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Health
The Truth About STDs - Viral
By SIECUS
Mar 20, 2006, 09:39 PST



There are more than 25 diseases spread primarily by sexual activity. Together these infections-called sexually transmitted diseases (STDs)-have created a significant public health challenge in the United States. While many STDs are curable, others are not. Even those that are curable often have no symptoms and go unrecognized for long periods of time. If left untreated, even curable STDs can result in long-term health problems for both men and women.

In the United States, an estimated 15 million people become infected with one or more STDs each year. In addition, an estimated 65 million people live with an incurable STD. Still, less than half of adults 18 to 44 years of age have ever been tested for an STD other than HIV/AIDS.1 This fact sheet is designed to provide health care professionals, educators, and individuals with basic information. It focuses on eight of the most common STDs and contains information on how they are spread, what signs and symptoms individuals should look for, and what treatment options are available. Those interested in learning more about these or other STDs can go the web site of the Centers for Disease Control and Prevention at http://www.cdc.gov/nchstp/dstd/disease_info.htm

Note: Some professionals use the term sexually transmitted infection (STI) instead of sexually transmitted disease (STD). This fact sheet uses the term STD.

TWO STD CATEGORIES: VIRAL AND BACTERIAL

STDs are often divided into two categories-viral and bacterial-based on the type of microorganism that causes the specific disease.

Those STDs caused by bacteria-such as Gonorrhea, Syphilis, and Chlamydia-are curable with antibiotics. On the other hand, those STDs caused by viruses are not curable. These include Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV), Herpes, and Hepatitis B. Medical treatment can, however, alleviate the symptoms of these STDs.

Some STDs are also caused by protozoa (Trichomoniasis) and other organisms (crabs/pubic lice and scabies). These STDs are curable with antibiotics or topical creams/lotions.

TESTING FOR STDs: WHAT'S INVOLVED

Less than half of adults 18 to 44 years of age in the United States have been tested for an STD other than HIV. Some people may not seek a test because they do not know they are at risk. Others may not seek a test because they are nervous, embarrassed, or unsure of what the tests involve.

There are many different ways health care providers screen for STDs. These can include visually examining sores or lesions, collecting fluid from the urethra or cervix with a cotton swab, testing urine or blood, or conducting a biopsy.

Individuals should seek an early diagnosis and treatment at the first sign of symptoms to avoid serious complications. They should also talk to their health care providers about having a routine STD screening as part of their annual physical or gynecological exam since many STDs have no symptoms. Women need to understand that STD screenings are not necessarily part of their annual gynecological exam and that Pap smears do not screen for STDs other than HPV.1

Reference

  1. http://www.ashastd.org/news/112102.htm

VIRAL STDS

HERPES

Herpes is a recurrent skin condition characterized by sores on the mouth or genitals. It is caused by the herpes simplex viruses called HSV-1 and HSV-2. Although HSV-1 most commonly causes "cold sores" or "fever blisters" on the mouth or face and HSV-2 most commonly causes sores on the penis or vulva, the viruses are identical under a microscope and either type can infect the mouth or genitals.21

Herpes is transmitted through skin-to-skin contact during unprotected anal, oral, or vaginal sex with an infected person or through kissing. This is possible even when no sores are present.

Herpes is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.22

Signs and Symptoms

  • Individuals are often not aware they are infected with Herpes because there are either no symptoms, mild symptoms that are not noticed, or symptoms that are mistaken for other health problems such as yeast infections, insect bites, and hemorrhoids.
  • Signs of Herpes may first appear within days. They may, however, not appear for weeks, months, or years. Symptoms can last for three or four weeks though they usually heal within two to 12 days.23
  • Symptoms may include one or more sores, blisters, cuts, pimples, bumps, or a rash. Other symptoms include an itching, burning, or tingling in either the genital area or the mouth, a fever, or swollen glands.24
  • Individuals usually have an average of four to five Herpes outbreaks a year. The recurrences tend to lessen in severity and frequency with time.25

Testing

Herpes is diagnosed through a visual examination of sores, an analysis of cultures from the sore(s), or blood tests.26

Treatment

There is no cure for Herpes. Antiviral medications can reduce the frequency of outbreaks and speed the healing of the outbreaks.

HEPATITIS B

Hepatitis B is a virus that causes chronic infection, cirrhosis (scarring), and cancer of the liver. The virus is present in blood, semen, vaginal secretions, and breast milk.

Hepatitis B is transmitted through unprotected anal, vaginal, and oral sex with an infected person; through contaminated needles or syringes; or from an infected mother to her newborn during childbirth or breast-feeding.

Hepatitis B is the only STD for which a vaccine is available. Individuals must take all three doses of the vaccine to protect themselves against infection. They can obtain the vaccine from their health care provider.27

Hepatitis B is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.28

Signs and Symptoms

  • Individuals will usually experience mild flu-like symptoms including fever, aches, appetite loss, and fatigue. Many people will experience no symptoms.29
  • Many people will develop a temporary jaundice (yellowing of the skin) as well as dark urine, nausea, and abdominal pain.30

Testing

Hepatitis B is diagnosed through blood tests.31

Treatment

There is no cure for Hepatitis B. Treatment varies depending on whether the infection is acute (newly acquired) or chronic (persistent).32

HUMAN IMMUNODEFICIENCY VIRUS

The Human Immunodeficiency Virus (HIV) causes an individual's immune system to weaken and lose its ability to fight off infections and cancers. After developing a number of these infections or reaching a certain blood count level, an HIV-positive person is diagnosed with Acquired Immunodeficiency Syndrome (AIDS).333

HIV is present in blood, semen, vaginal secretions, and breast milk. It is transmitted through unprotected anal, vaginal, and oral sex with an infected person; through contaminated needles or syringes used to inject drugs; or from an infected mother to her newborn during childbirth or breast-feeding.34

HIV is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.35

Signs and Symptoms

  • There are no symptoms of HIV infection.
  • The average time between HIV infection and AIDS is eight to 11 years.
  • Over time, HIV causes the body to develop opportunistic infections or cancers normally controlled by a healthy immune system.
  • AIDS symptoms are usually those of the opportunistic infection or cancer. These include fever, chills and sweats, chronic fatigue, appetite or weight loss, muscle and joint pain, long-lasting sore throat, swollen lymph nodes, diarrhea, yeast infections, and skin sores.
  • Opportunistic infections that most frequently affect someone with AIDS include Kaposi's sarcoma, Pneumocystis carinii pneumonia (PCP), tuberculosis, meningitis, and Herpes simplex infections.

Testing

HIV infection is diagnosed through blood tests. It can also be diagnosed through urine tests and an oral fluid test taken from the inside of the mouth.36 Individuals exposed to HIV may not test positive for three to six months. Individuals should test periodically for HIV if they feel they are at risk.

Treatment

There is no cure or vaccine for HIV or AIDS. There are, however, new combinations of drugs (called "cocktails") that allow people to live with the infection or HIV/AIDS for longer periods of time.

HIV TESTING

Tests that determine HIV infection look for antibodies produced by the body to fight the virus. Most people will develop such antibodies between 25 days and six months after infection. Although it is possible to test earlier, the CDC recommends testing six months after the last possible exposure.

Many places provide testing for HIV infection. These include local health departments, doctors' offices, hospitals, or specific HIV test sites.

Sites may provide pre- and post-test counseling for those who want it. They may also provide either anonymous (no name given) or confidential (name given only to doctor) testing. Some states require that doctors report positive results to state health departments. Individuals should check to determine procedures at individual sites.

Most HIV tests involve drawing blood to determine if antibodies specific to HIV are present. Other options include urine tests and oral fluid tests that involve taking a sample of fluid from inside the mouth with a cotton swab.

For more information about HIV tests and test sites, individuals should contact the CDC National AIDS Hotline at 1-800/342-2437 (English), 1-800/344-7432, (Spanish), or 1-800/243-7889 (TTY).

Reference

HUMAN PAPILLOMAVIRUS

There are over 100 strains of the Human Papillomavirus (HPV). Approximately a third of these strains cause warts that infect the genital tract. These warts can grow on the cervix, vagina, vulva, penis, scrotum, urethra, and anus. HPV can also cause other abnormal cells to grow on the cervix. Some strains of HPV can lead to cervical cancer.37

HPV is transmitted by direct skin-to-skin contact with an infected individual. It can also transmitted when warts are not present.38 It is sometimes transmitted from mother to infant during childbirth.39

Signs and Symptoms40

  • People with HPV may experience no visible signs or symptoms or may have warts in places they cannot see (such as the cervix).
  • Genital warts are raised or flat growths that are usually flesh colored or whitish in appearance.
  • Genital warts usually do not cause itching or burning.
  • If left untreated, genital warts may disappear. However, HPV infection remains and warts can reappear.

Testing

HPV is often diagnosed through a visual examination of genital warts. In some cases, a biopsy is necessary.

The presence of HPV on the cervix is detected through a Pap smear.41

Treatment

There is no cure for HPV. There are, however, a number of methods to remove warts.

HPV AND CERVICAL CANCER

Certain strains of HPV are considered the primary risk factor for cervical cancer. The majority of such cancers develop through a series of gradual precancerous lesions that are easily detected by a Pap smear, and can be removed.1

A Pap smear is a routine gynecological test in which a health care provider uses a cotton swab or similar instrument to collect cells from the cervix. The test looks for abnormal or precancerous cells. These cells may be signs of cervical cancer.2

Regular Pap smears reduce the risk of invasive cervical cancer by early detection of abnormal cells. In fact, over half of women with newly diagnosed cervical cancer had not had a Pap smear in five years.3

Researchers are developing a vaccine that targets HPV-16, one of the HPV strains that lead to cervical cancer. In initial trials, none of the women who received the vaccine showed HPV-16 infections or precancerous tissue. The vaccine is awaiting approval by the Food and Drug Administration (FDA).4

It is important to note that not every HPV infection will become cervical cancer. The National Cancer Institute points out that while HPV infection is common, cervical cancer is not.5

References

  1. http://www.ashastd.org/stdfaqs/paptest
  2. http://www.ashastd.org/hpvccrc/abcell.html#what
  3. http://rex.nci.nih.gov/massmedia/backgrounders/cervical.html
  4. P. Guthrie, "Vaccine Could Wipe Out Cervical Cancer; Study: New Drug 100% Effective against Disease," The Atlanta Journal and Constitution, November 21, 2002.
  5. http://rex.nci.nih.gov/massmedia/backgrounders/cervical.html

CONDOMS AND STDs: PREVENTION MESSAGES

Condoms can provide different levels of risk reduction for different STDs. There is no definitive study about condom effectiveness for all STDs. Definitive data are lacking on the degree of risk reduction that latex condoms provide for some STDs; for others, the evidence is considered inconclusive.

The Centers for Disease Control and Prevention (CDC) states, "It is important to note that the lack of data about the level of condom effectiveness indicates that more research is needed-not that latex condoms do not work."1

These are prevention messages recently developed by the CDC:

  • Latex condoms, when used consistently and correctly, are highly effective in preventing the transmission of HIV, the virus that causes AIDS. In addition, correct and consistent use of latex condoms can reduce the risk of other STDs.
  • Latex condoms, when used consistently and correctly, can reduce the risk of transmission of Gonorrhea, Chlamydia, and Trichomoniasis.
  • Latex condoms, when used consistently and correctly, can reduce the risk of Genital Herpes, Syphilis, and HPV only when the infected areas are covered or protected by the condom.2

References

  1. U.S. Centers for Disease Control and Prevention (CDC), Latex Condoms and Sexually Transmitted Diseases-Prevention Messages (Atlanta, GA: CDC, 2001), p. 2.
  2. Ibid.

UPDATE ON NONOXYNOL-9

In the past, public health experts recommended using condoms combined with Nonoxynol-9 (N-9), a spermicide, for increased protection against pregnancy, HIV, and STDs. Two recent studies, however, call into question the effectiveness and safety of N-9.

A study published by UNAIDS found that N-9 used without condoms was ineffective against HIV transmission. This study actually showed some evidence that N-9 increased the risk of HIV infection.

Researchers note that this study was conducted among commercial sex workers in Africa who are at increased risk and used an N-9 gel on a frequent basis. The adverse effects might not be seen at the same level among women who are using N-9 less frequently or in a different formulation.

As a result of this study, however, the CDC concluded that "given that N-9 has been proven ineffective against HIV transmission, the possibility of risk, with no benefit, indicates that N-9 should not be recommended as an effective means of HIV- prevention."1

A similar study published in the Journal of the American Medical Association found that N-9, when used with condoms, did not protect women from the bacteria that cause Gonorrhea and Chlamydia any better than condoms used alone.2

References

  1. Letter to Colleagues from Helene D. Gayle, M.D., M.P.H., director, National Center for HIV, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, August 4, 2000.
  2. R. E. Roddy, L. Zekeng, K. A. Ryan, U. Tamou, and K. G. Tweedy, "Effect of Nonoxynol-9 Gel on Urogenital Gonorrhea and Chlamydial Infection: A Randomized Controlled Trial," Journal of the American Medical Association, March 6, 2002, pp. 1117-22.

INCIDENCE AND PREVALENCE

People with STDs do not always seek testing or treatment, and health care providers do not always report all cases of diagnosed STDs. Therefore, in all likelihood, the number of STD cases included in the following statistics is less than the actual number of cases that occurred in the United States.

Chlamydia

  • Over 783,000 Chlamydia infections were reported to the CDC in 2001.42
  • The reported rate of Chlamydia among women (435.2 cases per 100,000 females) was approximately four times higher than the reported rate among men (113.9 per 100,000 males) in 2001.43
  • Female adolescents 15 to 19 years of age had the highest reported rates of Chlamydia (2,536.1 per 100,000) in 2001.44
  • Chlamydia infections increased from 50.8 to 278.3 per 100,000 between 1987 and 2001.45

Gonorrhea46

  • Over 361,000 cases of Gonorrhea were reported to the CDC in 2001.
  • The reported rate of Gonorrhea among women in 2001 (128.2 cases per 100,000 females) was similar to the rate in 2000 (126.7 per 100,000) and in 1999 (128.6 per 100,000).
  • The rate of Gonorrhea among men declined from 135.5 cases per 100,000 males in 1999 to 130.9 in 2000 and 128.2 in 2001.
  • Among women, those 15 to 19 years of age had the highest reported rate of Gonorrhea (703.2 per 100,000) in 2001.
  • Among men, those 20 to 24 years of age had the highest reported rate of Gonorrhea (563.6 per 100,000) in 2001.

Syphilis47

  • Over 6,100 cases of primary and secondary Syphilis cases were reported to the CDC in 2001.
  • The reported rate of primary and secondary Syphilis increased 15.4 percent among men (from 2.6 cases to 3.0 cases per 100,000) between 2000 and 2001. During this time, the rate declined 17.7 percent among women (from 1.7 to 1.4 cases per 100,000).

Herpes48

  • Approximately 25 percent of adults have Genital Herpes.
  • Over 45 million people 12 years of age and older (or one out of five) are infected with HSV-2, a Herpes virus.
  • Infection with HSV-2, a Herpes virus, is more common in women (approximately one out of four) than in men (almost one out of five). This may be due to the fact that male-to-female transmission is more efficient than female-to-male transmission.

Hepatitis B

  • The number of new Hepatitis B infections per year has declined from an average of 260,000 in the 1980s to approximately 78,000 in 2001.49
  • Of an estimated 1.25 million Americans chronically infected with Hepatitis B, 20 to 30 percent were infected during childhood.50

Human Immunodeficiency Virus (HIV)

  • Nearly 24,000 adult and adolescent males from the 39 areas of the country with confidential HIV-infection reporting were diagnosed as HIV positive in 2001.51
  • Over 11,000 adult and adolescent females from the 39 areas of the country with confidential HIV-infection reporting were diagnosed as HIV positive in 2001.52
  • Nearly 32,000 adult and adolescent males were diagnosed with AIDS in 2001. In total, over 666,000 cases among adult and adolescent males were reported through December 2001.53
  • Over 11,000 adult and adolescent females were diagnosed with AIDS in 2001. In total, over 141,000 cases among adult and adolescent females were reported through December 2001.54

Human Papillomavirus (HPV)

  • Approximately 5.5 million new cases of HPV infection are reported every year. At least 20 million Americans are already infected.55
  • Fifty to 75 percent of sexually active men and women will become infected with genital HPV at some point in their lives.56
  • Approximately 14,000 women are diagnosed with cervical cancer each year; over 5,000 die from this disease each year.57

STDS AMONG ADOLESCENTS AND YOUNG ADULTS

Teens are at high behavioral risk for acquiring most STDs. Teens and young adults are more likely than other age groups to have multiple sex partners and to engage in unprotected sex. In addition, young women are biologically more susceptible to Chlamydia, Gonorrhea, and HIV.

Chlamydia and Gonorrhea are the most common curable STDs among teens. Curable STDs are typically caused by bacteria that can be killed with antibiotics. However, if these diseases remain undetected and untreated, they can result in severe health consequences later in life.

The rate of new infections for Herpes and HPV-both viral STDs-is typically highest during the late teens and early twenties. Among women under the age of 25, studies have found that 28 to 46 percent are typically infected with HPV. Between 15 to 20 percent of young men and women have become infected with Herpes by the time they reach adulthood.

Reference

  • Tracking the Hidden Epidemics: Trends in STDs in the United States, 2000 (Atlanta, GA: Centers for Disease Control and Prevention, 2001), p. 4.

References

  1. http://www.ashastd.org/news/112102.htm
  2. http://www.ashastd.org/stdfaqs/chlamydia.html#what
  3. Ibid.
  4. Ibid.
  5. Ibid.
  6. http://www.goaskalice.columbia.edu/2020.html
  7. http://www.cdc.gov/nchstp/dstd/Fact_Sheets/FactsGonorrhea.htm
  8. http://www.ashastd.org/stdfaqs/gonorrhea.html#what
  9. Ibid.
  10. http://www.goaskalice.columbia.edu/2020.html
  11. http://www.ashastd.org/stdfaqs/syphilis.html#what
  12. Ibid.
  13. http://www.cdc.gov/nchstp/dstd/Fact_Sheets/Syphilis_Facts.htm
  14. The Boston Women's Health Book Collective, Our Bodies, Ourselves: For the New Century, (New York: Touchstone, 1998), p.355.
  15. http://www.ashastd.org/stdfaqs/syphilis.html
  16. http://www.cdc.gov/nchstp/dstd/Fact_Sheets/Syphilis_Facts.htm
  17. http://www.goaskalice.columbia.edu/2020.html
  18. http://www.cdc.gov/nchstp/dstd/Fact_Sheets/FactsTrichomoniasis.htm
  19. Ibid.
  20. http://www.goaskalice.columbia.edu/2020.html
  21. http://www.ashastd.org/stdfaqs/herpes.html
  22. Ibid.
  23. http://www.cdc.gov/nchstp/dstd/Fact_Sheets/facts_Genital_Herpes.htm
  24. http://www.ashastd.org/stdfaqs/herpes.html
  25. http://www.cdc.gov/nchstp/dstd/Fact_Sheets/facts_Genital_Herpes.htm
  26. http://www.goaskalice.columbia.edu/2020.html
  27. http://www.ashastd.org/stdfaqs/hepb.html
  28. Ibid.
  29. http://www.goaskalice.columbia.edu/0268.html
  30. Ibid.
  31. http://www.goaskalice.columbia.edu/2020.html
  32. http://www.ashastd.org/stdfaqs/hepb.html#get
  33. http://www.ashastd.org/stdfaqs/aidshiv.html
  34. http://www.ashastd.org/stdfaqs/aidshiv.html
  35. http://www.cdc.gov/hiv/pubs/faq/faq31.htm
  36. http://www.goaskalice.columbia.edu/2020.html
  37. http://www.plannedparenthood.org/library/STI/011120_hpv.html
  38. Ibid.
  39. http://www.ashastd.org/hpvccrc/gw.html#symptoms
  40. http://www.ppnyc.org/facts/facts/stdservices.html
  41. http://www.ashastd.org/hpvccrc/gw.html#symptoms
  42. Sexually Transmitted Disease Surveillance 2001 (Atlanta, GA: Division of STD Prevention, CDC, September 2002), p. 7.
  43. Ibid, p.8
  44. Ibid.
  45. Ibid, p.7
  46. Ibid, p.15, 16
  47. Ibid., p. 25,26
  48. http://www.cdc.gov/nchstp/dstd/Fact_Sheets/facts_Genital_Herpes.htm
  49. http://www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm
  50. Ibid.
  51. HIV Surveillance Report, vol. 13, no. 2 (Atlanta, GA: CDC, December 2001), p. 19, Table 10.
  52. Ibid., p. 21, Table 12.
  53. Ibid., p. 18, Table 9.
  54. Ibid., p. 20, Table 11.
  55. http://www.niaid.nih.gov/factsheets/stdhpv.htm
  56. http://www.ashastd.org/hpvccrc/quickfaq.html
  57. Ibid.




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