine by intimate and sexual contact, from kissing to vaginal, anal, and oral intercourse; use of unclean needles to inject drugs; accidental sticks with contaminated needles in the course of health care.

A blood test can diagnose HBV. In most cases, HBV infection clears within four to eight weeks. Some people, however, remain contagious for the rest of their lives.

Condoms offer some protection against HBV during vaginal, anal and oral intercourse, but the virus can be passed through kissing and other intimate touching. Children and adults who do not have HBV can get permanent protection with a series of HBV vaccinations.

Herpes (HSV)

Genital Herpes affects more than 30 million Americans, and a half million new cases are diagnosed every year.

There are two forms of genital herpes -- herpes simplex virus-1 and herpes simplex virus-2. Although herpes-1 is most often associated with cold sores and fever blisters, both forms of herpes may be sexually transmitted.

During pregnancy, herpes may cause miscarriage or stillbirth. If active herpes infections are present during childbirth, newborn infants may suffer serious health damage, including developmental disabilities and (rare) death.

Transmission is more common during the first episode of the herpes infection and less common during a recurrent herpes outbreak. Like many other viruses, the herpes simplex virus (HSV) remains in the body for life.

Symptoms of HSV

Symptoms of HSV include:

Primary outbreaks may cause:

Symptoms usually appear between two to 20 days after infection, but years may pass before an outbreak occurs. Recurrences may be related to emotional, physical or health stresses. Practicing strict hygiene is important during recurrences. If the sores are touched inadvertently, wash hands immediately. Be particularly careful when handling contact lenses and touching the eyes.

HSV is spread by touching, sexual intimacy (including kissing) and vaginal, anal and oral intercourse.

HSV may be passed from one partner to another or from one part of the body to another, whenever contact is made with an active herpes virus. Oral sex play can pass herpes from the mouth to the genitals or from the genitals to the mouth.

HSV is most contagious from the time the sores are present until they are completely healed and the scabs have fallen off. Recent studies show that some people may be contagious when they have no symptoms. Mucus membranes of the mouth, anus, vagina, penis, and the eyes are especially susceptible to infection.

Because HSV can be confused with syphilis, chancroid, and other STDs, examination of the sores and laboratory culturing of fluid samples taken from the sores are important. Definitive diagnosis may not be possible if the sores are dried or scabbed by the time you see a clinician. If you think you have herpes, it is important to have a diagnosis early in the outbreak.

While no cure for HSV exists, symptoms can be relieved. Valacyclovir and acyclovir can reduce recurrences.

Partners should refrain from sexual intimacy from the time they know the blisters are going to recur until after the scabs have completely fallen off the healed sores. Condoms offer some protection against the virus between outbreaks.

HPV Genital Warts

Human papilloma virus (HPV) infects 40 million women and men and each year about a million Americans are newly infected with genital HPVs.

More than 60 types of HPVs exist, causing a variety of warts and other conditions and can stay in the system for life. A few HPVs cause genital warts, but most genital HPV infections are not visible and have no symptoms. Some of these are associated with cancer of the cervix, vulva or penis.

Symptoms

Symptoms of HPV include warts on the genitals, in the urethra, in the anus and (rarely) in the throat. Genital warts are soft to the touch, may look like miniature cauliflower florets, and often itch. Untreated genital warts can grow to block the openings of the vagina, anus, or throat and become quite uncomfortable.

Warts usually take from two to three weeks after infection to develop. Genital warts grow more rapidly during pregnancy or when other infections are present.

Genital HPVs are spread by vaginal and anal intercourse. In rare cases, genital warts spread to the fetus during childbirth.

HPVs can be diagnosed by microscopic examination of tissue samples and clinical evaluation of warts during a physical or gynecological exam. Special magnifiers (colposcopes) can detect genital HPVs that cannot be seen with the naked eye during pelvic exams.

Pap tests may reveal pre-cancerous conditions caused by genital HPVs. Early treatment prevents cancer of the cervix. Though genital warts may recur, they can be removed by carefully applying, and often reapplying, a prescription medication, Podofilox, to the wart. Clinicians offer other treatments, including:

Condoms may offer some protection against genital HPVs, but the viruses may "shed" beyond the area protected by a condom.


This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA).




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