| ABC's of STD's
The following information was adapted from the brochure ABC's
of STD's, written in consultation with Daniel C. William, MD,
P.C. For more information, please contact GMHC's Gay Men's Counseling
and Education, at 212/367-1354. Due to explicit sexual content,
this content is meant for people over 18.
Overview
Ever since HIV reared its ugly head, it seems that we've swept
all other sexually transmitted diseases under the carpet of our
consciousness. It's been easy to do so. For one thing, they just
don't seem to be going around anymore, unless it's the occasional
irritating case of crabs, right? And compared to HIV, other STD's
seem relatively harmless; they might be briefly unpleasant, but
they're easy to treat and then they go away, never to return again,
right?
Well, the answer to both questions is, not exactly. STD's are still
with us, and their prevalence rates are rising. For example, a September
1997 report from the Centers for Disease Control showed that in
the past four years, the incidence of gonorrhea in gay and bisexual
men had risen 74%! Other national figures reveal that herpes is
on the rise as well.
As for harmlessness, some STD's, like gonorrhea, are easily treatable
and don't carry the possibility of causing problems down the line
unless they go untreated, as they often do. Others, like hepatitis,
can lead to weeks or months of acute and debilitating illness, or,
like herpes, to a lifetime of painful flare ups. But before we go
any further, it's important to make the following points:
- If you were to eliminate the risk for all STD's, you couldn't
have any physical contact with anyone — and that's not realistic
for most people. That's why it's important to stress that, as
with HIV, you don't get an STD from sex itself, but from having
unprotected sex with an infected person. Remember, all sex is
relational — meaning an intersection of two people, under
specific circumstances, for different reasons, and driven by different
feelings. And as much as you think about what kind of sex you
have, you should think about who you're having it with: do you
know him well enough to know his health status and, if not, are
you comfortable enough with him to ask or to inform him of yours?
Your relationship with your sex partner, whether he's your boyfriend
or a stranger, should play a large part in helping you determine
what you will and will not do with him.
Also, you have to consider what level of STD risk is acceptable
to you personally. Just as you might find oral sex without a
condom a low enough level of HIV risk while drawing the line
at unprotected anal sex, perhaps you'll get naked with a stranger
because crabs is something you could live with, but you won't
rim him because hepatitis A and parasites are ones you couldn't.
Like all choices about sex, STD risk ultimately comes down to
how you weigh what you like and value against its risk quotient.
- If you know you have an STD, you can limit the risk of spreading
it by taking the same precautions you wish someone would have
taken with you. While it's difficult and awkward to inform your
sex partner — and it can certainly kill the moment —
it's nevertheless important to do so, even later on, if that's
when you find out. Can you think of a time when a sex partner
informed you of his STD? Weren't you grateful for it? Consider
this a chance to return the favor.
- It's very important that you find a doctor with whom you feel
comfortable enough to talk explicitly about your sex life —
someone who incorporates your status as a sexually active gay
male into your overall health picture. If your doctor dismisses
as unnecessary your request for a hepatitis A or B vaccine or
for a general STD screening, he/she is not on your wavelength,
and you should look elsewhere.
- Finally, look at your personal STD history: have you had more
than one STD, or have you gotten the same STD more than once?
Maybe there's a pattern there telling you that you should cut
back on certain sexual practices or on your number of sexual partners.
Perhaps your sexual techniques can be made safer.
Having said all that, it's important to note that, while all
STD's are to varying degrees less serious than HIV, several
of them can increase both the infectiousness of an HIV-positive
man and the level of susceptibility to the virus of an HIV-negative
man. Consider this:
- If you're HIV-positive and have an outbreak of open sores
from herpes, chancroid or syphilis, for example, those sores
contain highly concentrated amounts of the virus.
- If you're HIV positive, infections like gonorrhea and chlamydia
in your penis can make you shed eight to ten times more HIV
in your semen. If you're HIV negative and have herpes, gonorrhea
or chlamydia, the toll they take on your immune system and
the way they can inflame your mucosal membranes makes you
more likely to contract HIV through unprotected sex with an
infected man.
- Combined with HIV infection, chronic but manageable STD's
like warts and herpes can lead to complicated and painful
conditions and may be associated with a more rapid progression
to AIDS. Even scabies, which is easily treated in HIV-negative
people, can lead to chronic, pervasive and highly contagious
skin problems if you're positive. For all these reasons, it's
perhaps more important than ever to know your ABCs when it
comes to STD's — what they are, tactics for avoiding
them as best you can as well as how to spot and treat them
if you are the unlucky recipient.
Before we venture into the STD Hall of Fame, though, let's
lay down the important stuff first:
If you've already had hepatitis A or B, you'll never get
either of them again. If you haven't, get vaccinated against
both hepatitis A and B now! You can make an appointment
with your private doctor or call us, at 212/367-1354, for
more information and referrals to a clinic. For hepatitis
B, you need to get shots on three separate visits. Vaccination
is an incredibly smart way of avoiding either form of this
very unpleasant disease, the latter of which can lead to
lifelong or deadly complications.
- Short of abstinence or absolute oath-taking monogamy, the
single best way to reduce your chances of contracting a number
of STD's, including HIV, is to have sex with a condom and
water-based lubricant. However unappetizing it might sound,
if you use a condom for oral sex and/or a cut-flat condom
or dental dam for anal-oral rimming, you further reduce your
risk. But remember, you can catch some STD's from open sores
or skin surfaces that a condom doesn't cover — a fact
which should reinforce the point that it's as important to
consider who you're having sex with as well as what kind of
sex you're having.
- If you think you have an STD, see your doctor (or go to
a city clinic) and get tested right away. Indications that
you might have an STD include: discharge from your penis,
itching or stinging when you urinate, and sores, blisters,
or rashes in the genital area. If you're having sex with lots
of partners, and taking some STD risks, it's a good idea to
get checked out for STD's regularly, say, every three to six
months. This is especially important, since some STD's don't
show symptoms — and a reminder that it's important to
have a doctor with whom you feel comfortable talking explicitly
about STD's and your sexual practices.
- Remember: it's not only the number of sex partners, but
the types of sex you're having that influence your risk of
getting an STD.
- If you're in a relationship and considering having sex without
condoms, discuss with your doctor and your partner the risks
involved. You and your partner should get tested for STD's
first — remember that HIV is also an STD.
Hepatitis A, B, and C Hepatitis A,
B, and C are infections caused by different viruses affecting your
liver. They are spread in different ways:
Hepatitis A
How Do You Get It?
When tiny particles of an infected person's feces get in your mouth
through rimming, your fingers or your penis. You can also get it
from contaminated food or by using utensils, plates or glasses previously
handled by an infected person.
How Do You Avoid It?
By getting vaccinated against it! Short of that, you can avoid
rimming, or do it with a cut-open condom or plastic food wrap. You
can also make sure neither you nor your partner's fingers get in
your mouth until after they've been washed thoroughly with soap
and water; although remember that fecal matter could travel from
ass to finger to other places, like your dick or his, before it
reaches your mouth.
Bottom line: Once you start playing with your partner's
ass, keep your mouth shut. Of course this means people who rim without
protection are at high risk for hepatitis A.
Symptoms?
You might not notice any, but if they do appear, they usually do
so in two to four weeks: diarrhea, nausea, vomiting, fever, exhaustion
and loss of appetite. Also: yellow (jaundiced) skin and eyes, dark
urine and pale feces.
Duration: One to four weeks.
Testing and Treament?
Your doctor will collect a blood sample and get it tested. There
is no effective medication for hepatitis A infection. You will need
to rest, eat well and cut back on alcohol because of potential serious
liver damage.
HIV Connection?
Your liver processes most medication, so if you're HIV positive,
you need to keep it healthy. If you're infected with hepatitis A
or hepatitis B, you may have to go off anti-HIV drugs, so vaccination
is a smart move if you're at risk.
What else should you know?
- A vaccine is available for hepatitis A and B through your private
doctor or through a clinic. There is no a vaccine for hepatitis
C.
- Avoid having sex until your doctor believes you are no longer
infectious.
- A low fat diet is more readily digested when you are sick with
hepatitis.
- Once you've recovered from hepatitis A, you can't pass on the
virus to others and you won't catch it again, but some people
carry the Hep B virus for life and can pass it onto others.
Hepatitis B
How Do You Get It?
By getting an infected person's blood or cum into your bloodstream
through unprotected anal or oral sex, or by sharing infected needles
and other injecting equipment, such as those for tattooing and/or
piercing. Unlike hepatitis A, you can't get it through dirty plates
or glasses.
How Do You Avoid It?
By getting vaccinated against it! Short of that, by using a condom
for anal sex and possibly for oral sex with an infected person,
and by not getting an infected person's cum in your mouth.
Symptoms?
The same as for hepatitis A, but they take up to six months to
appear. Again, they may not show up at all. Most chronic hepatitis
B carriers don't have any symptoms, but they have an increased risk
of developing cirrhosis of the liver, which, if left untreated,
can be fatal.
Testing and Treatment?
Your doctor will test for hepatitis B by drawing a blood sample.
Treatment for it is not given for most self-limited infections (when
symptoms last for only a few months). So, all you can do is rest
and eat well. For chronic cases, alpha-Interferon injections are
the standard treatment. The injections are usually self-administered
daily or three times a week, for four months; talk to your doctor
about them.
HIV Connection?
Hepatitis B is passed the same way as HIV, but much more easily.
If you contract it, you may also be putting yourself at risk for
HIV infection and might want to consider testing for that as well.
If you have HIV infection, you should consider the hepatitis B vaccine.
Though less effective than in HIV-negative people, the vaccine still
works for most persons.
What else should you know
Ten percent of people with hepatitis B become chronic carriers;
the majority of them show no symptoms but remain infectious and
at risk for potentially deadly liver cancer or cirrhosis of the
liver. If you are a chronic hepatitis B carrier it is important
to have your liver checked regularly and avoid exposing others to
your blood. Among HIV-positive people with hepatitis B, the chronicity
rate rises to 20% to 40%.
Hepatitis C
How Do You Get It?
The hepatitis formerly known as "non-A, non-B, now called "type
C hepatitis," with symptoms and diagnosis similar to those of HBV,
above. Rates of chronic HCV are much higher, however, with around
50% of those with HCV becoming chronic carriers, and one out of
five developing cirrhosis of the liver. Primarily transmitted through
infected blood or shared needles, an estimated 3.9 million Americans
are infected. HCV is the most common cause of liver transplants.
How Do You Avoid It?
Sexually, by observing the same general rules of avoidance with
infected people as those for hepatitis B or HIV. Otherwise, by using
clean needles or other injecting equipment (see safer
injection).
Symptoms?
The same as for Hep A and B; they take between two weeks and six
months to show up. Many hepatitis C patients never have symptoms.
Chronic hepatitis C infection is associated with cirrhosis of the
liver, which increases the risk of liver cancer. Half of hepatitis
C patients get chronic hepatitis C infection.
Testing and Treatment?
Your doctor draws a blood sample. The standard treatment is injections
of Interferon alpha 2B, three times a week for six to twelve months,
though fewer than 25% of patients get sustained results. In the
absence of better treatments, doctors drafting guidelines for the
International Hepatitis Foundation advise those without serious
HVC-related liver inflammation to await better treatments.
HIV Connection?
As with hepatitis B, if you contract hepatitis C, you're also putting
yourself at risk for HIV transmission. For HIV-positive people with
hepatitis C, the chronicity rate is higher than for people without
HIV.
What Else Should I Know?
Most people with hepatitis C will carry the virus in their blood
for life and can pass it on to others. As with hepatitis B, hepatitis
C can also lead to liver cirrhosis or liver cancer.
There are also other strains of hepatitis — D, E, and counting
— that seem to have similar symptoms.
Syphilis
Syphilis has not been commonly seen in gay men for many
years now, but it is serious enough to warrant attention. Syphilis
is caused by a bacterial infection that develops in several different
stages. The latter stages can lead to irreversible damage to the
central nervous system and heart.
How Do You Get It?
It's passed along by contact with the syphilis germ in a small,
sometimes inapparent sore, usually through unprotected oral or anal
sex with an infected person.
How Do I Avoid It?
By using condoms for anal sex with an infected person, and possibly
for oral sex with an infected person.
Symptoms?
The first stage shows up as a small, painless sore at the site
of infection (usually on your penis, ass or mouth) within ten days
to three months after being passed on. Half of all those infected
don't develop a visible sore. If the infection is rectal, the sore
is usually unnoticed. Nearby lymph nodes also tend to swell.
After the sore(s) have healed, secondary, flu-like symptoms appear
after about six to eight weeks: a sore throat, aching muscles and
joints, headache, swollen glands and loss of appetite. A rash may
appear all over, including on the palms and the soles of the feet.
Skin growths are also common: highly contagious, wart-like lesions
can appear in moist body folds, and the mucous areas of the mouth
and genitals can erupt with a silvery-gray rash.
If the disease is not treated, all symptoms disappear within 6
months, but the germs remain dormant for five to 35 years until,
for about one-third of all syphilis cases, third-stage syphilis
sets in. In this stage, syphilis can attack the brain, spinal cord,
heart or nervous system. Ignored, it can be fatal.
Testing and Treatment?
Your doctor can take a blood test, which identifies the presence
of antibodies against the syphilis germ. Proper treatment depends
on correctly identifying the stage. Treatment usually involves penicillin,
or tetracycline or erythromycin for those who are allergic to penicillin.
HIV Connection?
Syphilis is much more serious in people with HIV: as many as half
develop problems with their brain and central nervous system, even
if syphilis is in an early stage or has been treated with a standard
dose of antibiotics. Everyone with HIV should have a syphilis test,
even if they have no symptoms, and all who test positive and are
treated should have regular follow-up blood tests to ensure that
treatment was effective. If you have had neurosyphilis, follow-up
requires spinal taps.
Herpes
Herpes technically refers to a class of viruses causing
ailments ranging from chicken pox to "mono" to the AIDS-related
infection CMV (see fact
sheet). Say the word herpes, though, and most people think of
the blisters that appear on mouth, nose and genitals following infection
with two of the most common herpes viruses: Simplex I and Simplex
II. A recent study revealed that one in five Americans over the
age of 12 is infected with HSV-II, with fewer than 10% of those
infected reporting symptoms the overwhelming majority did not know
they had the virus. There is no cure for herpes.
How Do You Get It?
By making contact with herpes sores that are commonly on or near
the penis, balls, ass or mouth during the carrier's outbreak periods.
Herpes can also be transmitted, even if no visible sores are present;
this is called asymptomatic viral shedding. It is unclear whether
or not HSV is transmitted by semen. Once infected, outbreaks come
back particularly during times of physical or mental stress.
How Do You Avoid It?
During outbreak periods, you and your partner must use condoms
for anal and oral sex any time you have active herpes lesions. Even
this may not be 100% effective, since sores don't usually limit
themselves to the shaft of your penis.
If you have herpes, you are most contagious at the beginning of
an outbreak. That means that if you're feeling symptoms of an approaching
outbreak — itching, tingling around the site of infection,
a flu-like malaise — you shouldn't have sex. At the end of
an outbreak, only when the skin is completely clear is the danger
of infecting another person through skin-to-skin contact over.
Symptoms?
Symptoms of a herpes infection usually first appear anywhere from
two to 20 days after exposure to the virus, although people can
carry and transmit the virus for years without knowing that they
are infected.
During the initial herpes outbreak, a few days (or even hours)
before any lesions appear, you may feel an itching or tingling sensation
around your penis and/or ass, with or without swollen glands. Sores
then tend to erupt in clusters, usually around the head and shaft
of the penis, but can also appear on the area between the balls
and ass, anus, or inside the rectum. They flare up in the throat
in about 20% of people suffering from herpes. Touching the lesions
can, in rare cases, cause the infection to spread to your hands
and thighs, and even to your eyes. You might also experience fever,
muscle aches, and other flu-like symptoms. These lesions may persist
anywhere from two to seven weeks. Usually the pain increases over
the first six to seven days, reaching a peak between days seven
and 11. The first blisters start to dry up and scab over in about
four to 15 days; new lesions, forming between days four and 10,
appear more than 75% of the time.
Subsequent outbreaks are usually much less severe than the primary
infection, becoming less frequent over time. Some symptoms never
recur, and, again, the vast majority of HSV-I and HSV-II carriers
never have visible symptoms.
Testing and Treatment?
Looking at the type and location of sores is usually enough for
your doctor to identify herpes; several tests are available to provide
a more definitive diagnosis, but none is foolproof. Three antiviral
medications — acyclovir, famciclovir and valacyclovir —
are currently available to lessen the severity and length of the
outbreak and to prevent new lesions from forming, but cannot cure
a herpes infection.
There are some things you can do on your own to alleviate pain
and itching. First of all, avoid over-the-counter anti-itch medications;
most contain hydrocortisone, which interferes with healing. Take
acetaminophen or aspirin for general pain. Sores will heal faster
if you take warm baths with baking soda three to five times a day
and keep them clean and dry by wearing loose-fitting cotton boxers
or no underwear at all. You might try a blow dryer (on the lowest
setting) on your sores after you get out of the tub, to make sure
they're fully dry, and sprinkle a little cornstarch or baking soda
on them to keep moisture away.
HIV Connection?
If you're HIV positive, symptoms can be more severe and outbreaks
recurrent, especially in the advanced stages of HIV infection. Problems
can occur when recurring sores last more than a month, and with
herpes-associated inflammation of the eyes (herpetic retinitis).
Check with your doctor about the benefits of antiviral drugs that
may prevent and treat herpes outbreak.
If you are HIV positive, the HIV virus is highly concentrated in
the lesions that appear during a herpes outbreak, making it easier
for you to transmit HIV to your sexual partners.
If you're HIV negative and have herpes, a herpes flare-up can make
you more vulnerable to getting HIV.
Bacteria and Parasites
The three most common bacteria are shigella,
campylobacter, and salmonella. The first two are the
most common among gay men, and while salmonella is usually a result
of contaminated food, it can also show up among gay men as an STD.
The three most common parasites among gay men are amoebas
(Ehistolytica), giardia, and crytosporidium. It's
been estimated that 10% of the world population is infected with
amoebas, although less than 10% of those infected will develop
severe symptoms.
How Do You Get It?
Through any activity that transmits someone's feces to your mouth
— rimming, fingering, or sharing sex toys. If you keep playing
after anal sex, you can pick up an infection from licking or sucking
someone's balls, thighs, belly or butt cheeks.
How Do You Avoid It?
Contrary to popular thinking, a good anal scrub doesn't really
help. As with hepatitis A, however, an awareness of where your hands,
mouth and penis have been does. The bottom line is keeping an infected
person's feces out of your mouth.
Symptoms?
As many as half of all infections have no symptoms. Most bacterial
and parasite infections are similar, ranging from watery diarrhea
without significant cramping to bloody diarrhea with severe abdominal
pain. In some cases, more systemic effects such as fever, nausea,
vomiting and/or headache occur. Symptoms usually begin within 24
to 36 hours of infection.
Testing and Treatment?
Your doctor will collect a fecal sample and get it tested, although
stool samples often have to be repeated as many as three times.
Various antibiotics (the most familiar being Flagyl) are usually
prescribed to combat bacterial and parasitic infections. As with
any course of antibiotics, it is critical that you finish the medication,
even if your symptoms have subsided.
HIV Connection?
If you're on an anti-HIV medication that causes episodes of diarrhea,
a bacterial or parasitic infection can go undetected and untreated.
If you have AIDS, these infections can develop into severe illnesses,
which may recur after treatment. Whether you're HIV-positive or
negative, if you play around with your partner's ass, it's a good
idea to include a stool test during routine physical exams.
What Else Should You Know?
When rimming, use a latex barrier, such as a dental dam or sheets
of clear plastic food wrap.
Warts
Caused by a virus known as the Human papilloma virus (HPV), warts
can appear on the penis, anus, inside the rectum or, less commonly,
inside the mouth. Like herpes, there is no way to rid your body
of the virus, which means that your first outbreak of warts is not
likely to be your last. Like herpes, there is also no real medication
to prevent them. The faster you treat them, though, the less they
spread.
How Do You Get Them?
Transmission is a bit mysterious. Many men who get anal warts do
not necessarily get penetrated or, if they do, their partner may
not have warts on his penis. Warts seem likely to be transmitted
on the surface of the skin, so if someone who has warts touches
his ass, then touches yours, you can get them fairly easily.
How Do You Avoid Them?
Using condoms for anal sex is essential, and if you're playing
with someone's ass, avoid touching your own ass right after. Beyond
that, it's difficult to say how best to prevent them, other than
submitting your sex partner to a physical exam before you touch
his privates, although take a peek first, if you can.
Symptoms?
Warts have an incubation period of anywhere from several months
to several years, with an average of one to six months, so they
may show up "inexplicably" during a sexual dry spell, or after.
Once you have them, you'll notice them fairly easily, if they're
external. If you think you have a wart on your penis, soak a handkerchief
in diluted vinegar, then press it on the affected area for about
six minutes. The warts will become lighter in color and easier to
see. You should see or feel small flesh-colored, cauliflower-like
growths; they sometimes appear in clumps. They are not usually itchy
or painful. Penile warts usually appear along the shaft, or under
the foreskin. For uncut men, the moist, warm environment under the
foreskin can facilitate the spread of warts.
Anal warts tend to grow on the perianal skin, and internal warts
usually cause rectal bleeding with bowel movements and intercourse.
If you have warts on your anus, make sure the doctor checks inside,
too.
Testing and Treatment?
Genital warts can only be treated by a doctor — do not
use over-the-counter wart medication on your delicate penis or ass!
Warts can be destroyed with trichloroacetic acid (TCA) or podophyllin,
frozen off with liquid nitrogen, or burned off with electrocautery
or laser therapy. In extreme cases, a doctor must surgically remove
large clusters of warts. Injecting the warts with Interferon, an
antiviral agent, may act directly against HPV instead of just destroying
the growths. All these treatments range from highly irritating to
extremely painful, and must be performed weekly for several months.
Another new treatment, for external warts only, is imiquimod (brand
name Aldara), a topical cream approved by the FDA in March 1997.
You apply it at home, three times a week for up to 16 weeks; it
slowly causes warts to disappear. It also works on the immune system,
bolstering it to help it attack the warts. It can't rid your body
of the virus entirely, but by killing off much of the active virus,
it may reduce transmission rates. Unfortunately, you can only use
it externally, so if you want to have internal anal warts removed,
you'll have to go with the painful methods for the time being. Imiquimod's
use by HIV-positive people has not been tested.
HIV Connection?
HIV-positive people are more likely to develop giant condyloma,
which are warts that grow rapidly and markedly in size. In most
cases they can only be treated by surgical removal. Some studies
have shown that HIV infection combined with HPV infection can increase
the incidence of abnormal rectal growths and the risk of rectal
cancer.
What Else Should I Know?
If you don't get genital warts removed, they get much bigger and
are hard to clear up. They are also associated with an increased
risk of cancers, whether or not you are HIV positive.
Warts are the most common STD in the U.S.; they are three times
as common as herpes.
Gonorrhea
Gonorrhea, otherwise known as the clap, is caused by gonorrhea
bacteria in your urethra, throat or ass. It often appears simultaneously
with another STD called chlamydia (see Chlamydia).
How do you get it?
Through touching the penis, throat or ass of an infected person
with your own, whether that's through unprotected oral or anal sex,
or through other modes of contact. Since the bacteria are present
in fluids other than semen, someone need not come in your mouth
or ass to infect you. For example, if someone has gonorrhea of the
throat and gives you head, your urethra can easily pick it up. If
you're doing the sucking, you can also get it from pre-cum.
How do you avoid it?
Using condoms for anal and possibly oral sex with an infected person
is the best way to keep from getting gonorrhea. Urinating after
sex may help flush out bacteria from the urethra, although there
is not much hard evidence to support this idea.
Symptoms?
You may have none, but if you do, they often show up two to ten
days after being exposed. They include:
- a creamy or yellow discharge from your penis, if you have it
there (urethritis)
- itching or burning in the opening of your penis when you come
or urinate
- a sore throat, if you have it in the throat (pharyngitis), but
this form is usually asymptomatic
- a discharge and an itch when you shit, or possibly blood and/or
mucus in your stool, burning rectal pain, pain during bowel movements,
and a false alarm urge to defecate, if you have it in the ass
(proctitis).
Even if the symptoms clear up, the infection may still be there.
Testing and Treatment?
Your doctor swabs a small amount of fluid from your penis, throat
or ass and looks at it under a microscope. There are also new tests
that can detect gonorrhea through a urine sample, but it has to
be sent to a lab. Even if you have no symptoms, routine gonorrhea
testing should be a part of all physical exams. Asymptomatic men
can easily spread the infection through both anal and oral sex without
condoms.
Treatment is a course of antibiotics, followed by a week of oral
antichlamydia drugs. To completely eradicate a gonococcal infection,
treatment of your most recent sexual partners is also helpful.
HIV Connection?
If you're HIV positive, check with your doctor about whether the
antibiotics prescribed are right for you. Untreated, gonorrhea can
increase the amount of HIV in your semen. What else should you know?
Left untreated, gonorrhea's symptoms will clear up over the course
of several weeks, but the infection persists. It can then lead to
a serious infection in your balls (epidydimitis) or a narrowing
of the urethra (stricture). Untreated gonorrhea in your throat or
ass can develop into ulcers. These increase your risk of getting
or passing on HIV if you have anal or oral sex without a condom.
It can also harm your reproductive system, making it impossible
to have children.
Chlamydia and NGU
Chlamydia is a very common STD and is caused by bacteria. Nongonococcal
Urethritis (NGU) is an infection of the tube inside your penis (urethra).
Like gonorrhea, a chlamydia infection is usually limited to the
site of infection and has similar symptoms. Up to 40% of chlamydia
infections are asymptomatic, making it difficult to diagnose. Chlamydia
and gonorrhea often occur simultaneously.
How Do You Get It?
Through unprotected anal and oral sex with an infected person.
How Do You Avoid It?
By using condoms for anal and oral sex with an infected person.
Symptoms?
You may not have any symptoms with chlamydia. Symptoms often show
up seven to 21 days after being exposed, and include:
- a watery, white discharge from your penis that is most noticeable
in the morning
- itching or pain in the opening of your penis that often fades
after you urinate.
Testing and Treatment?
Urine tests for chlamydia have been recently developed, replacing
the painful urethral culture of the recent past. The infection is
then treated with antibiotics.
What Else Should I Know?
Chlamydia may develop into a serious infection if not treated.
Crabs and Scabies
The common cold of STD's, crabs are tiny bugs that live
near or on your pubic hair, although sometimes they move to other
body hair, like beards, mustaches, eyelashes and underarms.
Scabies are tiny bugs that burrow under your skin. They
can be passed by everything from heavy humping to sharing a towel.
Even though both crabs and scabies are highly irritating, they are
both harmless, easily and quickly treated, and certainly not worth
the anxiety caused by some other STD's.
How Do You Get It?
Crabs jump and scabies move from person to person by close contact,
often during sex. You can also catch crabs and scabies by sharing
clothes, bed sheets or towels with someone who has them.
How Do You Avoid It?
If you're fooling around with someone playing host to crabs or
scabies, no change in sexual behavior, short of isolation, can really
protect you. If you're carrying the bothersome critters, it's probably
the polite thing to keep your distance from your boyfriend, sex
buddy, et al., until you've taken care of the problem.
Symptoms?
For crabs: itching, itching, itching, although you may not
itch at all until you have had them for some time. The itching usually
begins about five days after you've been bitten, and is concentrated
wherever you have pubic hair. Crabs are also well suited to facial
hair — eyelashes, eyebrows and beards. They are about 1mm long,
visible to the naked eye, and look like little crabs (hence the
name). You might also see some waxy white specks attached to your
pubic hairs. These are the eggs, called nits, and they are usually
so well cemented they often need to be removed with a very fine
comb.
For scabies: It is only after about ten days after infestation
that the skin develops an allergic reaction, although a carrier
can pass them along before that point. If you're itching like mad
but can't see any signs of crabs, especially if your hands are itching
most, you may have scabies. Mites are much smaller than lice, and
instead of attaching to the surface of the skin like crabs do, scabies
burrow underneath to lay their eggs. And unlike crabs, everyone
who has scabies eventually develops itching. Scabies burrow under
the skin, causing short, wavy, dirty-looking lines that cut across
the normal lines of the skin, usually limited to the webbed skin
between the fingers as well as on the wrists, elbows and penis.
Small lesions and papules that can look like eczema or common rash
occur with the burrows.
Testing and Treatment?
For crabs: Most over-the-counter shampoos used to treat
head lice will do the trick. Rid and Triple X are good, as is A200
Pyrinate, which requires two applications. For crabs on your eyelashes
or eyebrows, coat them with Vaseline and they die from lack of oxygen.
You can't use crab shampoo around your eyes. You'll also have to
wash all your clothes, sheets, and towels in hot water to kill the
crabs and their eggs. About a week later unhatched eggs may hatch,
and additional treatment may be needed.
For scabies: Topical lotions (for example, Elimite) are
available by prescription only. To rid your body of mites, you must
rub the lotion thoroughly into every inch of skin, from the soles
of your feet all the way up to (but not including) your head. Wash
it off thoroughly after eight to 14 hours. The itching from scabies
may take days or weeks to completely subside, even after you are
completely rid of them.
HIV Connection?
People with AIDS can develop a condition known as Norwegian, or
crusted, scabies. The skin erupts into scaly patches containing
large numbers of mites. These patches of skin shed frequently, making
it even more contagious.
What Else Should You Know?
If you don't get treated for crabs or scabies, they won't go away,
and the severe itching they cause will continue.
As bad as the itching may be with both crabs and scabies, you should
avoid hydrocortisone creams, which can make the underlying problem
worse.
Other STD's
There are some STD's that are not explained. Just for the record,
however, here are a few:
Trichomoniasis
Otherwise known as trich, it is caused by a parasite known as trichomonas
vaginalis, because it was originally believed to infect only the
vagina, although this has been proven untrue. Still, man-to-man
transmission is unlikely, since in men trich only resides in the
urethra. What's more, it is difficult to detect in men, and lab
testing is accurate only up to 60% of the time. However, the standard
course of treatment is with metronidazole (Flagyl).
Molluscum
Molluscum is a viral infection of the skin. It is a common problem
for HIV-positive people with compromised immune systems, on whom
it most often appears on the face, chest and torso. It is transmissible
through skin-to-skin contact with people who have it. The lesions
appear as small, smooth bumps with a dent in the center, usually
flesh colored and growing to just a bit smaller than a thumbtack.
They can be frozen or burned off, or surgically removed. Some people
report success with prescription anti-acne drugs. Some HIV-positive
people taking the potent new anti-viral cocktails find that the
molluscum get better as their immune system improves.
Chancroid, LGV and Granuloma
Inguinale While all three
of these STD's are relatively rare, they can lead to serious consequences
if misdiagnosed and/or left untreated. They are all characterized
by open genital sores that may be mistaken for herpes or syphilis
lesions. Contact with infected areas usually transmits these infections.
Chancroid and LGV must be diagnosed through laboratory tests, while
granuloma inguinale can be identified by visual inspection alone.
All three conditions are treatable with antibiotics, although HIV
infection can make chancroid resistant to treatment. In addition,
any STD that includes open sores makes it easier to transmit HIV,
which is usually concentrated at the site of a lesion.
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