Condoms
It is recommended to use condoms during each sexual encounter. When used properly, condoms are highly effective in preventing pregnancy and preventing the transmission of sexually transmitted infections (STIs). Condoms provide an effective barrier and blocks the exchange of bodily fluids that may be infected.
Depo Provera
A progesterone "shot" that is given every three months. The dosage is similar to the combined birth control pill. It suppresses ovulation (release of egg from the ovary), creates a thick mucous in the cervix, and thins the endometrium (lining tissue of the uterus). As a result, sperm motility and implantation is hindered. Therefore, this method can be an effective tool in preventing an unwanted pregnancy, but does not provide protection against STIs.
Diaphragms and Caps
Diaphragms and caps are flexible latex barriers used with spermicidal cream or jelly. The barrier and spermicide block and kill sperm moving toward the uterus. The diaphragm or cap is placed in the vagina to cover the cervix and is inserted before intercourse. The diaphragm (similar to the one pictured here without a hole in the center)) has a flexible rim and a dome shaped reservoir. However, the cap can be left in place for 48 hours and additional contraceptive cream or jelly is definitely needed everytime you have intercourse. The cervical cap is a small cap made of soft latex. The woman puts spermicide (which kills sperm) into the diaphragm or cap, places it up into her vagina and onto her cervix (the opening of the uterus or womb). Suction keeps the diaphragm or cap in place so sperm cannot enter the uterus. If you are interested in either the diaphragm or cap, you need to see your health care provider to be fitted for them. Therefore, this method can be an effective tool in preventing an unwanted pregnancy, but does not provide protection against STIs.
Female Condom
The female condom is the same type of contraceptive device as the male condom, except that it fits inside of the vagina with an inner ring over the cervix and an outer ring over the vulva. The outer ring keeps the condom from being pushed up into the vagina, provides a protective cover over the outside of the vagina, and prevents sperm from contacting the area. Therefore, this method can be an effective tool in preventing an unwanted pregnancy and protection against STIs.
Hormonal Contraceptives (birth control pills)
Birth control pills are a series of pills taken three out of four weeks and contain synthetic hormones (estrogen and / or progesterone). The hormones are similar to those normally produced by a woman. It suppresses ovulation (the release of an egg from the ovary), creates a thick mucous in the cervix, and thins the endometrium (lining in tissue of the uterus). As a result, sperm motility and implantation are hindered. Therefore, this method can be an effective tool in preventing an unwanted pregnancy, but does not provide protection against STIs.
Spermicides
There are various types of spermicides including: foams, creams, jellies, suppositories, and foaming tablets. They are all available from a drugstore without a prescription. Foam is considered to be the most effective of these preparations. When used properly, spermicides are effective in preventing an unwanted pregnancy by blocking the cervix and killing sperm. They do not provide protection against STIs.
Regardless of the spermicide you choose, they must be inserted in the vagina before each act of intercourse. For extra protection, they may be used in combination with a condom, a diaphragm, or a cervical cap.
Chlamydia
In the United States, chlamydia is the most reported STI. Chlamydia trachomatis is the bacterium that causes chlamydia and is transmitted during sexual intercourse (anal, vaginal, and / or oral). Each year, it is estimated that 2.8 million people are infected with chlamydia. Approximately 75% of infected women and 50% of infected men have no symptoms. Therefore, it is recommended that sexually active individuals have an annual test to detect this infection (CDC, 2006a). When symptoms are present, they occur between 1 to 3 weeks after exposure. When detected early, antibiotics can treat and cure a chlamydia infection.
Signs and Symptoms in Women:
Signs and Symptoms in Men:
Complications:
Chlamydia infection can cause pelvic inflammatory disease (PID) and occurs in 40% of untreated women. PID occurs in the pelvic area and results in permanent damage to reproductive organs (uterus, fallopian tubes, 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" (CDC, 2006a). If pregnant, the infection can cause premature delivery. Also, an infected mother can pass the infection to her child during vaginal delivery. In the newborn, pink eye and pnuemonia can develop (CDC, 2004b).
It is rare for complications to occur in men, but the infection can spread to the "epididymis (a tube that carries sperm to the testis)." As a result, the infection can cause "pain, fever, and rarely, sterility" (CDC, 2006a).
Reducing Your Risk of Transmission:
To prevent complications of untreated Chlamydia infections, sexually active women and men at risk for Chlamydia should have a routine test every year. All women who are pregnant should be screened for Chlamydia.
Genital Warts
Genital warts are mucousal warts caused by the genital human papillomavirus (genital HPV) and is a very common sexually transmitted infection. "At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives" (CDC, 2004a). There are over 100 different types of HPV and about 30 of these are sexually transmitted. There are about 10 genital HPV that can lead to cervical cancer. Most people who are infected do not show any signs or symptoms. Therefore, they do not know they are transmitting genital HPV through genital contact. At this time, there is no cure for HPV.
Signs and Symptoms:
If signs or symptoms are present, they appear as genital or mucousal warts. They are usually small, soft, flesh-colored (pink or brown), cauliflower-like growths that may be found by themselves or in clusters. They are usually painless, but can be associated with itching and irritation.
Usually genital warts can be seen and felt in the outer genitalia, but can grow inside the anus, vagina, urethra, or cervix. They can also be spread to the throat, eyes, or under the nail from oral sex or manual stimulation.
Seek Treatment If:
Reducing Your Risk of Transmission
Gonorrhea
Gonorrhea is a common STI, which is caused by a bacterial infection called Neisseria gonorrhea. In the United States, it is estimated that 700,000 individuals become newly infected with Gonorrhea each year (CDC, 2006b). Gonorrhea grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth, or rectum. This bacteria can be passed from person to person during sexual activity (vaginal, oral, and anal intercourse) leading to infections of the cervix, vagina, urethra, anus, mouth, and eyes. In many men and women, gonorrhea produces no symptoms. If signs and symptoms occur, they usually appear two to five days after infection. Some symptoms may take up to 30 days to present itself. When detected early, Gonorrhea can be treated and cured with antibiotics.
Signs and Symptoms in Women:
Signs and Symptoms in Men:
Complications:
If the Gonorrhea infection is untreated, serious and permanent health problems could result in both women and men. The bacteria can spread to the bloodstream and infect the joints, heart valves, or the brain. "In addition, people with gonorrhea are more likely to contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are more likely to transmit HIV to someone else" (CDC, 2006b).
In women, pelvic inflammatory disease (PID) is a common result of the gonorrhea infection. In the United States, it is estimated that about one million women develop PID each year. "PID can lead to internal abscesses (pus-filled 'pockets' that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy [pregnancy in the fallopian tube]" (CDC,2006b). This can be a life-threatening condition to the mother if not detected early. An infected woman who is pregnant may give the infection to her infant as the baby passes through the birth canal during delivery. Most states require that the eyes of newborns be treated with silver nitrate or other medication immediately after birth to prevent gonococcal infection of the eyes, which can lead to blindness. The baby can also develop a "joint infection or a life-threatening blood infection (CDC, 2006b). Due to the risk of gonococcal infection to both mother and child, doctors recommend that a pregnant woman have at least one test for gonorrhea during her pregnancy. Also, a baby can get the infection by an infected mother during vaginal delivery.
In men, the infection can spread causing prostatitis (prostate inflammation) and epididymo-orchitis (inflammation of the epididymis and testes).
Reducing Your Risk of Transmission
To prevent complications of untreated gonorrhea infections, sexually active women and men at risk for gonorrhea should have a routine test every year. All women who are pregnant should be screened for gonorrhea.
Hepatitis B
Hepatitis B (HBV) is a virus, which can lead to liver disease. In the United States, it is estimated that one out of 20 individuals will be infected with HBV at some point in their lives. "People of all ages get hepatitis B and about 5,000 die each year from sickness caused by HBV" (CDC, 2006c). HBV can be transmitted by direct exposure to contaminated blood/bodily fluids and by sexual contact. This includes the sharing of intravenous drugs and drug works. An infected mother can pass the infection to her baby during birth. HBV infection can result in acute hepatitis or chronic hepatitis. In acute HBV, an individual may develop flu-like symptoms or no signs/symptoms at all. In chronic HBV, an individual serves as a reservoir for the infection and may not develop any signs/symptoms. In the world, about 2 billion individuals become infected with HBV. Of those, "more than 350 million" develop chronic HBV infection (WHO, 2000).
Signs and Symptoms
Complications:
Chronic HBV infection develops in 90% of infants who are infected with HBV at birth, 30% of children who are infected with HBV between the ages of 1 and 5, and 6% of individuals who are infected with HBV older than 5 (CDC, 2006d). An individual who has chronic HBV infection is at an increased risk for developing cirrhosis (scarring of the liver), liver cancer, and liver failure. As a result, 15 - 25% of these individuals may die at a younger age due to liver cirrhosis or liver cancer (CDC, 2006c).
Reducing Your Risk of Transmission:
Syphilis
In the United States, there were 32,000 cases of syphilis reported in 2002, which included 6,862 cases of primary and secondary (P&S) syphilis (CDC, 2004c). Syphilis is a bacterial infection caused by Treponema pallidum, which can be transmitted sexually or congenitally (pregnant mother to baby). Syphilis is transmitted by exposure to a syphilis sore through anal, vaginal or oral sex. Sores usually appear on the external genitals, vagina, anus, or in the rectum. Sores can also appear in the mouth and on the lips. Unfortunately, many people are unable to recognize the sores and transmit the infection unknowingly. Many people who are infected with syphilis do not have any signs or symptoms for years, but are at risk for complications if not treated. When detected early, syphilis can be cured and treated with antibiotics.
Syphilis occurs in three stages:
Primary stage: This stage begins with an appearance of a chancre sore (firm, round, small, and painless) that occurs between 10 and 90 days from infection. The sore usually appears at the infection site. The chancre sore will remain 3 to 6 weeks from onset and disappear without treatment. If treatment is not obtained, syphilis will progress to the secondary stage.
Secondary stage: This stage begins with the appearance of a skin rash and mucous membrane lesions, which occur as the chancre is healing or has healed. A skin rash is the hallmark of this stage and lesions may appear again. The lesions are very infectious in this stage. The appearance of the rash may include: rough, red, reddish brown spots on the palms of the hands and the bottoms of the feet. Some rashes can appear faint and unnoticeable. Without treatment, these symptoms will disappear and syphilis will progress to late stage.
Latent stage/Late stage (Tertiary): In latent stage, there are no signs or symptoms in this stage and the individual is still infected, which begins when the symptoms of secondary stage disappear. In the late stage, irreversible damage occurs to internal organs and do not show up until many years later. The internal organs that can be damaged include: the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. As a result, the signs and symptoms may include: difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, dementia, and death (CDC, 2004c).
Complications:
A pregnant woman has a higher risk of giving birth to a baby who has already died or dies shortly after birth. A baby infected with syphilis may have no signs or symptoms. If treatment is not rendered, the baby can become developmentally delayed, have seizures, or die (CDC, 2004c).
Signs and Symptoms (of untreated syphilis):
Primary symptoms: (Gandhi, 2006)
Secondary symptoms: (Gandhi, 2005)
Late symptoms (tertiary stage): (Smith, 2006)
STI Facts
STI Prevention
Staying Healthy
Practice "Outercourse"
The only sure way to prevent STIs is to avoid contact between the penis, vagina, mouth and anus. You can touch, cuddle, massage, or tell each other your fantasies. In general, using your hands to give pleasure is safe.
Use a condom
Use a condom from start to finish every time you have sex. Female condoms and male condoms are now available. For extra protection, use a spermicidal jelly or foam during vaginal sex. Use it with condoms, not in place of them.
Be Prepared
Have condoms on hand and be ready to use them. Be aware that people often don't make good decisions in the heat of the moment, especially if they are under the influence of alcohol or drugs.
Limit the Number of Partners
The more people you have sex with, the greater your risk of getting an STI. If your partner has sex with others, you are also at risk.
Get Tested
If you think you have an STI, go to your health care provider or clinic right away. Ask your partner to get tested too, so you won't pass a disease back and forth. If you have sex, get a check up at least once a year.
Assess STI Risk
It is important to know your risk and see your healthcare provider for possible treatment options based on level of risk. The STD Wizard is a website to assess your personal risk of attaining an STI (also known as STD or sexually transmitted disease). It is completely anonymous and does not require the input of any identifiable information. In order to ensure confidentiality the Privacy Policy should be read and guidelines should be followed. The Wizard will ask a series of questions about personal information, such as: age, gender, ethnicity, and sexual practices. The questions should be answered as truthfully as possible. Your answers will be assessed and recommendations based on your responses will be given. A copy of the questions and your responses with the recommendations can be printed for personal information or for your healthcare provider.
The Gynecological Examination ("The Pap")
What is a gynecological examination?
A gynecological examination includes a Pap test (a cervical cancer screening test), pelvic examination, clinical breast examination, and sometimes sexually transmitted infection testing. When you have a gynecological examination at the Student Health Services (SHS), you will be tested for gonorrhea and chlamydia. If you have any questions regarding which STI test was administered, ask your clinician.
How to Prepare for a Gynecological Examination?
For at least 48 hours prior to the appointment, it is recommended that you refrain from vaginal sexual intercourse and avoid inserting anything into your vagina (vaginal creams, douches or other preparations).
References:
Center for Disease Control and Prevention (CDC). (2006a). Chlamydia Fact Sheet. Retrieved on April 20, 2007, from http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm#symptoms.
Center for Disease Control and Prevention (CDC). (2006b). Gonorrhea Fact Sheet. Retrieved on May 3, 2007, from http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm
Center for Disease Control and Prevention (CDC). (2006c). Hepatitis Fact Sheet. Retrieved on May 3, 2007, from http://www.cdc.gov/std/hepatitis/STDFact-Hepatitis-B.htm
Center for Disease Control and Prevention (CDC). (2006d). Viral Hepatitis B Fact Sheet. Retrieved on May 10, 2007, from http://www.cdc.gov/Ncidod/diseases/hepatitis/b/fact.htm
Center for Disease Control and Prevention (CDC). (2004a). Genital HPV Infection Fact Sheet. Retrieved on April 26, 2007, from http://www.cdc.gov/std/HPV/STDFact-HPV.htm
Center for Disease Control and Prevention (CDC). (2004b). STDs and Pregnancy. Retrieved on April 20, 2007, from http://www.cdc.gov/std/STDFact-STDs&Pregnancy.htm
Center for Disease Control and Prevention (CDC). (2004c). Syphilis Fact Sheet. Retrieved on May 10, 2007, from http://www.cdc.gov/std/Syphilis/STDFact-Syphilis.htm
Gandhi, M. (2006). Syphilis - Primary. Medical Encyclopedia MedlinePlus. Retrieved on May 10, 2007, from http://www.nlm.nih.gov/medlineplus/ency/article/000861.htm
Gandhi, M. (2005). Syphilis - Secondary. Medical Encyclopedia MedlinePlus. Retrieved on May 10, 2007, from http://www.nlm.nih.gov/medlineplus/ency/article/000854.htm
Mast, E.E., Margolis, H.S., Fiore, A.E., Brink, E.W., Goldstein, S.T., Wang, S.A., Moyer, L.A., Bell, B.P., and Alter, M.J. (2005). A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. Morbidity and Mortality Weekly Report (MMWR). 54(RR16); 1-23. Retrieved on May 4, 2007, from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm
Smith, D.S. (2006). Syphilis - Tertiary. Medical Encyclopedia MedlinePlus. Retrieved on May 10, 2007, from http://www.nlm.nih.gov/medlineplus/ency/article/000662.htm
World Health Organization (WHO). (2000). Hepatitis B Fact Sheet. Retrieved on May 4, 2007, from http://www.who.int/mediacentre/factsheets/fs204/en/
Web Resources
American Social Health Association Centers for Disease Control & Prevention Choosing a Contraceptive Intellihealth Mayo Clinic Planned Parenthood Federation of America Sex Talk. org
