Posted in 2006 with about 22000 reads

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Im sure this needs updates

STD's

STD Topics-Resource suggested by Paragod
There seems to be a need of information on STDs. This will be a summary of searchable info as reference for hobbyists and ASP's. If you have alternate info, please share it. If you could provide links to your sources, it will keep the topic clearer.

I searched using ASPD's excellent Engine and found no easy resource for STD information on ASPD. There have been a couple of primary topics discussed in a review. This is a summary of essential information from the Center for Disease Control. Statistical information is current only through 2002 on some topics and 2004 on others. Links are provider to allow you to do any other research you wish. When available, symptoms, testing, prevention and other significant information will be bold, italic or underlined.

============Primary STDs=================
· Bacterial Vaginosis (BV)
· Chlamydia and LGV
· Genital Herpes
· Gonorrhea
· Hepatitis (viral)
· HIV/AIDS
· Human Papillomavirus (HPV) Infection
· Pelvic Inflammatory Disease (PID)
· Syphilis
· Trichomoniasis
============================== ==========
These STDs will not have seperate posts. For more information follow the link:

Bacterial Vaginosis
Bacterial Vaginosis (BV) is the name of a condition in women where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. It is sometimes accompanied by discharge, odor, pain, itching, or burning.
Women with BV may have an abnormal vaginal discharge with an unpleasant odor. Some women report a strong fish-like odor, especially after intercourse. Discharge, if present, is usually white or gray; it can be thin. Women with BV may also have burning during urination or itching around the outside of the vagina, or both. Some women with BV report no signs or symptoms at all.

Trichomoniasis
Trichomoniasis is caused by the single-celled protozoan parasite, Trichomonas vaginalis. The vagina is the most common site of infection in women, and the urethra (urine canal) is the most common site of infection in men. The parasite is sexually transmitted through penis-to-vagina intercourse or vulva-to-vulva (the genital area outside the vagina) contact with an infected partner. Women can acquire the disease from infected men or women, but men usually contract it only from infected women.

Pelvic Inflammatory Disease (PID)
Symptoms of PID vary from none to severe. When PID is caused by chlamydial infection, a woman may experience mild symptoms or no symptoms at all, while serious damage is being done to her reproductive organs. Because of vague symptoms, PID goes unrecognized by women and their health care providers about two thirds of the time. Women who have symptoms of PID most commonly have lower abdominal pain. Other signs and symptoms include fever, unusual vaginal discharge that may have a foul odor, painful intercourse, painful urination, irregular menstrual bleeding, and pain in the right upper abdomen (rare). PID is difficult to diagnose because the symptoms are often subtle and mild. Many episodes of PID go undetected because the woman or her health care provider fails to recognize the implications of mild or nonspecific symptoms. Because there are no precise tests for PID, a diagnosis is usually based on clinical findings. If symptoms such as lower abdominal pain are present, a health care provider should perform a physical examination to determine the nature and location of the pain and check for fever, abnormal vaginal or cervical discharge, and for evidence of gonorrheal or chlamydial infection. If the findings suggest PID, treatment is necessary.
The health care provider may also order tests to identify the infection-causing organism (e.g., chlamydial or gonorrheal infection) or to distinguish between PID and other problems with similar symptoms. A pelvic ultrasound is a helpful procedure for diagnosing PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present. In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end (laparoscope) is inserted through a small incision in the lower abdomen. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.

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Part 2

Chlamydia

Chlamydia

Statistics:

Chlamydia is a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis, which can damage a woman's reproductive organs. Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man.
Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States. In 2002, 834,555 chlamydial infections were reported to CDC from 50 states and the District of Columbia. Under-reporting is substantial because most people with chlamydia are not aware of their infections and do not seek testing. Also, testing is not often done if patients are treated for their symptoms. An estimated 2.8 million Americans are infected with chlamydia each year. Women are frequently re-infected if their sex partners are not treated.
Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.
Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection. Because the cervix (opening to the uterus) of teenage girls and young women is not fully matured, they are at particularly high risk for infection if sexually active. Since chlamydia can be transmitted by oral or anal sex, men who have sex with men are also at risk for chlamydial infection
Chlamydia is known as a "silent" disease because about three quarters of infected women and about half of infected men have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure.
In women, the bacteria initially infect the cervix and the urethra (urine canal). Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. When the infection spreads from the cervix to the fallopian tubes, some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. Chlamydial infection of the cervix can spread to the rectum.
Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Pain and swelling in the testicles are uncommon.
Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner.
If untreated, chlamydial infections can progress to serious reproductive and other health problems with both short-term and long-term consequences. Like the disease itself, the damage that chlamydia causes is often "silent."
In women, untreated infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). This happens in up to 40 percent of women with untreated chlamydia. PID can cause permanent damage to the fallopian tubes, uterus, and surrounding tissues. The damage can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy (pregnancy outside the uterus). Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed.
To help prevent the serious consequences of chlamydia, screening at least annually for chlamydia is recommended for all sexually active women age 25 years and younger. An annual screening test also is recommended for older women with risk factors for chlamydia (a new sex partner or multiple sex partners).
Complications among men are rare. Infection sometimes spreads to the epididymis (a tube that carries sperm from the testis), causing pain, fever, and, rarely, sterility.
Rarely, genital chlamydial infection can cause arthritis that can be accompanied by skin lesions and inflammation of the eye and urethra (Reiter's syndrome).
There are laboratory tests to diagnose chlamydia. Some can be performed on urine, other tests require that a specimen be collected from a site such as the penis or cervix.
The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia.
Chlamydia screening is recommended annually for all sexually active women 25 years of age and younger. An annual screening test also is recommended for older women with risk factors for chlamydia (a new sex partner or multiple sex partners).
Any genital symptoms such as discharge or burning during urination or unusual sore or rash should be a signal to stop having sex and to consult a health care provider immediately. If a person has been treated for chlamydia (or any other STD), he or she should notify all recent sex partners so they can see a health care provider and be treated. This will reduce the risk that the sex partners will develop serious complications from chlamydia and will also reduce the person's risk of becoming re-infected. The person and all of his or her sex partners must avoid sex until they have completed their treatment for chlamydia.

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Part 3

Papillomavirus - genital warts

Papillomavirus

Statistics:

Genital HPV infection is a sexually transmitted disease (STD) that is caused by human papillomavirus (HPV). Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or rectum. Most people who become infected with HPV will not have any symptoms and will clear the infection on their own.
Some of these viruses are called "high-risk" types, and may cause abnormal Pap tests. They may also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called "low-risk" types, and they may cause mild Pap test abnormalities or genital warts. Genital warts are single or multiple growths or bumps that appear in the genital area, and sometimes are cauliflower shaped.
Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year.
The types of HPV that infect the genital area are spread primarily through genital contact. Most HPV infections have no signs or symptoms; therefore, most infected persons are unaware they are infected, yet they can transmit the virus to a sex partner. Rarely, a pregnant woman can pass HPV to her baby during vaginal delivery. A baby that is exposed to HPV very rarely develops warts in the throat or voice box.
Most people who have a genital HPV infection do not know they are infected. The virus lives in the skin or mucous membranes and usually causes no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis. Very rarely, HPV infection results in anal or genital cancers.
[i]Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area.[/u] They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks or months, or not at all.
Genital warts are diagnosed by visual inspection. Visible genital warts can be removed by medications the patient applies, or by treatments performed by a health care provider. Some individuals choose to forego treatment to see if the warts will disappear on their own. No treatment regimen for genital warts is better than another, and no one treatment regimen is ideal for all cases.
Most women are diagnosed with HPV on the basis of abnormal Pap tests. A Pap test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. Also, a specific test is available to detect HPV DNA in women. The test may be used in women with mild Pap test abnormalities, or in women >30 years of age at the time of Pap testing. The results of HPV DNA testing can help health care providers decide if further tests or treatment are necessary.
No HPV tests are available for men.
There is no "cure" for HPV infection, although in most women the infection goes away on its own. The treatments provided are directed to the changes in the skin or mucous membrane caused by HPV infection, such as warts and pre-cancerous changes in the cervix.
All types of HPV can cause mild Pap test abnormalities which do not have serious consequences. Approximately 10 of the 30 identified genital HPV types can lead, in rare cases, to development of cervical cancer. Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with "high-risk" types of HPV is the main risk factor for cervical cancer.
A Pap test can detect pre-cancerous and cancerous cells on the cervix. Regular Pap testing and careful medical follow-up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life threatening cervical cancer. The Pap test used in U.S. cervical cancer screening programs is responsible for greatly reducing deaths from cervical cancer. For 2004, the American Cancer Society estimates that about 10,520 women will develop invasive cervical cancer and about 3,900 women will die from this disease. Most women who develop invasive cervical cancer have not had regular cervical cancer screening.
The surest way to eliminate risk for genital HPV infection is to refrain from any genital contact with another individual.
For those who choose to be sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections. However, it is difficult to determine whether a partner who has been sexually active in the past is currently infected.
For those choosing to be sexually active and who are not in long-term mutually monogamous relationships, reducing the number of sexual partners and choosing a partner less likely to be infected may reduce the risk of genital HPV infection. Partners less likely to be infected include those who have had no or few prior sex partners.
HPV infection can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease.

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Part 4

Syphilis
Statistics:

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called “the great imitator� because so many of the signs and symptoms are indistinguishable from those of other diseases.
In the United States, health officials reported over 32,000 cases of syphilis in 2002, including 6,862 cases of primary and secondary (P&S) syphilis. In 2002, half of all P&S syphilis cases were reported from 16 counties and 1 city; and most P&S syphilis cases occurred in persons 20 to 39 years of age. The incidence of infectious syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age. Reported cases of congenital syphilis in newborns decreased from 2001 to 2002, with 492 new cases reported in 2001 compared to 412 cases in 2002.
Between 2001 and 2002, the number of reported P & S syphilis cases increased 12.4 percent. Rates in women continued to decrease, and overall, the rate in men was 3.5 times that in women. This, in conjunction with reports of syphilis outbreaks in men who have sex with men (MSM), suggests that rates of syphilis in MSM are increasing.
Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.
Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission appears to occur from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, most transmission is from persons who are unaware of their infection.
Primary Stage
The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.
Secondary Stage
Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and late stages of disease.
Late Stage
The latent (hidden) stage of syphilis begins when secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. In the late stages of syphilis, it may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.
Some health care providers can diagnose syphilis by examining material from a chancre (infectious sore) using a special microscope called a dark-field microscope. If syphilis bacteria are present in the sore, they will show up when observed through the microscope.
A blood test is another way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.
Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present.
Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes, such as syphilis, disrupt barriers that provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to HIV. Having other STDs is also an important predictor for becoming HIV infected because STDs are a marker for behaviors associated with HIV transmission.
Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.
Because effective treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual behaviors put them at risk for STDs.
Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.
Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Talking with a health care provider will help to determine the need to be re-tested for syphilis after treatment has been received.

The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken.
Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of syphilis, as well as genital herpes and chancroid, only when the infected area or site of potential exposure is protected.
Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are no more effective than other lubricated condoms in protecting against the transmission of STDs. Based on findings from several research studies, N-9 may itself cause genital lesions, providing a point of entry for HIV and other STDs. In June 2001, the CDC recommended that N-9 not be used as a microbicide or lubricant during anal intercourse. Transmission of a STD, including syphilis cannot be prevented by washing the genitals, urinating, and or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to see a doctor immediately.

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Part 5

Genital herpes

Genital herpes
Statistics:

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.
Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.
Results of a nationally representative study show that genital herpes infection is common in the United States. Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had genital HSV infection. Between the late 1970s and the early 1990s, the number of Americans with genital herpes infection increased 30 percent.
Genital HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of five). This may be due to male-to-female transmissions being more likely than female-to-male transmission.
HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, but they also are released between outbreaks from skin that does not appear to be broken or to have a sore. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.
HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips, so-called "fever blisters." HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.
Most people infected with HSV-2 are not aware of their infection. However, if signs and symptoms occur during the first outbreak, they can be quite pronounced. The first outbreak usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. Other signs and symptoms during the primary episode may include a second crop of sores, and flu-like symptoms, including fever and swollen glands. However, most individuals with HSV-2 infection may never have sores, or they may have very mild signs that they do not even notice or that they mistake for insect bites or another skin condition.
Most people diagnosed with a first episode of genital herpes can expect to have several (typically four or five) outbreaks (symptomatic recurrences) within a year. Over time these recurrences usually decrease in frequency.
Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress in people who know they are infected.
In addition, genital HSV can cause potentially fatal infections in babies. It is important that women avoid contracting herpes during pregnancy because a first episode during pregnancy causes a greater risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Fortunately, infection of a baby from a woman with herpes infection is rare.
Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious.
The signs and symptoms associated with HSV-2 can vary greatly. Health care providers can diagnose genital herpes by visual inspection if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be difficult to diagnose between outbreaks. Blood tests, which detect HSV-1 or HSV-2 infection, may be helpful, although the results are not always clear-cut.
There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners.
The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Genital ulcer diseases can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes only when the infected area or site of potential exposure is protected. Since a condom may not cover all infected areas, even correct and consistent use of latex condoms cannot guarantee protection from genital herpes.
Persons with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected. Sex partners can seek testing to determine if they are infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection.

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Part 6

Gonorrhea

Gonorrhea

Statistics

Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.
Gonorrhea is a very common infectious disease. CDC estimates that more than 700,000 persons in the U.S. get new gonorrheal infections each year. Only about half of these infections are reported to CDC. In 2002, 351,852 cases of gonorrhea were reported to CDC. In the period from 1975 to 1997, the national gonorrhea rate declined, following the implementation of the national gonorrhea control program in the mid-1970s. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2002, the rate of reported gonorrheal infections was 125.0 per 100,000 persons.
Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery.
People who have had gonorrhea and received treatment may get infected again if they have sexual contact with a person infected with gonorrhea.
Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans.
Although many men with gonorrhea may have no symptoms at all, some men have some signs or symptoms that appear two to five days after infection; symptoms can take as long as 30 days to appear. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles.
In women, the symptoms of gonorrhea are often mild, but most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.
Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may cause no symptoms. Infections in the throat may cause a sore throat but usually causes no symptoms.
Untreated gonorrhea can cause serious and permanent health problems in both women and men.
In women, gonorrhea is a common cause of pelvic inflammatory disease (PID). About one million women each year in the United States develop PID. Women with PID do not necessarily have symptoms. When symptoms are present, they can be very severe and can include abdominal pain and fever. PID can lead to internal abscesses (pus-filled “pockets� that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube.
In men, gonorrhea can cause epididymitis, a painful condition of the testicles that can lead to infertility if left untreated.
Gonorrhea can spread to the blood or joints. This condition can be life threatening. In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are more likely to transmit HIV to someone else.
Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testing from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to a laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by testing a urine sample. A quick laboratory test for gonorrhea that can be done in some clinics or doctor's offices is a Gram stain. A Gram stain of a sample from a urethra or a cervix allows the doctor to see the gonorrhea bacterium under a microscope. This test works better for men than for women.
Several antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. Because many people with gonorrhea also have chlamydia, another sexually transmitted disease, antibiotics for both infections are usually given together. Persons with gonorrhea should be tested for other STDs.
It is important to take all of the medication prescribed to cure gonorrhea. Although medication will stop the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhea. If a person's symptoms continue even after receiving treatment, he or she should return to a doctor to be reevaluated.
The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea.
Any genital symptoms such as discharge or burning during urination or unusual sore or rash should be a signal to stop having sex and to see a doctor immediately. If a person has been diagnosed and treated for gonorrhea, he or she should notify all recent sex partners so they can see a health care provider and be treated. This will reduce the risk that the sex partners will develop serious complications from gonorrhea and will also reduce the person's risk of becoming re-infected. The person and all of his or her sex partners must avoid sex until they have completed their treatment for gonorrhea.

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Part 7

HIV

HIV Questions and Answers (Q&A)

How Effective Are Latex Condoms in Preventing HIV?
Latex condoms, when used consistently and correctly, are highly effective in preventing heterosexual sexual transmission of HIV, the virus that causes AIDS. Research on the effectiveness of latex condoms in preventing heterosexual transmission is both comprehensive and conclusive. The ability of latex condoms to prevent transmission has been scientifically established in laboratory studies as well as in epidemiologic studies of uninfected persons at very high risk of infection because they were involved in sexual relationships with HIV-infected partners. The most recent meta-analysis of epidemiologic studies of condom effectiveness was published by Weller and Davis in 2004. This analysis refines and updates their previous report published in 1999. The analysis demonstrates that the consistent use of latex condoms provides a high degree of protection against heterosexual transmission of HIV. It should be noted that condom use cannot provide absolute protection against HIV. The surest way to avoid transmission of HIV is to abstain from sexual intercourse or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected.

How can I tell if I'm infected with HIV?
What are the symptoms?
The only way to know if you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected. Many people who are infected with HIV do not have any symptoms at all for many years.

The following may be warning signs of HIV infection:
· rapid weight loss
· dry cough
· recurring fever or profuse night sweats
· profound and unexplained fatigue
· swollen lymph glands in the armpits, groin, or neck
· diarrhea that lasts for more than a week
· white spots or unusual blemishes on the tongue, in the mouth, or in the throat
· pneumonia
· red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
· memory loss, depression, and other neurological disorders

However, no one should assume they are infected if they have any of these symptoms. Each of these symptoms can be related to other illnesses. Again, the only way to determine whether you are infected is to be tested for HIV infection. For information on where to find an HIV testing site, visit the National HIV Testing Resources Web site at http://www.hivtest.org or call CDC-INFO 24 Hours/Day at1-800-CDC-INFO (232-4636), 1-888-232-6348 (TTY), in English, en Español.

You also cannot rely on symptoms to establish that a person has AIDS. The symptoms of AIDS are similar to the symptoms of many other illnesses. AIDS is a medical diagnosis made by a doctor based on specific criteria established by the CDC. For more information refer to the Morbidity and Mortality Weekly Report “ 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults � at http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm.

How is HIV passed from one person to another?
HIV transmission can occur when blood, semen (cum), pre-seminal fluid (pre-cum), vaginal fluid, or breast milk from an infected person enters the body of an uninfected person.
HIV can enter the body through a vein (e.g., injection drug use), the lining of the anus or rectum, the lining of the vagina and/or cervix, the opening to the penis, the mouth, other mucous membranes (e.g., eyes or inside of the nose), or cuts and sores. Intact, healthy skin is an excellent barrier against HIV and other viruses and bacteria.
These are the most common ways that HIV is transmitted from one person to another:
· by having sex (anal, vaginal, or oral) with an HIV-infected person;
· by sharing needles or injection equipment with an injection drug user who is infected with HIV; or
· from HIV-infected women to their babies before or during birth, or through breast-feeding after birth.

HIV also can be transmitted through receipt of infected blood or blood clotting factors. However, since 1985, all donated blood in the United States has been tested for HIV. Therefore, the risk of infection through transfusion of blood or blood products is extremely low. The U.S. blood supply is considered to be among the safest in the world.
For more information, see "How safe is the blood supply in the United States?")

Some health-care workers have become infected after being stuck with needles containing HIV-infected blood or, less frequently when infected blood comes in contact with a worker's open cut or is splashed into a worker's eyes or inside their nose. There has been only one instance of patients being infected by an HIV-infected dentist to his patients.
For more information, see "Are health care workers at risk of getting HIV on the job?" and "Are patients in a health care setting at risk of getting HIV?" If you would like more information or have personal concerns, call CDC-INFO 24 Hours/Day at 1-800-CDC-INFO (232-4636), 1-888-232-6348 (TTY), in English, en Español.

Which body fluids transmit HIV?

These body fluids have been shown to contain high concentrations of HIV:
· blood
· semen
· vaginal fluid
· breast milk
· other body fluids containing blood
The following are additional body fluids that may transmit the virus that health care workers may come into contact with:
· fluid surrounding the brain and the spinal cord
· fluid surrounding bone joints
· fluid surrounding an unborn baby
HIV has been found in the saliva and tears of some persons living with HIV, but in very low quantities. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

What are the different HIV screening tests available in the U.S.?
In most cases the EIA (enzyme immunoassay), performed on blood drawn from a vein, is the standard screening test used to detect the presence of antibodies to HIV. A reactive EIA must be used with a follow-up confirmatory test such as the Western blot to make a positive diagnosis. There are EIA tests that use other body fluids to screen for antibodies to HIV. These include:
· Oral Fluid Tests – use oral fluid (not saliva) that is collected from the mouth using a special collection device. This is an EIA antibody test similar to the standard blood EIA test and requires a follow-up confirmatory Western Blot using the same oral fluid sample.
· Urine Tests – use urine instead of blood. The sensitivity and specificity (accuracy) are somewhat less than that of the blood and oral fluid tests. This is also an EIA antibody test similar to blood EIA tests and requires a follow-up confirmatory Western Blot using the same urine sample.
Rapid Tests:
A rapid test is a screening test that produces very quick results, in approximately 20-60 minutes. Rapid tests use blood or oral fluid to look for the presence of antibodies to HIV. As is true for all screening tests, a reactive rapid HIV test result must be confirmed with a follow-up confirmatory test before a final diagnosis of infection can be made. These tests have similar accuracy rates as traditional EIA screening tests. Please visit the rapid HIV testing section of the Divisions of HIV/AIDS Prevention Web site for details.
Home Testing Kits:
Consumer-controlled test kits (popularly known as "home testing kits") were first licensed in 1997. Although home HIV tests are sometimes advertised through the Internet, currently only the Home Access HIV-1 Test System is approved by the Food and Drug Administration. (The accuracy of other home test kits cannot be verified). The Home Access HIV-1 Test System can be found at most local drug stores. It is not a true home test, but a home collection kit. The testing procedure involves pricking a finger with a special device, placing drops of blood on a specially treated card, and then mailing the card in to be tested at a licensed laboratory. Customers are given an identification number to use when phoning in for the results. Callers may speak to a counselor before taking the test, while waiting for the test result, and when the results are given. All individuals receiving a positive test result are provided referrals for a follow-up confirmatory test, as well as information and resources on treatment and support services.
There are other tests that are used in screening the blood supply and for rare cases when standard tests are unable to detect antibodies to HIV.
For additional information on the various types of HIV tests, visit the Food and Drug Administration (FDA) Center for Biologics


More resources:
Evaluation and Research at http://www.fda.gov/cber/products/testkits.htm .


HIV Counseling, Testing, and Referral Resources
http://www.cdc.gov/hiv/topics/prev_p...-Resources.htm


Rapid HIV Testing
http://www.cdc.gov/hiv/rapid_testing/index.htm


Statistics and Surveillance
http://www.cdc.gov/hiv/topics/surveillance/index.htm

Basic Statistics
http://www.cdc.gov/hiv/topics/surveillance/basic.htm

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Part 9

Hepatitis

Hepatitis

===========================
Hepatitis A: is a liver disease caused by the hepatitis A virus (HAV). Hepatitis A can affect anyone. In the United States, hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics.
How is hepatitis A virus transmitted?
Hepatitis A virus is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. This type of transmission is called "fecal-oral." For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed.

Most infections result from contact with a household member or sex partner who has hepatitis A. Casual contact, as in the usual office, factory, or school setting, does not spread the virus.

What are the signs and symptoms of hepatitis A?
Persons with hepatitis A virus infection may not have any signs or symptoms of the disease. Older persons are more likely to have symptoms than children. If symptoms are present, they usually occur abruptly and may include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes). Symptoms usually last less than 2 months; a few persons are ill for as long as 6 months. The average incubation period for hepatitis A is 28 days (range: 15–50 days).

If you've had hepatitis A in the past, can you get it again?
No. Once you recover from hepatitis A you develop antibodies that provide life-long protection from future infections. After recovering from hepatitis A, you will never get it again and you cannot transmit the virus to others.

How do you know if you have hepatitis A?
A blood test (IgM anti-HAV) is needed to diagnose hepatitis A. Talk to your doctor or someone from your local health department if you suspect that you have been exposed to hepatitis A or any type of viral hepatitis.

How can you prevent hepatitis A?
Always wash your hands after using the bathroom, changing a diaper, or before preparing or eating food.

Two products are used to prevent hepatitis A virus infection: immune globulin and hepatitis A vaccine.

Immune globulin is a preparation of antibodies that can be given before exposure for short-term protection against hepatitis A and for persons who have already been exposed to hepatitis A virus. Immune globulin must be given within 2 weeks after exposure to hepatitis A virus for maximum protection.

Hepatitis A vaccine has been licensed in the United States for use in persons 12 months of age and older. The vaccine is recommended (before exposure to hepatitis A virus) for persons who are more likely to get hepatitis A virus infection or are more likely to get seriously ill if they do get hepatitis A. The vaccines currently licensed in the United States are HAVRIX® (manufactured by GlaxoSmithKline) and VAQTA® (manufactured by Merck & Co., Inc).
Who Should Get Vaccinated Against Hepatitis A?
How do you kill hepatitis A virus (HAV)?
HAV can live outside the body for months, depending on the environmental conditions. HAV is killed by heating to 185 degrees F. (85 degrees C.) for one minute. However, HAV can still be spread from cooked food if it gets contaminated after cooking. Adequate chlorination of water, as recommended in the US, kills HAV that may get into the water supply.

For information on disinfectants and sterilants used to kill viruses like HAV on hard surfaces (e.g., counter tops, tables, floors) see: http://www.cdc.gov/ncidod/hip/Sterile/sterile.htm.

Can I donate blood if I have had any type of viral hepatitis?
If you had any type of viral hepatitis since aged 11 years, you are not eligible to donate blood. In addition, if you ever tested positive for hepatitis B or hepatitis C, at any age, you are not eligible to donate, even if you were never sick or jaundiced from the infection.
==========================
Hepatitis B: is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.
How do you know if you have hepatitis B?
Only a blood test can tell for sure.

How is HBV spread?
HBV is spread when blood from an infected person enters the body of a person who is not infected. For example, HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use might reduce transmission), by sharing drugs, needles, or "works" when "shooting" drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth.

Hepatitis B is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, coughing, sneezing or by casual contact.

How long does it take for a blood test, such as HBsAg, to be positive after exposure to hepatitis B virus?
HBsAg will be detected in an infected person’s blood on the average of 4 weeks (range 1-9 weeks) after exposure to the virus. About 1 out of 2 patients will no longer be infectious by 7 weeks after onset of symptoms and all patients, who do not remain chronically infected, will be HBsAg-negative by 15 weeks after onset of symptoms.

If a person has symptoms, how long does it take for symptoms to occur after exposure to hepatitis B virus?
If symptoms occur, they occur on the average of 12 weeks (range 9-21 weeks) after exposure to hepatitis B virus. Symptoms occur in about 70% of patients. Symptoms are more likely to occur in adults than in children.

What are the symptoms of hepatitis B?
Sometimes a person with HBV infection has no symptoms at all. The older you are, the more apt you are to have symptoms. You might be infected with HBV (and be spreading the virus) and not know it.

If you have symptoms, they might include:

yellow skin or yellowing of the whites of your eyes (jaundice)
tiredness
loss of appetite
nausea
abdominal discomfort
dark urine
clay-colored bowel movements
joint pain
What are the risk factors for hepatitis B?
You are at increased risk of HBV infection if you:

have sex with someone infected with HBV
have sex with more than one partner
shoot drugs
are a man and have sex with a man
live in the same house with someone who has chronic (long-term) HBV infection
have a job that involves contact with human blood
are a client in a home for the developmentally disabled
have hemophilia
travel to areas where hepatitis B is common (country listing)
One out of 20 people in the United States will get infected with HBV some time during their lives.

Your risk is higher if your parents were born in Southeast Asia, Africa, the Amazon Basin in South America, the Pacific Islands, or the Middle East.

Is there a cure for hepatitis B?
There are no medications available for recently acquired (acute) HBV infection. Hepatitis B vaccine is available for the prevention of HBV infection. There are antiviral drugs available for the treatment of chronic HBV infection.

How common is HBV infection in the U.S.?
In 2003, an estimated 73,000 people were infected with HBV. People of all ages get hepatitis B and about 5,000 die per year of sickness caused by HBV.

If you are pregnant, should you worry about hepatitis B?
Yes, you should get a blood test to check for HBV infection early in your pregnancy. This test is called hepatitis B surface antigen (HBsAg). If you test HBsAg-negative early in pregnancy, but continue behaviors that put you at risk for HBV infection (e.g., multiple sex partners, injection drug use), you should be retested for HBsAg close to delivery. If your HBsAg test is positive, this means you are infected with HBV and can give the virus to your baby. Babies who get HBV at birth might develop chronic HBV infection that can lead to cirrhosis of the liver or liver cancer.

If your blood test is positive, your baby should receive the first dose of hepatitis B vaccine, along with another shot, hepatitis B immune globulin (called HBIG), at birth. The second dose of vaccine should be given at aged 1-2 months and the third dose at aged 6 months (but not before aged 24 weeks).

Can I donate blood if I have had any type of viral hepatitis?
If you had any type of viral hepatitis since aged 11 years, you are not eligible to donate blood. In addition, if you ever tested positive for hepatitis B or hepatitis C, at any age, you are not eligible to donate, even if you were never sick or jaundiced from the infection.

How long can HBV survive outside the body?
HBV can survive outside the body at least 7 days and still be capable of causing infection.

What do you use to remove HBV from environmental surfaces?
You should clean up any blood spills - including dried blood, which can still be infectious - using 1:10 dilution of one part household bleach to 10 parts of water for disinfecting the area. Use gloves when cleaning up any blood spills.

=======================
Hepatitis C: is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have the disease. HCV is spread by contact with the blood of an infected person.
There are several blood tests that can be done to determine if you have been infected with HCV. Your doctor may order just one or a combination of these tests. The following are the types of tests your doctor may order and the purpose for each:

a) Anti-HCV (antibody to HCV)
EIA (enzyme immunoassay) or CIA (enhanced chemiluminescence immunoassay)
Test is usually done first. If positive, it should be confirmed

RIBA (recombinant immunoblot assay)
A supplemental test used to confirm a positive EIA test

Anti-HCV does not tell whether the infection is new (acute), chronic (long-term) or is no longer present.

b) Qualitative tests to detect presence or absence of virus (HCV RNA)
c) Quantitative tests to detect amount (titer) of virus (HCV RNA)

A single positive PCR test indicates infection with HCV. A single negative test does not prove that a person is not infected. Virus may be present in the blood and just not found by PCR. Also, a person infected in the past who has recovered may have a negative test. When hepatitis C is suspected and PCR is negative, PCR should be repeated.

Who should get tested for hepatitis C?

persons who ever injected illegal drugs, including those who injected once or a few times many years ago
persons who were treated for clotting problems with a blood product made before 1987 when more advanced methods for manufacturing the products were developed
persons who were notified that they received blood from a donor who later tested positive for hepatitis C
persons who received a blood transfusion or solid organ transplant before July 1992 when better testing of blood donors became available
long-term hemodialysis patients
persons who have signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
healthcare workers after exposures (e.g., needle sticks or splashes to the eye ) to HCV-positive blood on the job
children born to HCV-positive women
What is the next step if you have a confirmed positive anti-HCV test?
Measure the level of ALT ( alanine aminotransferase, a liver enzyme) in the blood. An elevated ALT indicates inflammation of the liver and you should be checked further for chronic (long-term) liver disease and possible treatment. The evaluation should be done by a healthcare professional familiar with chronic hepatitis C.

Can you have a normal liver enzyme (e.g., ALT) level and still have chronic hepatitis C?
Yes. It is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some persons have a liver enzyme level that is normal for over a year but they still have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6 to 12 month period. If the liver enzyme level remains normal, your doctor may check it less frequently, such as once a year.

=========================
Hepatitis D: is a liver disease caused by the hepatitis D virus (HDV), a defective virus that needs the hepatitis B virus to exist. Hepatitis D virus (HDV) is found in the blood of persons infected with the virus.
SIGNS & SYMPTOMS
jaundice
fatigue
abdominal pain
loss of appetite
nausea, vomiting
joint pain
dark (tea colored) urine


CAUSE Hepatitis D virus (HDV)

LONG-TERM EFFECTS
WITHOUT VACCINATION HDV can be acquired either as
a co-infection (occurs simultaneously) with hepatitis B virus (HBV) or
as a superinfection in persons with existing chronic HBV infection.
HBV-HDV co-infection:
may have more severe acute disease and a higher risk (2%-20%) of developing acute liver failure compared with those infected with HBV alone
HBV-HDV superinfection
chronic HBV carriers who acquire HDV superinfection usually develop chronic HDV infection
progression to cirrhosis is believed to be more common with HBV/HDV chronic infections


TRANSMISSION Occurs when blood from an infected person enters the body of a person who is not immune.
HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission);
By sharing drugs, needles, or "works" when "shooting" drugs;
Through needlesticks or sharps exposures on the job; or
From an infected mother to her baby during birth.


RISK GROUPS Injection drug users
Men who have sex with men
Hemodialysis patients
Sex contacts of infected persons

Health care and public safety workers
Infants born to infected mothers
(very rare)


PREVENTION Hepatitis B vaccination
HBV-HDV coinfection
pre- or post-exposure prophylaxis (hepatitis B immune globulin or vaccine) to prevent HBV infection
HBV-HDV superinfection
education to reduce risk behaviors among persons with chronic HBV infection


VACCINE RECOMMENDATIONS Hepatitis B vaccine should be given to prevent HBV/HDV co-infection

TREATMENT & MEDICAL MANAGEMENT Acute HDV infection
Supportive care
Chronic HDV infection
interferon-alfa
liver transplant


=============================
Hepatitis E: is a liver disease caused by the hepatitis E virus (HEV) transmitted in much the same way as hepatitis A virus. Hepatitis E, however, does not occur often in the United States.

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Part 10
Stats

STD Count
State Name STD Count Denominator STD Rate (per 100,000)Arkansas (05) 22,448 8,114,856 276.63
Colorado (08) 40,306 13,444,073 299.8
District of Columbia (11) 9,759 1,715,618 568.83
Florida (12) 122,065 49,799,628 245.11
Georgia (13) 103,524 25,526,297 405.56
Hawaii (15) 14,032 3,716,821 377.53
Illinois (17) 140,111 37,721,467 371.44
Indiana (18) 49,433 18,444,879 268
Iowa (19) 18,385 8,805,487 208.79
Kansas (20) 20,083 8,133,893 246.91
Michigan (26) 95,934 30,107,158 318.64
Missouri (29) 48,700 16,982,467 286.77
Nebraska (31) 12,724 5,178,399 245.71
New York (36) 154,738 57,399,414 269.58
Ohio (39) 118,207 34,232,322 345.31
Oklahoma (40) 32,295 10,457,005 308.84
Texas (48) 208,473 64,930,769 321.07

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In conclusion

What does it all mean??

http://www.cdc.gov/std/stats/trends2004.htm
Trends in Reportable Sexually Transmitted Diseases in the United States, 2004
National Surveillance Data for Chlamydia, Gonorrhea, and Syphilis

Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. While substantial progress has been made in preventing, diagnosing, and treating certain STDs in recent years, CDC estimates that [u]19 million new infections occur each year, almost half of them among young people ages 15 to 24.
1 In addition to the physical and psychological consequences of STDs, these diseases also exact a tremendous economic toll. Direct medical costs associated with STDs in the United States are estimated at $13 billion annually.
2 This document summarizes 2004 national data on trends in notifiable STDs — chlamydia, gonorrhea, and syphilis — that are published in CDC's report, Sexually Transmitted Disease Surveillance 2004 (available at www.CDC.gov/STD/stats). These data, which are useful for examining overall trends and trends among populations at risk, represent only a small proportion of the true national burden of STDs. Many cases of notifiable STDs go undiagnosed, and some highly prevalent viral infections, such as human papillomavirus and genital herpes, are not reported at all.

Chlamydia: Expanded Screening Efforts Result in More Reported Cases, But Majority of Infections Remain Undiagnosed
Chlamydia remains the most commonly reported infectious disease in the United States. In 2004, 929,462 chlamydia diagnoses were reported, up from 877,478 in 2003. Even so, most chlamydia cases go undiagnosed. It is estimated that there are approximately 2.8 million new cases of chlamydia in the United States each year.1

The national rate of reported chlamydia in 2004 was 319.6 cases per 100,000 population, an increase of 5.9 percent from 2003 (301.7). The increases in reported cases and rates likely reflect the continued expansion of screening efforts and increased use of more sensitive diagnostic tests, rather than an actual increase in new infections.
Impact on Women
Women, especially young women, are hit hardest by chlamydia. Studies have found that chlamydia is more common among young women than young men, and the long-term consequences of untreated disease for women are much more severe. The chlamydia case rate for females in 2004 was 3.3 times higher than for males (485.0 vs. 147.1). However, much of this difference reflects the fact that women are far more likely to be screened than men. Females ages 15 to 19 had the highest chlamydia rate (2,761.5), followed by females ages 20 to 24 (2,630.7).
[u]African-American women are also disproportionately impacted by chlamydia. In 2004, the rate of reported chlamydia among black females (1,722.3) was more than 7.5 times that of white females (226.6). Because case reports do not provide a complete account of the burden of disease, researchers also evaluate chlamydia prevalence in subgroups of the population to better estimate the true extent of the disease. For example, data from chlamydia screening in family planning clinics across the United States indicates that roughly 6 percent of 15- to 24-year-old females in these settings are infected. [/b]

Importance of Screening
Because chlamydia is most common among young women, CDC recommends annual chlamydia screening for sexually active women under age 26, as well as older women with risk factors such as new or multiple sex partners.5 Data from a study in a managed care setting suggest that chlamydia screening and treatment can reduce incidence of PID by over 50 percent.6 Unfortunately, many sexually active young women are not being tested for chlamydia, in part reflecting a lack of awareness among some providers and limited resources for screening.5,7 Recent research has shown that a simple change in clinical procedures — coupling chlamydia tests with routine Pap testing — can sharply increase the proportion of sexually active young women screened.8 Stepping up screening efforts is critical to preventing the serious health consequences of this infection, particularly infertility.
While screening is critical for sexually active young women, improved testing and treatment among men could help reduce transmission to women. The availability of urine tests for chlamydia may be contributing to increased detection of the disease in men, and consequently the rising rates of reported chlamydia in men in recent years (from 99.6 in 2000 to 147.1 in 2004).
Health Consequences of Chlamydia

Chlamydia is a bacterial infection that can easily be cured with antibiotics, but it is usually asymptomatic and often undiagnosed. Untreated, it can cause severe health consequences for women, including pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. Up to 40 percent of females with untreated chlamydia infections develop PID, and 20 percent of those may become infertile.3 In addition, women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed.4 Complications from chlamydia among men are relatively uncommon, but may include epididymitis and urethritis, which can cause pain, fever, and in rare cases, sterility.
Gonorrhea: Disease Rate Falls to Historic Low But Drug Resistance on the Rise
Gonorrhea is the second most commonly reported infectious disease in the United States, with 330,132 cases reported in 2004. From a high of 467.7 cases per 100,000 population reported in 1975, the U.S. gonorrhea rate fell to 113.5 in 2004 (a 76% decline) — the lowest recorded level since reporting began in 1941. More recently, from 2003 to 2004, the rate fell 1.5 percent (from 115.2 cases per 100,000 population to 113.5). Like chlamydia, however, gonorrhea is substantially under diagnosed and under reported, and approximately twice as many new infections are estimated to occur each year as are reported.1

Racial Disparities Persist
African Americans remain the group most heavily affected by gonorrhea. While the rate of gonorrhea among blacks fell 3.0 percent from 2003 to 2004, the reported 2004 rate per 100,000 population for blacks (629.6) was 19 times greater than for whites (33.3). In 2003, the rate for blacks was 20 times higher than the rate for whites.
American Indians/Alaska Natives had the second-highest gonorrhea rate in 2004 (117.7, up 14.8% from 2003), followed by Hispanics (71.3, up 2.3% from 2003), whites (33.3, up 2.1% from 2003), and Asians/Pacific Islanders (21.4, down 3.2% from 2003).
Ethnic minorities in the United States have traditionally had higher rates of reported gonorrhea and other STDs, in part a reflection of limited access to quality health care, poverty, and higher background prevalence of disease in these populations.
Drug Resistance Increasing In Communities Across the United States
Drug resistance is an increasingly important concern in the treatment and prevention of gonorrhea.10 CDC monitors trends in gonorrhea drug resistance through the Gonococcal Isolate Surveillance Project (GISP), which tests gonorrhea samples (“isolates�) from the first 25 men with urethral gonorrhea attending STD clinics each month in sentinel clinics across the United States (28 cities in 2004).11
Overall, 6.8 percent of gonorrhea isolates tested through GISP in 2004 demonstrated resistance to fluoroquinolones, a leading class of antibiotics used to treat the disease, compared to 4.1 percent in 2003 and 2.2 percent in 2002. Resistance is especially worrisome among men who have sex with men (MSM), where resistance was eight times higher than among heterosexuals (23.8% vs. 2.9%).
In April 2004, CDC recommended that fluoroquinolones no longer be used as treatment for gonorrhea among MSM. Fluoroquinolones are also not recommended to treat gonorrhea in anyone in California and Hawaii, where fluoroquinolone-resistant cases have been widespread for several years. Outside of these states in 2004, 17.8 percent of gonorrhea isolates among MSM were resistant to fluoroquinolones, while resistance among heterosexuals remained low at 1.3 percent.
Health Consequences of Gonorrhea

While gonorrhea is easily cured, untreated cases can lead to serious health problems. Among women, gonorrhea is a major cause of PID, which can lead to chronic pelvic pain, ectopic pregnancy, and infertility. In men, untreated gonorrhea can cause epididymitis, a painful condition of the testicles that can result in infertility. In addition, studies suggest that presence of gonorrhea infection makes an individual three to five times more likely to acquire HIV, if exposed.9
Syphilis: Cases Increase for Fourth Consecutive Year
The rate of primary and secondary (P&S) syphilis — the most infectious stages of the disease — decreased throughout the 1990s, and in 2000 reached an all-time low. However, over the past four years the syphilis rate in the United States has been increasing. Between 2003 and 2004 alone, the national P&S syphilis rate increased 8 percent, from 2.5 to 2.7 cases per 100,000 population; during this time, reported P&S cases in the United States increased from 7,177 to 7,980.
Overall, increases in P&S syphilis rates between 2000 and 2004 were observed only among men. The rate of P&S syphilis among males rose 81 percent between 2000 and 2004 (from 2.6 to 4.7), and 11.9 percent between 2003 (4.2) and 2004. Notably, in 2004 — for the first time in over 10 years — the rate among females did not decrease, remaining at 0.8. Between 2003 and 2004, the rate of congenital syphilis (i.e., transmission from mother to child) decreased 17.8 percent (from 10.7 to 8.8 per 100,000 live births), likely reflecting the substantial reduction in syphilis among women that has occurred over the past decade.

Rising Rate Driven By Cases Among Men
Increasing cases of P&S syphilis among MSM are believed to be largely responsible for the overall increases in the national syphilis rate observed since 2000. Until very recently, CDC has not collected data by risk group. However, the male-to-female ratio for P&S syphilis has risen steadily between 2000 and 2004 (from 1.5 to 5.9), suggesting increased syphilis transmission among MSM. This increase occurred among all racial and ethnic groups. Additionally, CDC estimates that MSM comprised 64 percent of P&S syphilis cases in 2004, up from 5 percent in 1999.12

Recent Declines Among African Americans Possibly Reversing
In 2004, the P&S syphilis rate among blacks increased for the first time in more than a decade — 16.9 percent from 2003 to 2004 (from 7.7 to 9.0), with the most significant increases among black men. Between 2003 and 2004, the syphilis rate among black males increased 22.6 percent (from 11.5 to 14.1), while the rate among black women rose 2.4 percent (from 4.2 to 4.3). In addition, the male-to-female ratio for blacks rose from 2.7 in 2003 to 3.3 in 2004, suggesting increases among black MSM.
Racial gaps in syphilis rates are narrowing, with rates in 2004 5.6 times higher among blacks than among whites, a substantially lower differential than in 2000, when the rate among blacks was 24 times greater than among whites. This narrowing reflects both declining disease rates among African Americans and the significant increases among white men in recent years. Continued progress in eliminating this disease will require an ongoing commitment to syphilis education, testing, and treatment in all populations affected.

Urban Areas Bear Greatest Syphilis Burden
Syphilis remains a public health problem in metropolitan areas with large populations of MSM. For the third consecutive year, San Francisco had the highest P&S rate of any U.S. city in 2004 (45.9). Other leading cities include Atlanta, Georgia (34.6); Baltimore, Maryland (33.2); New Orleans, Louisiana (16.4); St Louis, Missouri (14.1); Detroit, Michigan (13.5); Washington, D.C. (12.2); Dallas, Texas (11.6); Jersey City, New Jersey (10.8); and Chicago, Illinois (9.7).
Health Consequences of Syphilis

Syphilis, a genital ulcerative disease, is highly infectious, but easily curable in its early (primary and secondary) stages. If untreated, it can lead to serious long-term complications, including nerve, cardiovascular, and organ damage, and even death. Congenital syphilis can cause stillbirth, death soon after birth, and physical deformity and neurological complications in children who survive. Syphilis, like many other STDs, facilitates the spread of HIV, increasing transmission of the virus at least two- to five-fold.13
Cities with Highest Reported Rates of P&S Syphilis, 2004
(click map to view larger image)

References
1 Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health 2004;36(1):6-10.
2 HW Chesson, JM Blandford, TL Gift, G Tao, KL Irwin. The estimated direct medical cost of STDs among American youth, 2000. Abstract P075. 2004 National STD Prevention Conference. Philadelphia, PA. March 8-11, 2004.
3 Hillis SD and Wasserheit JN. Screening for Chlamydia — A Key to the Prevention of Pelvic Inflammatory Disease. New England Journal of Medicine 1996;334(21):1399-1401.
4 CDC. Press Release: New CDC treatment guidelines critical to preventing consequences of sexually transmitted diseases. May 9, 2002. Available at: www.cdc.gov/od/oc/media/pressrel/fs020509.htm.
5 CDC. Sexually Transmitted Disease Surveillance, 2004. Atlanta, GA: U.S. Department of Health and Human Services, September 2005.
6 Scholes D et al. Prevention of Pelvic Inflammatory Disease by Screening for Cervical Chlamydial Infection. New England Journal of Medicine 1996; 334(21):1362-1366.
7 CDC. Chlamydia screening among sexually active young female enrollees of health plans — United States, 1999 – 2001. Morbidity and Mortality Weekly Report 2004;53(42):983-985.
8 Burstein G et al. Chlamydia screening in a health plan before and after a national performance measure introduction. Obstetrics & Gynecology 2005;106(2):327-334.
9 Fleming DT and Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sexually Transmitted Infections 1999;75:3-17.
10 CDC. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae among men who have sex with men — United States, 2003, and revised recommendations for gonorrhea treatment, 2004. Morbidity and Mortality Weekly Report 2004;53(16):335-338.
11 CDC. Gonococcal Isolate Surveillance Project. Available at: www.cdc.gov/std/gisp.
12 CDC. Unpublished data.
13 CDC. HIV Prevention Through Early Detection and Treatment of Other Sexually Transmitted Diseases — United States Recommendations of the Advisory Committee for HIV and STD Prevention. Morbidity and Mortality Weekly Report 1998; 47(RR-12):1-24.

[ss4699]

Who should get tested and when

Long and short??

There is a lot of information there to absorb. Symptoms seem to overlap. But itching is BAD.

TESTING
Testing at my annual physical, with an understanding with the doctor on confidentiality.
As long as the tests are negative, I was told, it was not a problem. But a postive test would require informing any partners.

PROTECTION
While condoms don't stop everything, it seems like they are well worth the effort for my "money".

ALERTS
Any providers/client that comes up positive has a responsibility to notify in my mind.

But what if you just think ya got the "itch"? Post an alert or not? Would a provider or client lie about an infection? Ofcourse they might. Better to warn and correct after if needed? That is one to discuss!

So any thoughts? Some of the ladies may have even more background thatwhat has posted, but lets wait and see!

[ss4699]

General Symptoms/Prevention

General Symptoms/Prevention

http://familydoctor.org/165.xml


STDs: Common Symptoms & Tips on Prevention
What are sexually transmitted diseases?
Sexually transmitted diseases (STDs) are infections you can get by having sex with someone who has an infection. These infections are usually passed by having intercourse, but they can also be passed through other types of sex. STDs can be caused by viruses or bacteria. STDs caused by viruses include hepatitis B, herpes, HIV and the human papilloma virus (HPV). STDs caused by bacteria include chlamydia, gonorrhea and syphilis.


Am I at risk for having an STD?
If you've ever had sex, you may be at risk for having an STD. Your risk is higher if you have had many sex partners, have had sex with someone who has had many partners or have had sex without using condoms. Some common symptoms of STDs are listed in the box below.



Common signs/symptoms of STDs
Itching around the vagina and/or discharge from the vagina for women
Discharge from the penis for men
Pain during sex, when urinating and/or in the pelvic area
Sore throats in people who have oral sex
Pain in the anus for people who have anal sex
Chancre sores (painless red sores) on the genital area, anus, tongue and/or throat
A scaly rash on the palms of your hands and the soles of your feet
Dark urine, loose, light-colored stools, and yellow eyes and skin
Small blisters that turn into scabs on the genital area
Swollen glands, fever and body aches
Unusual infections, unexplained fatigue, night sweats and weight loss
Soft, flesh-colored warts around the genital area




Should I be checked for STDs?
See your doctor if you're at risk for having an STD, if you have any STD symptoms or if you have concerns about whether you have one. STDs can cause problems if left untreated.

For example, chlamydia can lead to problems that can cause women not to be able to have children. HPV can lead to cancer of the cervix or penis, and syphilis can lead to paralysis, mental problems, heart damage, blindness and death.


How are STDs diagnosed?
Most STDs can be diagnosed through an exam by your doctor, a culture of the secretions from your vagina or penis, or through a blood test.


Can STDs be prevented?
Yes. The only sure way to prevent STDs is by not having sex. If you have sex, you can lower your risk by only having sex with someone who isn't having sex with anyone else and who doesn't have an STD.

You should always use condoms when having sex, including oral and anal sex.


What else should I do?
Limit the number of sex partners you have. Ask your partner if he or she has an STD and tell your partner if you have had one. Talk about whether you've both been tested for STDs and whether you should be tested.

Look for signs of an STD in your sex partner. But remember that STDs don't always show their symptoms. Don't have sex if you or your partner are being treated for an STD.

Wash your genitals with soap and water and urinate soon after you have sex. This may help clean away some germs before they have a chance to infect you.


Do condoms prevent STDs?
Male latex condoms can reduce your risk of getting an STD if used correctly. Be sure to use them every time you have sex, during all types of sex, including vaginal, anal and oral sex. Female condoms aren't as effective as male condoms, but should be used when a man won't use a male condom.

Remember, though, that condoms aren't 100% safe and can't protect you from coming in contact with some sores, such as those that can occur with herpes, or warts, which can occur with HPV infection.


Should I use a spermicide to help prevent STDs?
No. It was once thought that spermicides with nonoxynol-9 could help prevent STDs much like they help prevent pregnancy -- by damaging the organisms that cause the diseases. New research has shown that nonoxynol-9 can also irritate a woman’s vagina and cervix, actually increasing the risk of STD infection.

Be sure to also check the ingredients of any other sex-related products you own, such as lubricants and condoms. Some brands of these products may have nonoxynol-9 added to them. If you are unsure if your spermicide or any other product contains nonoxynol-9, ask your doctor before using it.

[ss4699]

Doctors and reporting

Doctors and reporting

If I get examined and find out that I'm infected, what next?
I'm doing some follow up on this topic and will have more information later, but this much is for sure:

This is the primary statement for the AMA website on STDs, and reporting. You can read the full case at: http://www.ama-assn.org/ama/pub/category/15548.html

http://www.ama-assn.org
Q. May the physician avoid full disclosure?
A. No. This paternalistic deception would violate the AMA Code of Medical Ethics, which states:
The patient’s right of self-decision can be effectively exercised only if the patient possesses enough information to enable an intelligent choice…. The physician’s obligation is to present the medical facts accurately to the patient or to the individual responsible for the patient’s care and to make recommendations for management in accordance with good medical practice [1].
The Code also counsels: "… a physician should at all times deal honestly and openly with patients. Patients have a right to know their past and present medical status and to be free of any mistaken beliefs concerning their conditions� [2].
Deceiving Ann would postpone embarrassment for Dr Charon and for Tom at the expense of depriving Ann of the information she needs and deserves. Ann must discuss her recent sexual history and name any partners, so that all potentially infected persons can be diagnosed and treated. Why would she do that without knowing why a sexual history is being taken? Ann should report symptoms related to her diagnosis. How can she do that without knowing what the diagnosis is? Ann needs follow-up testing. How can Dr Charon collect genitourinary specimens if Ann believes he is treating a sinus problem?
Ann and Tom would benefit from a shared understanding of, and a shared plan for, their marriage and family. Dr Charon cannot force this dialogue to occur, but he must refrain from deceptive actions that would harm this process.
Q. Must physicians always preserve the patient's secrets?
A. Physicians must understand the limits to confidentiality and must never promise more confidentiality than can be given.
The AMA's “Principles of Medical Ethics� provide that "[a] physician…shall safeguard patient confidences and privacy within the constraints of the law� [3]. When does the law require disclosure of confidential information without the patient's express or implied consent?
Laws and ethics require disclosure of information in certain dangerous situations. Evidence of child abuse or neglect and abuse or neglect of a vulnerable adult must be reported whenever required by law [4]. Evidence of a crime must be reported if the law requires. Physicians must also report a credible threat of injury to others [5].
Laws require reporting of public health concerns to public health authorities. Ethics require compliance with those reporting laws. Physicians must report gonorrhea in every US state.
Q. Can other professionals help evaluate and treat patients with STIs appropriately?
A. Public health authorities classically use "contact tracing" methods to bring STI contacts to evaluation and treatment without violating confidentiality. Persons reported to have STIs are interviewed promptly by public health disease investigators. These investigators are generally not licensed clinicians. They are trained in interviewing techniques, STI epidemiology, and how to maintain confidentiality while finding and protecting partners. Interviewing each confirmed patient, they take histories of all sexual experience relevant to the particular STI and determine how to locate the patient's recent sexual contacts. Contacts are told that they may have been exposed, without disclosing the index patient's identity, and are urged to seek examination and treatment. Some jurisdictions follow up with each contact as needed until medical evaluation is completed. Other jurisdictions are notified of out-of-area contacts if feasible.
The scope of this service varies greatly in different jurisdictions. Some departments use contact tracing for all gonorrhea cases. Other departments reserve contact tracing for a few selected situations or diagnoses. Because traditional partner notification is not always available or successful, public health researchers are exploring alternative strategies for promoting treatment of partners exposed to STIs [6].

================
links:
. American Medical Association. Opinion 8.08. Informed consent. AMA Code of Medical Ethics. Available at: http://www.ama-assn.org/apps/pf_new/...nE/E-8.01.HTM. Accessed August 12, 2005.
2. American Medical Association. Opinion 8.12. Patient information. AMA Code of Medical Ethics. Available at: http://www.ama-assn.org/apps/pf_new/...nE/E-8.01.HTM. Accessed August 12, 2005.
3. American Medical Association. Principles of medical ethics. Principle IV. AMA Code of Medical Ethics. Available at: http://www.ama-assn.org/ama/pub/category/2512.html. Accessed August 12, 2005.
4. American Medical Association. Opinion 2.02. Abuse of spouses, children, elderly persons, and others at risk. AMA Code of Medical Ethics. Available at: http://www.ama-assn.org/apps/pf_new/...nE/E-2.01.HTM. Accessed August 12, 2005.
5. American Medical Association. Opinion 5.05. Confidentiality. AMA Code of Medical Ethics. Available at: http://www.ama-assn.org/apps/pf_new/...nE/E-5.01.HTM. Accessed August 12, 2005.
6. Golden MR. Expedited partner therapy for sexually transmitted diseases. Clin Inf Dis. 2005;41:630-633.

[Grizzly]

Beating a dead horse SS. I believe there is a forum on here dealing with this kind of information.

Please stop spamming the site, who cares if these posts are from some other site.

[guest010313]

Yah I really don't get who this guy is. I saw a thread full of people kinda kissing his ass and I don't know why.