STDs

Physicians Series Brochure: STDs

YES, WHEN TWO PEOPLE HAVE SEXUAL INTERCOURSE, they are having intercourse with everyone with whom they both have ever had intercourse, because many sexually transmitted diseases have no symptoms and are very difficult – if not impossible – to cure.

SEXUALLY TRANSMITTED DISEASES (STDs) are increasing in the U.S. and many are at epidemic proportions. Most are spread by sexual intercourse, oral sex and anal sex. Many STDs can seriously damage you forever. People who have one STD generally have acquired more than one and have dramatically increased their chances of acquiring HIV. The best way to avoid contracting STDs is to avoid sexual activity outside a faithful monogamous marriage.

 
The STD rate among teenagers and young adults is high. The Centers for Disease Control (CDC) report that two-thirds of all STD cases occur among persons under 25 years of age (Hidden Epidemic, 1996).

Many of these diseases cause long-term, adverse effects. Women’s health and future ability to bear children can be jeopardized. More babies are born with birth defects from STDs than all the children stricken with polio in the 1950s (Hager H. Gayle, MD, MPH, Dir. CDC Center for HIV/STD, 1/98).

 

The CDC report that STDs infect 3 million teens or more each year because many cases of STDs among teens go unreported. 80 percent of those STD-infected have no symptoms and may not realize they are infected (Safe Sex, J. McIlhaney, MD).

Teens compose 10% of the population but contract 25% of the STDs each year (MISH, 7/97). Between 100,000 and 150,000 American women become sterile each year because of STD-related infections (American Social Health Association, 1994; CDC, 1994 Annual Report).

There are over 50 known STDs at this time. The most commonly occurring STDs are: (1) Chlamydia, (2) Gonorrhea, (3) Syphilis, (4) Trichomonas, (5) Hepatitis B, HBV, (6) Herpes Simplex Type II, HSV-2 (7) Human Papilloma Virus, HPV (genital warts), and (8) HIV/AIDS.

Chlamydia is the most common STD among young adults. It also increases the risk of contracting HIV (AIDS) from an infected partner.

Chlamydia infects human mucus membranes of the vagina, rectum and mouth, and can move upward from the cervix into the pelvic organs.

If left untreated, chlamydia can cause Pelvic Inflammatory Disease (PID) in women. Symptoms/damage caused to the reproductive organs by the PID. The serious long-term consequences of PID cannot be overstressed. PID often renders the female sterile (unable to bear children). It is the most common cause of sterility, causing about 40% of PID in the US (CDC, STD/HIV Annual Rpt, '97).

About 1 million U.S. women suffer from symptomatic PID each year, causing over 25% (1/4) of the infertility in women pursuing in vitro of chlamydia infection are mild compared to the fertilization in the US (CDC, ASRM, HHS, '99). Left untreated, chlamydia (and/or repeated episodes of PID) results in even higher rates of infertility. Nearly 1 of 10 first pregnancies following PID are ectopic or tubal pregnancies (CDC, STD/HIV Annual Report, '91).

The staggering number of 3 million per year are infected by chlamydia, and sexually active (SA) teens have the highest prevalence. It most frequently infects men and women who have had more than one sexual partner. Eighty-five percent of infected women and 40% of infected men have no symptoms. Chlamydia infects 10-30% of SA 15-19 year olds (CDC, MMWR, v. 47, RR-1, 23 Jan 98).

Other complications of chlamydia: adult pneumonia, ear infections, heart muscle infection, uterus infection after childbirth, miscarriage or premature delivery.

 

Gonorrhea The risk of contracting HIV/AIDS from an HIV+ partner increases if gonorrhea is present. Approximately 650,000 new cases are reported annually with the highest rates among teens (CDC, '97; Medical Instit., '03). At least 2580% of female gonorrhea infections have no symptoms.

Gonorrhea is caused by a bacterium (N. gonorrhea), and antibiotic-resistant forms are appearing. Approximately 650,000 new cases of this disease are reported annually with the highest rates among teens (CDC, 1997; Medical Inst., 2003).

At least 25-80 percent of female gonorrhea infections have no symptoms (CDC, 1998; Medical Inst., 2003).

Gonorrhea causes Pelvic Inflammatory Disease (PID) in 10-20 percent of infected women. Among US women seeking help to become pregnant, 1 in 4 are infertile due to PID. Infected pregnant women are at increased risk of miscarriage or pre-term birth. Symptoms in men include pus and painful urination. The risk of contracting HIV(AIDS) from an HIV+ partner increases if gonorrhea is present.

 

Syphilis

Syphilis is transmitted by a parasite called a spirochete. Primary Syphilis, the first stage, is manifested by non-painful ulcers, usually on the external genitalia; untreated, the disease progresses to Secondary Syphilis when other organ systems can be affected. As the disease advances to Tertiary Syphilis, brain disorders, heart disease and death can result. Syphilis is most common in the South (CDC, 1997).

 

Trichomonas

Trichomonas is transmitted by a protozoan parasite mainly through sexual contact. About 5-10 percent of U.S. women are infected, with 5 million new cases per year (200 million cases/year worldwide). Most (50-80 percent) women have no symptoms; trichomonas causes inflammation of the vagina/cervix: irritation, swelling, itching, abdominal pain. In males, the urethra is infected: discharge from penis; burning during urination. Infected pregnant women may experience premature rupture of membranes and pre-term labor/birth. The presence of this disease also increases the risk of contracting HIV (AIDS) from an infected partner. This STD is treated with metronidazole.

 

Hepatitis B

Hepatitis B (HBV) is caused by a virus and results in chronic liver disease. There is no cure. Annually, 100,000 – 200,000 cases are reported. About 6,000 U.S. deat

hs occur annually from HBV infection.

 

Herpes Simplex II

Herpes Simplex II (HSV-2) is a virus unique to humans. Two types exist: Type I causes fever blisters (not STD); Type II causes STD infections. Twenty-five percent (1 in 4) of sexually active women, and 20 percent of sexually active men, are infected with HSV-2 (CDC, 11/96) and 1,000,000 new cases are reported each year, with at least 45 million Americans diagnosed with HSV-2 (CDC, 1/98). This means that 1 in 5 Americans over age 11 has HSV-2; also, 45 percent of black Americans over age 11 are infected with HSV-2.

About 8 days after exposure, lesions/blisters appear in the area of exposure and become painful ulcers; these initial symptoms resolve in 2-3 weeks. However, the virus can be transmitted to others even if there are no symptoms, and 90% of HSV-2 infected people have no symptoms.

Herpes II remains dormant in the nerve ganglions of the pelvis and periodically erupts in painful blisters and ulcerations in the genital area, tongue, eyes, lips, hands or other body parts. Males and females will usually suffer from occasional outbreaks. HSV-2 is highly infectious.

Herpes II is essentially incurable. Anti-viral medications have been used to control the symptoms and decrease the number of outbreaks; but, they do not eliminate the virus from the body or prevent transmission to sexual partners.

This virus can be transmitted to a baby via vaginal delivery; a C-section may be performed to avoid this. Another serious consequence of HSV-2 is that infected persons are at an increased risk for HIV (AIDS) infection, may be more able to spread HIV to others (JAMA, 1998; Medical Inst., 2003), and may progress to AIDS more rapidly.

 

Human Papilloma Virus

Human Papilloma Virus (HPV) infects the skin and mucus membranes of mouth, cervix, vagina, urethra, and anus. About 30 of the 100+ strains of HPV cause genital infections. At least 38-46 percent (up to 60 percent) of sexually active women contract HPV (NEJM, 2/98). Over 20 million Americans (1 in 14) are reportedly infected with HPV (CDC, 11/96).

There are 5-6 million U.S. infections per year. Many HPV infections resolve spontaneously; however, in people who remain infected with HPV, even without symptoms, the chances of warts and cancer increase. HPV is also highly contagious (1 in 2 chance). Both males and females can infect others with the papilloma virus and yet have no apparent warts/symptoms.

HPV disease is manifested by genital warts (Condylomata acuminata) around the cervix, vulva, rectum or penis. Topical chemotheraphy, surgical removal, cryotherapy and laser treatment are utilized to control the warts; however, the infection may remain and can still be passed on to a sexual partner. Also, warts frequently recur.

Vaginal and cervical HPV infection may result in abnormal Pap smear cells (pre-cancer) which are very difficult to eliminate once diagnosed and which can become cancerous. About 2.5 million U.S. women have abnormal Pap smears each year. Five strains are known to cause cervical cancer, two other strains can cause invasive cancer within one year of infection.

HPV is the primary cause of over 99 percent of cervical cancers and is associated with other cancers including oral, vaginal, anal, and penile (penis) cancer. One study of 796,337 women found that almost 25 percent (1 in 4) of the abnormal pap smears evaluated were from 15-19 year-old women. Cervical cancer occurs in about 13,000 U.S. women every year and 5,000 U.S. women die each year (CDC, 11/96; Medical Inst., 2003). Condoms provide no protection from HPV.

The risk of acquiring HPV (and developing cervical cancer) is directly related to two factors: age of the woman at first sexual intercourse (the younger her age, the greater the risk); and the number of sexual partners (the greater the number of different partners, the greater the risk) (D. Higby, MD, Baystate Medical Center, MA).

Pap smears should be obtained yearly by sexually active women to screen for pre-cancerous cervical cells at the onset of sexual activity no matter how young the patient. The best way to avoid HPV infection is to abstain from sexual activity outside marriage and remain faithful during marriage.

 

Human Immune Deficiency Virus

Human Immune Deficiency Virus (HIV) has no symptoms in most patients, but to date, infected persons ultimately develop full-blown AIDS.

Acquired Immune Deficiency Syndrome (AIDS) was first recognized in the 1980s. As of 12/00, 800,000-900,000 U.S. people with HIV are reported (CDC). The number of deaths from AIDS to date has been over 581,400, about half the number of cases reported.

There have been 31,400 AIDS cases in young people under the age of 25, as of 12/96 (CDC, 12/96); 8,908 AIDS cases in children 12/under (CDC, 12/00). Twenty-five percent (1 in 4) of all new diagnosed HIV infections are found in people under the age of 22 (MISH, 97). It is also important to know that CDC data for HIV only includes 39 states and "areas"; thus, HIV numbers are probably much greater.

According to the CDC, 67 percent of those diagnosed with AIDS have been homosexual males and/or intravenous drug users (12/00). Other high risk groups include recipients of infected blood transfusions and women whose sexual partners are intravenous drug abusers or bisexual males.

Women infected with the HIV virus before or during pregnancy have about one chance in three of transmitting the HIV virus to the baby. (CDC, America Responds to AIDS).

Early symptoms of AIDS include an acute mononucleosis-like syndrome in many patients. The incubation period from exposure to manifestation of HIV has ranged from five days to three months or longer.

A negative blood test for HIV does not verify that a person is free from the virus; testing should be performed again 6 months after exposure. Many new strains of non-HIV forms of AIDS are beginning to appear for which no tests are yet available.

If STDs such as Herpes sores or HPV genital warts — or even chlamydia or gonorrhea — are already present, the HIV virus has a quick and easy route into the person’s body through these infection sites — thus, the chance of HIV transmission is greatly increased when other STDs are already present.

 

CONDOMS have be

en portrayed as a means of "safe sex" to provide protection from all STDs. It should be noted that condoms provide minimal protection at best against any STD, including HIV (AIDS).

Condoms have microscopic holes through which STD viruses can pass, as well as occasional cracks, defects and deterioration which allow the passage of larger STD microorganisms (C.M. Roland, Editor of "Rubber Chemistry and Technology," Washington Times, 4/22/92). Also, it is highly unlikely that condoms will remain perfectly in place every time. As one study showed, 14.6 percent of the condoms slipped or broke (Trussel, Warner, Hatcher, Family Planning Perspectives, 1/92).

Condoms, used correctly, "reduce the risk" of contracting Chlamydia by 3%; Gonorrhea by 13% to 34%; and Herpes II by 20% to 39%, "compared to having sex without using condoms". Condoms provide "no protection" from HPV [Cates & Stone, "Family Planning, STDs, and Contraceptive Choice", Fam.Plan.Persp., v.24, 1992]. A draft report from UN AIDS found that even when condoms are used consistently, the failure rate for protection against HIV is an estimated 10 percent [6/03].

Chemical contraceptives ("The Pill," "Shot," "Patch") provide no protection against any STD, and may change the vaginal lining, making it more susceptible to STDs (CDC, 1998).

The dangerous effects of Sexually Transmitted Diseases easily outweigh the momentary benefits of non-marital sexual activity/intercourse. As physicians, we encourage you to stop and seriously consider all the alternatives before you begin sexual involvement.

If you are sexually involved outside marriage at this time, we urge you to consider Secondary Virginity. Secondary Virginity allows you to return to the state of sexual abstinence in order to guard your health and put your mind at ease.

If you are not having sex, you don’t have to worry about these diseases! Avoid the anxieties and fears associated with sexual involvement outside marriage. Avoid situations and occasions that place you in danger, and just say, "No"!!

1st Printing, 4/10/91; 2nd Printing, 5/7/91; 2nd Edition, Rev. 11/92; 3rd Edition, 11/96; 3rd Edition, Rev. 8/97; 4th Edition, 8/99; 5th Edition, 9/03

© 2007 Alabama Physicians for Life, Inc., Post Office Box 2478, Cullman, Alabama 35056-2478

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