Sexually Transmitted Infections (STIs)

HPV | NGU | Molluscum | Herpes | Chlamydia | HIV/AIDS

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Human Papilloma Virus (HPV)

HPV, also known as Condyloma or Genital Warts, is caused by the HPV virus and is similar to the common skin wart. When discovered on pap smears, HPV has been linked to cervical cancer in women.

Symptoms

None, or you may notice small "bumps" in the genital area or on the penis. The symptoms usually appear 3 weeks to 9 months after contact with an infected person, with the average incubation period being about 3 months. New warts may appear months after treatment through previous autoinoculation or the long-term existence of the virus in the latent phase. The diagnosis is made by the clinician using direct observation or through a pap smear.

How is HPV Spread?

HPV is spread by direct vaginal, penile, anal/or oral contact with an infected person. Occasionally warts can be spread from hands to genital areas.

Treatment

Medications are used to treat the wart produced by HPV, in the form of either solution or cauterization. Following treatment, the warts should dry up and fall off; this treatment may be repeated weekly if necessary. Sexual partner(s) should be checked by a doctor and treated at the same time. Condoms should be worn by male partners until treatment is complete. HPV identified on a pap smear will be referred for colposcopy.

It is important to keep regular appointments for treatment. Following initial treatment, return visits are advised only if the warts are not successfully treated or if the warts return in the future.

Prevention

Avoid sexual contact (oral, vaginal, penile, and/or anal) if you or your partner(s) have or suspect you have HPV. If there are warts are on the penis, condoms should be worn until treatment is complete. However, this does not guarantee that the virus will not spread.

In June 2006, the first vaccine was developed to prevent cervical cancer and other diseases in females caused by certain types of genital human papillomavirus (HPV) became available. The vaccine, Gardasil®, protects against four HPV types, which together cause 70% of cervical cancers and 90% of genital warts. The vaccine has been approved by the FDA for use in girls/women, ages 9-26 years. Gardasil® is given through a series of three shots over a six-month period. Ideally, females should get the vaccine before they are sexually active, but women who are already sexually active may benefit as well. It is not yet known whether the vaccine is effective for boys/men. For more information about this vaccine as well as the relationship between HPV and cervical cancer, visit the CDC's page on HPV Vaccine Questions and Answers. For instructions on obtaining Gardasil from Health Services and/or finding out if your insurance coverage will pay for Gardasil, please visit our Gardasil Information page.

Your Responsibility

If you have HPV, inform your partner(s) so that they can be examined and/or treated, even if apparently asymptomatic. HPV is highly contagious and can spread enough to block the vaginal and/or rectal openings. Females with HPV found on a pap smear have an increased risk of developing cervical cancer. Therefore, pap smears should be done annually, and you may be referred to a gynecologist for a colposcopy.

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Non-Gonococcal Urethritis (NGU)

Non-gonococcal urethritis is considered a sexually transmitted disease. For many years the clinical syndrome of inflammation of the urethra, purulent discharge and painful urination in the male was synonymous with gonorrhea. Non-gonococcal urethritis means the cause is linked to another offending micro-organism which causes the inflammation of the urethra. Chlamydia trachomatis has been recovered from 30 to 50% of patients diagnosed as having NGU. The other micro-organisms include Ureaplasma urealyticum, Mycoplasma hominis, Herpes simplex virus, Haemophilus vaginalis, Candida albicans and Trichomonas vaginalis.

With so many offending organisms, it becomes important to try and establish what is causing the urethritis. NGU is spread by sexual contact with a partner who has one of the various vaginal infections. It can also develop in persons who have not had sexual contact. If NGU is caused by chlamydia microorganism, symptoms may appear 7 to 14 days after infection. If the cause is from one of the other infections there are different time periods. The clinician will try to elicit a good history as to when these symptoms first appeared and what the symptoms are.

Symptoms and Diagnosis

In men, symptoms may include pain while urinating or frequent urge to urinate, watery, mucous discharge from the penis, possibly white in color. There may be a large or small amount of discharge. Most women usually have no symptoms if the Chlamydia trachomatis is causing the problem. If one of the other conditions exist, women may have symptoms. Some women may feel pain while urinating, frequency and also have a vaginal discharge. Women are more likely to be carriers of NGU. In men, NGU is diagnosed having cultures and slide tests of the sample material taken from the urethra. In women, a culture of the cervix will also be taken.

Treatment

NGU is treated with antibiotics or other appropriate measures, determined by what is causing the discomfort. Suggestions to follow during treatment includes the recommendation of drinking lots of liquids. Cranberry juice and water are considered valuable. Alcohol and caffeine should be avoided because they may irritate the urethra. Frequent urination especially after genital contact is considered essential. Frequent soaking in a warm bath is also recommended.

Prevention of NGU

  • Discuss NGU with your partner(s).
  • Avoid sexual contact (anal, penile, oral and vaginal contact) if you or your partner(s) have symptoms or a diagnosed case of NGU.
  • Use of condoms by male partner(s), if appropriate, to prevent them from getting the infection and/or passing it back to you.
  • Avoid genital contact with discharge from the urinary opening of an infected partner.
  • Tight clothing, especially if made of synthetic fabrics, keeps the area moist, does not allow your skin pores to breathe, and can allow bacteria to grow more easily. Loose clothing will help keep the area dry and cause less irritation of the urethra.
  • Wear cotton underpants (or cotton crotch).
  • Always urinate when you have the urge.
  • Drink lots of fluids every day. especially water and cranberry juice.
  • Avoid alcohol, tea and coffee.
  • Urinate and drink water after genital contact.

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Molluscum Contagiosum

Molluscum is a benign viral disease of the skin. It is a virus of the pox group, and until recently was seen mostly in children. In our population, it most often appears in the genital area.

Symptoms

Molluscum presents as smooth, firm, spherical papules, usually on the lower abdomen, pubis, genitalia, and inner thighs. The papules measure from 3 to 8 mm in diameter, have an umbilical-like depression and a curdy white material can be expressed from the center. The number of lesions varies from one to 20, but may occur as many as 100. There is no uniform arrangement, but rather a haphazard distribution. Most patient are asymptomatic, but a few may complain of itching or tenderness.

How is Molluscum Spread?

The disease is transmitted either by direct contact or possibly through vehicles such as shared towels or gym equipment. In adults, the disease is considered to be sexually transmitted, based on the location of the lesions, number of sexual partners, and number of other STIs among the infected. The incubation period ranges from 1 week to 6 months, with an average of around 3 to 8 weeks.

Treatment

Without treatment, molluscum persists from 6 months to 2 years; each lesion may remain about 2 months. Treatment is provided to decrease the possibility of autoinoculation and/or transmission of the infection and aesthetic reasons. The best treatment for the infection is to open the papules, evacuate all of the contents, and scrape the base. A variety of chemical irritants have been used, as well as laser or cryotherapy.

Recommendations

Patients are to be reassured of the benign nature and that the disease is not associated with systemic spread or sequelae. Patients should be warned that new lesions may appear after treatment, scarring is possible, and sexual partners should be examined.

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Herpes

Herpes Simplex is an infectious, usually harmless, uncomfortable viral disease characterized by inflamed blisters which appear around the mouth or the genitals. Different forms of the virus cause chickenpox, mononucleosis, shingles, and herpes simplex. The viral typing is determined by the lesion location, although this is not a definite criteria for diagnosis. Mouth fever blisters or cold sores ordinarily have their primary infection occurring before one year of age. This type is know as Herpes Simplex I. Blisters which occur on the vaginal labia or the penis are painful and tend to develop three to seven days following sexual contact. This type is usually caused by the Herpes Simplex II virus. The blisters on the mouth and the labia can both be spread from one area to another through sexual contact (oral, anal, penile and vaginal). None of the viral infections confer immunity.

Symptoms

When there is a primary or first infection, some individuals may have fever, enlarge groin glands, exquisite pain at the blister site and painful urination. Light skinned individuals tend to have large red sores, while dark skinned individuals have gray sores. Just before a sore appears, there may be tingling or itching in the area where the sore is about to appear. These sores may last 4 to 6 weeks. Some people may be acutely ill and others are simply uncomfortable. The usual herpetic genital disease, which follows an acute clinical course, undergoes remissions without complete clearance of the viral agent. This means an individual may have one attack, recover and be all right. It also means the infection might lie dormant after the initial attack and then suddenly recur, causing severe itching of the genital site prior to the sores breaking out. The return of the herpes sores, although uncomfortable, is not as prolonged as the initial or primary infection. The sores tend to be smaller and not as painful. In women, there may be sores on the cervix, which can be detected by a slight amount of bleeding and visual examination.

How is Herpes Spread?

Herpes is spread during sexual or close body contact, usually in the presence of a blister. Active virus can be present on the skin from the first warning signals (called "prodrome" symptoms) until the sore is completely gone. At other times asymptomatic "shedding" may occur.

Diagnosis and Treatment

Diagnosis of herpes is made by a visual examination of the blisters and/or herpes viral culture. Pap smears may be helpful to confirm the presence of the herpes virus. It is also important to establish a differential diagnosis from other lesion-causing vaginitis. There is also an antibody blood test, which is expensive to do, and sometimes is not really diagnostic, but might help to show a person has herpes at the time of the infection outbreak.

Currently, there is no herpes cure. There is treatment for the discomfort and this will be discussed by your clinician. You may be given oral and/or topical medication. To prevent further infection, avoid scratching the sores if they itch and try to keep the area clean and dry. Avoid tight fitting clothing and wear underpants with a cotton crotch. If urination is painful, go to the bathroom sitting in a bathtub of warm water or pour warm water over the area if sitting on the toilet. Dry the area well. Pat dry. Intercourse should be avoided if painful.

Prevention of Herpes

If you or your partner(s) have open cold sores or genital sores, contact with your mouth, vagina, penis or anus should be avoided. In order to prevent a rare chance of infecting the eyes, do not touch the lesion with your hands. Avoid direct contact until all sores are totally healed, not just scabbed over. Use of condoms by male partner(s) may prevent the spread of herpes but are no guarantee you will not become infected. Warm baths or sitz baths, with the water over 110 , are thought to help prevent the growth of the virus. Factors such as fever, sun exposure, menstruation, psychological stress, certain systemic diseases and medications are thought to be precipitating factors to recurrent herpes.

Go to this site for more information about herpes.

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Chlamydia

Chlamydia are small bacteria and are the cause of the most common STI in the U.S. today. The bacteria chlamydia trachomatis often infect the urethra in men and the cervix in women. Although the clinical course may be silent, the complications and sequela can be serious.

Symptoms

Three clinical syndromes exist in women with the infection:

  1. mucopurulent cervicitis, often noted as a vaginal discharge or spotting or break through bleeding (esp. after intercourse),
  2. urethral syndrome or urethritis, or burning upon urination, and
  3. pain in the lower abdomen.

Men usually experience painful urination or the need to urinate more frequently. Women often have no symptoms and up to 30% of men may have few or no symptoms!

How is it Spread?

It is transmitted by contact with the vagina, mouth, eyes, urethra or rectum of an infected individual. The incubation period for c trachomatis infection is 1 to 2 weeks after exposure.

Possible Results

Sterility in both men and women may result if left untreated. Chlamydia may pass to newborns in the birth canal and cause eye damage and/or pneumonia.

Diagnosis and Treatment

Diagnosis is made by sexual history, examination of the discharge and special tests. Treatment is with antibiotic therapy. It is important to take the medication exactly as directed by your health care provider, to have your partner treated (preferably at the same time as your own treatment), and to abstain from sexual intercourse until treatment is completed.

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HIV/AIDS

The human immunodeficiency virus, known as HIV, is commonly spead by having unprotected sex with an infected partner. The virus can enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during oral sex. HIV can also be spread through contact with infected blood, but given today's standards, the risk of contracting HIV in this manner is small. Other ways in which HIV is transmitted include sharing needles for drug use and mother-to-child during pregnancy. Acquired Immune Deficiency Syndrome, or AIDS, is the condition which develops in the advanced stages of HIV infection.

Early HIV infection often causes no symptoms. Therefore, the infection is diagnosed by testing a person's blood for the presence of antibodies (disease-fighting proteins) to HIV. These antibodies generally do not reach detectable levels in the blood for at least 1-3 months following infection; it may take as long as six months for the antibodies to be produced in quantities large enough to show up in standard blood tests. If you believe you may have been exposed to the HIV virus, you should get an HIV test within 6 weeks to 12 months after possible exposure; early testing allows for prompt treatment as well as reduced spread of the virus to others.

For information on obtaining HIV testing on campus, visit the HS Our Services page. More general information about HIV/AIDS diagnosis and treatment can be found on the National Institute of Health web site. Finally, NYS offers a toll-free HIV Counseling Hotline with trained HIV counselors. The hotline is available Monday and Friday, 2-8 p.m., Tuesday through Thursday, 10 a.m.-8 p.m., and Saturday and Sunday, 10 a.m.-6 p.m., and it can be accessed from anywhere in New York State by calling 1-800-872-2777.

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