Sexually Transmitted Infections

How common is trichomoniasis, and what possible complications are associated with this infection?

The possibility of getting a sexually transmitted infection has caused me to be extremely cautious and selective about whom I choose to be sexual with. It also makes every decision in a sexual relationship so critical and has made me much more careful in the choices I make. (Authors’ files)

In this chapter, we discuss a variety of sexually transmitted infections (STIs)[3]— that is, infections that can be transmitted through sexual interaction. ■ Table 15.1 sum­marizes the STIs described in this chapter. Some of these infections are curable; others are not. As we will see, the consequences of STIs—such as compromised health, pain and discomfort, infertility, and even death—can adversely affect the quality of our lives.

Our purpose in including a chapter on STIs is not to discourage you from exploring the joys of sexuality. Rather, we wish to help you make good decisions by presenting a realistic picture of what STIs are, how to recognize them, what should be done to treat them, and what measures can be taken to avoid contracting or transmitting them. We believe that this information is especially relevant to our college-age readers. The trans­mission of STIs on American college campuses continues to pose significant health con­cerns (Williams et al., 2008). Moreover, it is estimated that about half the STIs diagnosed annually in the United States occur among 15- to 24-year-olds, although that population constitutes only one quarter of the overall sexually active population in the United States (Dariotis et al., 2011). Furthermore, most HIV infections in America occur among young people under the age of 30 (Barnard, 2011; Crosby & Danner, 2008).

You may wonder why we postpone our discussion of HIV/AIDS until later in this chapter. Certainly AIDS has received far more attention in the media than any of the other infections discussed in this chapter. This emphasis on AIDS, although understand­able in view of the continuing worldwide spread of this deadly ailment, tends to obscure the fact that many other STIs are substantially more prevalent. Furthermore, many of these commonly occurring STIs, such as chlamydia and genital warts, pose major health risks that are escalating in proportion to the increasing incidence of these infections.

Many factors contribute to the epidemic of STIs in the United States. Engaging in risky sexual behavior, such as having multiple sexual partners and unprotected (condom­less) sex, is a prime reason for the high incidence of STIs. Such behavior is especially prevalent during adolescence and early adulthood, when the incidence of STIs is the high­est (Workowski et al., 2010). It is also believed that increased use of oral contraceptives has contributed to the epidemic of STIs—both by increasing susceptibility of women to some STIs and by reducing the use of condoms, a contraceptive method known to offer protection against many infections. Lack of adequate public health measures and lim­ited access to effective systems for prevention and treatment of STIs also contribute to this ongoing epidemic. In addition, many health-care providers in the United States are reluctant to ask questions about their patients’ sexual behaviors, thus missing opportuni­ties for STI-related counseling, diagnosis, and treatment. Moreover, a number of stud­ies indicate that many college students do not receive adequate STI-related information from their college or university health service (Williams et al., 2008).

The spread of STIs is facilitated by the unfortunate fact that many of these infections do not produce obvious symptoms. In some cases, particularly among women, there may be no outward signs at all. Under these circumstances, people may unknowingly infect others. In addition, feelings of guilt and embarrassment that often accompany having an STI may prevent people from seeking adequate treatment or from informing their sexual partners. In the Let’s Talk About It box, "Telling a Partner," we explore why informing sexual partners is important and suggest ways to do so more easily.

In the following sections, we focus on the most common STIs. We also provide an expanded discussion of AIDS and the progress being made in treating this dreadful malady. The Centers for Disease Control and Prevention (CDC) periodically provides updated guidelines for treating STIs. The most recent guidelines, published at the end of 2010 (Workowski et al., 2010), are the basis for most of the treatment information provided for the infections discussed in this chapter.

At a Glance

■ TABLE 15.1 Common Sexually Transmitted Infections: Transmission, Symptoms, and Treatment

STI	Transmission	Symptoms	Treatment(s)
Chlamydia	The Chlamydia trachomatis bacterium is passed through sexual contact. Infection can spread from one body site to another via fingers.	Women: Pelvic inflammatory disease, disrupted menstruation, pelvic pain, raised temperature, nausea, vomiting, headache, infertility, and ecto­pic pregnancy. Men: Urethra infection; discharge and burning during urination; with epididymitis, heaviness in and painful swelling at bottom of affected testis, inflammation of scrotum.	Doxycycline by mouth for several days, or one dose of azithromycin.
Gonorrhea	The Neisseria gonorrhoeae bacterium is passed through penile-vaginal, oral-genital, oral-anal, or genital-anal contact.	Women: Green or yellowish discharge (usually remains undetected); pelvic inflammatory disease may develop. Men: Cloudy discharge from penis and burning during urination; complications include painful swelling at bottom of affected testis and inflam­mation of scrotum.	Dual therapy of one dose of a cephalosporin medi­cation (e. g., ceftriaxone), plus one dose of azithro­mycin (or doxycycline for 7 days).
Nongono­ coccal urethritis (NGU)	Primarily caused by various bacteria transmitted through coitus. Some NGU results from aller­gic reactions or from Tricho­monas infection.	Women: Mild discharge of pus from vagina (often remains undetected). Men: Discharge from penis and irritation during urination.	One dose of azithromy­cin, or doxycycline for 7 days.

Syphilis The Treponema pallidum bacterium is passed from open lesions during penile-vaginal, oral-genital, oral-anal, or geni­tal-anal contact.

Primary Stage: Painless chancre at site where bacterium entered body.

Benzathine penicillin G, doxycycline, tetracycline, or ceftriaxone.

Secondary Stage: Chancre disappears, and gener­alized skin rash appears.

Latent Stage: There may be no visible symptoms.

Tertiary Stage: Heart failure, blindness, mental disturbance, and more; death may result.

Sexually Transmitted Infections

■ TABLE 15.1 Common Sexually Transmitted Infections: Transmission, Symptoms, and Treatment (continued)

STI Transmission Symptoms Treatment(s)

Hepatitis B virus can be passed Varies from no symptoms to mild, flulike symp — through blood, semen, vaginal toms to an incapacitating illness characterized by secretions, and saliva. Man — high fever, vomiting, and severe abdominal pain. ual, oral, or penile stimulation of anus is strongly associated with spread of hepatitis B.

Hepatitis A is spread by means of oral-anal contact, especially when the mouth encounters fecal matter.

Hepatitis C is spread through intravenous drug use and less frequently through contami­nated blood products, sexual contact, or mother-to-fetus or mother-to-infant contact.

Bacterial vaginosis	Different types of bacterial microorganisms are passed through coitus.	Women: Fishy — or musty-smelling, light-gray, thin discharge (consistency of flour paste). Men: Usually asymptomatic.	Metronidazole (Flagyl) by mouth. Intravaginal applications of topical metronidazole gel or clindamycin cream.
Candi-	The fungus Candida albicans	Women: White, "cheesy" discharge, irritation of	Vaginal suppositories
diasis (yeast	accelerates growth when	vaginal and vulval tissues.	or topical cream, such
infection)	normal chemical balance of the vagina is disturbed. Can be passed through sexual interaction.	Men: Usually asymptomatic but may have itching or reddening of the penis and burning during urination.	as clotrimazole and miconazole. Oral fluoconazole or itraconazole.
Trichomo-	The protozoan parasite Tricho-	Women: White or yellow vaginal discharge with	One dose of metronida-
niasis	monas vaginalis is usually passed through sexual contact.	unpleasant odor; vulva is sore and irritated. Men: Usually asymptomatic but may have urethral discharge, urge to urinate frequently, or painful urination.	zole (Flagyl or tinidazole) for women and men.
Pubic lice	Pubic louse is spread through	Persistent itching.	Prescription or over-the-
("crabs")	body contact or through shared clothing or bedding.	Lice are visible and can be located in pubic or other body hair.	counter medications (lotions or creams) applied to all affected areas.
Scabies	Highly contagious. Can be passed by close physical contact (sexual and nonsexual).	Small bumps and a red rash that itch intensely (especially at night).	Topical scabicide applied from neck down to toes.

If you want more information, we recommend that you contact your county health service, an STI/STD clinic, or a Planned Parenthood clinic, or that you call the National STI Resource Center.* These services can answer questions, send free literature, and, most important, give you the name and phone number of a local physician or public clinic that will treat STIs for free or at minimal cost.