Genital Herpes, Genital Warts (Human Papilloma virus or HPV), Chlamydia,
HIV and AIDS
WebMD Medical Reference in collaboration with
Sexual Health:
Genital Herpes
Genital herpes is a highly contagious infection usually spread through
intercourse with a person with infected sores, but it can be passed through
oral or anal sex as well. It may also be spread even when sores are not
visible.
Genital herpes can also be transmitted (spread) to a newborn during birth if
the mother has an active infection.
What Causes Genital Herpes?
Usually, this infection is caused by the herpes simplex virus-2 (HSV-2)
although herpes simplex virus-1 (HSV-1), the virus responsible for cold
sores, may occasionally cause this disease. It can be spread by an infected
partner who does not have any sores and may not even know they have the
disease.
How Common Is Genital Herpes?
At least 45 million American adults and adolescents have genital herpes
that's 1 out of every 4 to 5 people, making it one of the most common
sexually transmitted diseases. Since the late 1970s, the number of Americans
with genital herpes infection has increased 30%, mostly in teens and young
adults.
Genital herpes is more common in women than in men.
How Do I Know If I Have Genital Herpes?
Most people infected with genital herpes have very minimal or no signs or
symptoms of their disease. The first attack of herpes usually follows this
course:
Skin on or near the sex organ becomes inflamed. Skin may burn, itch
or be painful.
Blister-like sores appear on or near the sex organs.
Sores open, scab over, and then heal.
Symptoms that may also be present when the virus first appears include:
Swollen glands
Fever
Headache
Burning when passing urine
Muscle aches
The first outbreak of herpes can last for several weeks. After the outbreak,
the virus retreats to the nervous system, where it remains inactive until
something triggers it to become active again.
Typically, another outbreak can appear weeks or months after the first, but
it almost always is less severe and shorter than the first episode. Although
the infection can stay in the body indefinitely, the number of outbreaks
tends to decrease over a period of years.
How Often Do Outbreaks Happen?
How often outbreaks occur depends on the person. On average, people with
herpes experience about four outbreaks a year. The first outbreak usually is
the most painful and takes the longest to heal. The pain and recovery time
often decrease with each outbreak.
What Triggers an Outbreak?
It depends on the person. Some commonly reported triggers include:
Stress
Illness
Surgery
Vigorous sex
Diet
Monthly period
How Are Genital Herpes Diagnosed?
Your doctor can diagnose genital herpes by visual inspection if the outbreak
is typical, and by taking a sample from the sore(s). But, HSV infections can
be difficult to diagnose between outbreaks. Your doctor may check for ulcers
internally on the cervix in women and the urethra in men. Blood tests
that detect HSV-1 or HSV-2 infection may be helpful, although the results
are not always easy to interpret.
How Is Genital Herpes Treated?
There is no cure for genital herpes, but your doctor can prescribe anti-
virus medicines, in pill or ointment form, that may help the sores heal
faster.
Over-the-counter painkillers may help with the discomfort.
If recurrences of your genital herpes are frequent, your doctor may
prescribe an antiviral medication (Famvir, Valtrex and Zovirax) to take on a
regular basis to help suppress the outbreaks.
How Does Genital Herpes Affect a Pregnant Woman and Her Baby?
Outbreaks of genital herpes during pregnancy have been associated with
miscarriage, stillbirth, prematurity, and herpes infection causing severe
brain injury and possible blindness in the baby. Still, women with herpes
can give birth to healthy babies. If you have herpes and plan to have
children, discuss your illness with your doctor.
How Can I Protect Myself From Herpes?
Practice SEXUAL ABSTINENCE
Do not have sex with someone who has an open sore on his or her sex
organs.
Always use a latex condom during sex.
Limit your number of sex partners.
Taking antiviral medications (like Valtrex) can reduce the risk of a person
with genital herpes from spreading the disease, but that doesn't eliminate
the risk. Be sure to practice the measures listed above to decrease risk.
Can Herpes Be Cured?
There is no cure for herpes. Once a person has the virus, it remains in the
body. The virus lies inactive in the nerve cells until something triggers it
to become active again. These herpes "outbreaks," which can include the
painful herpes sores, can be controlled with medication.
What Can I Do If I Have Herpes?
Many people who find out that they have herpes feel depressed knowing that
they will always have the virus and can give it to others. But you are not
alone. If you have herpes, you should learn all that you can about herpes.
Information will help you to manage your disease and feel better about
yourself. It also helps to talk about your illness with a trusted friend.
If you have herpes, you can still have sex, if you use a condom (and/or have
your partner use a condom), and you tell your partner about your illness.
You also can still have children.
Genital Warts (Human Papillomavirus or HPV)
Warts are caused by viruses and can appear anywhere on the body. Those that
show up in the genital area are caused by the human papillomavirus, commonly
called HPV, and are easily transmitted by sexual contact.
HPV infection is the most common sexually transmitted disease in North
America and certain forms of the virus can cause cervical and penile cancer.
According to the Center for Disease Control and Prevention at least 50% of
sexually active men and women will get a genital HPV infection at some point
in their lives.
After a person has been infected, it may take one to three months (or longer
in some cases) for warts to appear. Some people who have been infected never
get warts. If you think you have been infected, see your doctor, even if you
cannot see warts.
What Do Genital Warts Look Like?
Genital warts look like small flesh-colored, pink or red growths in or
around the sex organs. The warts may look similar to the small parts of a
cauliflower or they may be very tiny and difficult to see. They often appear
in clusters of three or four, and may grow and spread rapidly. They usually
are not painful, although they may cause mild pain, bleeding and itching.
How Do I Know If I Have Genital Warts?
Like many STDs, HPV does not always have visible symptoms. But when symptoms
do occur, warts may be seen around the genital area. In women, warts can
develop on the outside and inside of the vagina, on the cervix (the opening
to the uterus), or around the anus. In men, they may be seen on the tip of
the penis, the shaft of the penis, on the scrotum, or around the anus.
Genital warts also can develop in the mouth or throat of a person who has
had oral sex with an infected person.
Because there is no way to predict whether the warts will grow or disappear,
people who suspect that they have been infected should be examined and
treated, if necessary.
What Tests Are Used to Detect Genital Warts?
Your doctor may perform the following tests to check for genital warts:
An examination of visible growths to see if they look like genital
warts
Application of a mild acetic acid (vinegar) solution to highlight
less visible growths.
A complete pelvic exam and Pap smear (for women).
A specialized test for HPV, collected in a way similar to a Pap
smear.
Biopsy of cervical tissue to make sure there are no abnormal cells
that could develop into HPV-related cervical cancer. A biopsy
involves taking a small sample of tissue from the cervix and
examining it under a microscope.
Examination of the rectum.
A fluid sample test for gonorrhea and chlamydia.
A blood sample test for syphilis.
Tests for gonorrhea, chlamydia and syphilis are taken because STDs often
occur together and share similar symptoms. Sometimes female patients are
referred to a gynecologist (a doctor who specializes in female reproductive
health) for further testing and biopsy.
How Are Genital Warts Treated?
Unfortunately, no treatment can kill the virus that causes the warts. Your
doctor can remove the warts with laser therapy or by freezing or applying
chemicals. Some prescription treatments are available for at home use.
Surgery may be necessary for warts that are large or difficult to treat.
Still, recurrence remains a problem. You may need to return to your doctor
for more treatment.
What Should I Do While I Have the Warts?
If you have genital warts:
Keep the area as dry as possible.
Wear all-cotton underwear. Man-made fabrics can irritate the area
and trap moisture.
What Happens If I Don't Get Treated?
Unfortunately, despite treatment, having HPV can increase your risk of
cervical cancer or cancer of the penis. But not all forms of the virus are
associated with these cancers. If you have genital warts, it is important to
get annual check-ups to screen for cervical or penile cancer.
How Can I Prevent Infection?
Your best bet at preventing infection is SEXUAL ABSTINENCE or limit sexual
contact to one uninfected person. If that is not an option, condoms may
provide some protection, but condoms are not 100% effective since they do
not cover the entire penis or surrounding areas.
Vaccines against HPV are currently being studied and are showing great
promise in reducing infections. If investigations continue to demonstrate
safety and effectiveness, a vaccine may be available within the year for
widespread public use.Currently, there is no cure for hepatitis B. Luckily,
the disease is limited in most acute cases and occasionally disappears in
those with chronic disease.
Chlamydia
Chlamydia is one of the most common sexually transmitted diseases in the
U.S. This infection is easily spread because it often causes no symptoms and
may be unknowingly passed to sexual partners. In fact, about 75% of
infections in women and 50% in men are without symptoms.
How Do I Know if I Have Chlamydia?
It is not easy to tell if you are infected with chlamydia since symptoms are
not always apparent. But when they do occur, they are usually noticeable
within 1-3 weeks of contact and can include the following:
Symptoms in Women
Abnormal vaginal discharge that may have an odor
Bleeding between periods
Painful periods
Abdominal pain with fever
Pain when having sex
Itching or burning in or around the vagina
Pain when urinating
How Is Chlamydia Diagnosed?
There are a few different tests your doctor can use to check for chlamydia.
He or she will probably use a swab to take a sample from the urethra in men
or from the cervix in women and then will send the specimen to a laboratory
to be analyzed. There are also other tests which check a urine sample for
the presence of the bacteria.
How Is Chlamydia Treated?
If you have chlamydia, your doctor will prescribe oral antibiotics, usually
azithromycin (Zithromax) or doxycycline. Your doctor will also recommend
your partner(s) be treated as well to prevent reinfection and further spread
of the disease.
With treatment, the infection should clear up in about a week or two. It is
important to finish all of your antibiotics even if you feel better.
Women with severe infection may require hospitalization, intravenous
antibiotics (medicine given through a vein), and pain medicine.
After taking antibiotics, people should be retested to be sure the infection
is cured. This is particularly important if you are unsure that your partner
(s) obtained treatment. Do not have sex until you are sure both you and your
partner no longer have the disease.
What Happens If I Don't Get Treated?
If you do not get treated for Chlamydia, you run the risk of several health
problems.
For women:
If left untreated, the infection can cause pelvic inflammatory disease which
can lead to damage of the fallopian tubes (the tubes connecting the ovaries
to the uterus) or even cause infertility (the inability to have children),
and untreated chlamydia infection could increase the risk of ectopic
pregnancy (when the fertilized egg implants and develops outside the uterus.)
Furthermore, chlamydia may cause premature births (giving birth too early)and
the infection can be passed along from the mother to her child during child
birth, causing an eye infection, blindness or pneumonia in the newborn.
How Can I Prevent Infection?
To reduce your risk of infection:
o Use condoms correctly every time you have sex.
o Limit the number of sex partners.
o Practice SEXUAL ABSTINENCE
o If you think you are infected, avoid sexual contact and see a doctor.
Any genital symptoms such as discharge or burning during urination or an
unusual sore or rash should be a signal to stop having sex and to consult a
doctor immediately. If you are told you have chlamydia or any other STD and
receive treatment, you should notify all of your recent sex partners so that
they can see a doctor and be treated.
Because chlamydia often occurs without symptoms, people who are infected may
unknowingly infect their sex partners. Many doctors recommend that all
persons who have more than one sex partner should be tested for chlamydia
regularly, even in the absence of symptoms.
HIV and AIDS
Human immunodeficiency virus, or HIV, is the virus that causes acquired
immune deficiency syndrome (AIDS). The virus weakens a person's ability to
fight infections and cancer. People with HIV are said to have AIDS when they
develop certain infections or cancers or when their CD4 count is less than
200. CD4 count is determined by a blood test in a doctor's office.
Having HIV does not always mean that you have AIDS. It can take many years
for people with the virus to develop AIDS. HIV and AIDS cannot be cured.
Although people with AIDS will likely one day die from an AIDS-related
illness, there are ways to help people stay healthy and live-longer.
How Does HIV and AIDS Cause Illness?
HIV attacks and destroys a type of white blood cell called a CD4 cell. This
cell's main function is to fight disease. When a person's CD4 cell count
gets low, they are more susceptible to illnesses.
What Is AIDS?
AIDS is the final stage of HIV infection. When the immune system CD4 cells
drop to a very low level, a person's ability to fight infection is lost. In
addition, there are several conditions that occur in people with HIV
infection with this degree of immune system failure -- these are called AIDS
defining illnesses.
How Do People Get HIV?
According to the Center for Disease Control and Prevention, in the U.S. the
estimated number of people with HIV/AIDS is about 1,185,000 with
approximately 25% of them unaware of their infection. The estimated number
of new cases of HIV is 42,000 each year. A person gets HIV when an infected
person's body fluids (blood, semen, fluids from the vagina or breast milk)
enter his or her bloodstream. The virus can enter the blood through linings
in the mouth, anus or sex organs (the penis and vagina), or through broken
skin.
Both men and women can spread HIV. A person with HIV can feel okay and still
give the virus to others. Pregnant women with HIV also can give the virus to
their babies.
Common ways people get HIV:
Sharing a needle to take drugs.
Having unprotected sex with an infected person.
A mother to her child during breast feeding
Contact with body fluids (blood/semen/vaginal)
You cannot get HIV from:
Touching or hugging someone who has HIV/AIDS.
Public bathrooms or swimming pools.
Sharing cups, utensils, or telephones with someone who has HIV/AIDS.
Bug bites.
Who Can Get HIV?
Anyone can get HIV if they engage in certain activities. You may have a
higher risk of getting HIV if you:
Have unprotected sex. This means vaginal or anal intercourse without
a condom or oral sex without a latex barrier with a person
infected with HIV.
Share needles to inject drugs or steroids with an infected person.
The disease can also be transmitted by dirty needles used to make a
tattoo or in body piercing.
Receive a blood transfusion from an infected person. This is very
unlikely in the U.S. and Western Europe, where all blood is tested
for HIV infection.
Are born to a mother with HIV infection. A baby can also get HIV
from the breast milk of an infected woman.
If you fall into any of the categories above, you should consider
being tested for HIV.
Health care workers are at risk on the job and should take special
precautions. Some health care workers have become infected after being stuck
with needles containing HIV-infected blood or less frequently, after
infected blood comes into contact with an open cut or through splashes into
the worker's eyes or inside their nose.
HIV Tests
The only way to know if you have HIV is to take an HIV test. Most tests
looks for signs of HIV in your blood. A small sample of blood is taken from
your arm. The blood is sent to a lab and tested for HIV. There are other
tests available that check for HIV in the urine and oral fluid. The urine
test is not very sensitive. There are currently two FDA approved oral fluid
tests. They are OraSure and OraQuick Advance.
Because of the inaccurate results, the FDA has not approved any of the home-
use HIV tests which allow people to interpret their tests in a few minutes
at home. There is however a Home Access test approved which can be found at
most drugstores. In this test blood from a finger prick is placed on a card
and sent to a licensed laboratory. Consumers are given an identification
number to use when phoning for results and have the opportunity to speak
with a counselor if desired.
Clinics that do HIV tests keep your test results secret. Some clinics even
perform HIV tests without ever taking your name (anonymous testing). You
must go back to the clinic to get your results. A positive test means that
you have HIV. A negative test means that no signs of HIV were found in your
blood.
Before taking an HIV test:
Ask the clinic what privacy rules it follows
Think about how knowing you have HIV would change your life
Ask your doctor or nurse any questions you have about HIV, AIDS or
the HIV test
Who Should Be Tested?
Currently, it is recommended that people who engage in risky behaviors such
as unprotected sex or needle-sharing and all pregnant women be tested for
HIV infection.
Does HIV Have Symptoms?
Some people get flu-like symptoms a month or two after they have been
infected. These symptoms often go away within a week to a month. A person
can have HIV for many years before feeling ill.
As the disease progresses, both women and men may experience yeast
infections on the tongue (thrush), and women may develop severe vaginal
yeast infections or pelvic inflammatory disease.
What Are the Symptoms of AIDS?
Signs that HIV is turning into AIDS include:
A fever that won't go away.
Sweating while you sleep.
Feeling tired all the time. (not from stress or lack of sleep)
Feeling sick all the time.
Losing weight.
Swollen glands. (neck, groin or underarms)
What Infections Do People With AIDS Get?
People with AIDS are extremely vulnerable to infection, called AIDS defining
illnesses, and often exhibit the following conditions:
Kaposi's sarcoma, a skin tumor that looks like dark purple blotches.
Mental changes and headaches due to fungal infections or tumors in
the brain and spinal cord.
Shortness of breath and difficulty breathing due to infections of
the lungs.
Dementia.
Severe malnutrition.
Chronic diarrhea.
How Is AIDS Diagnosed?
If a person with HIV infection has a CD4 count that drops below 200 or if
certain infections appear (AIDS defining illnesses) that person is
considered to have AIDS.
How Is HIV Treated?
We've come along way from the days when diagnosis with HIV equaled a death
sentence. Today, there are a variety of treatments that, when used in
combination can significantly slow down and in some cases stop altogether,
the progression of HIV infection.
After HIV infection is confirmed, your doctor will start you on a drug
regimen consisting of several drugs; combinations of different types of anti-
HIV drugs sometimes are called HAART, for highly-active anti-retroviral
therapy (HIV is a kind of virus called a retrovirus).
Unfortunately, taking HAART therapy isn't easy. These drugs must be taken at
exactly the right time, every single day. Also, a range of side effects may
occur, including: diarrhea, nausea, or abnormal distribution of body fat.
And, the virus often mutates, or changes, making the treatments ineffective.
If your disease has progressed to AIDS, your treatment may also include
drugs to combat and prevent certain infections.
How Do I Know if the HIV Treatments Are Working?
Your doctor can monitor how well your treatment is working by measuring the
amount of HIV in your blood (also called the viral load.) The goal is to get
the viral load so low with HAART treatment as to be undetectable.
How Can I Keep From Getting HIV?
The best way to protect yourself is to avoid activities that put you at
risk. Practice SEXUAL ABSTINENCE. Never share a needle. There's no way to
tell by looking at someone if he or she has HIV.
Always protect yourself.
SEXUAL ABSTINENCE
Use latex condoms (rubbers) whenever you have any type of sex
(vaginal, anal, or oral).
Don't use condoms made from animal products.
Use water-based lubricants. Oil-based lubricants can weaken condoms.
Never share needles to take drugs.
Avoid getting drunk or high. People who are drunk or high may be
less likely to protect themselves.
How Can I Prevent HIV From Progressing to AIDS?
You can help prolong your life by taking good care of yourself and insisting
on good medical care from a doctor experienced at treating people with HIV
infection. Also. be consistent about taking your HIV medications as
prescribed.
What Is the Outlook for Someone With HIV or AIDS?
It depends on how the virus responds to early treatment. When treatment
fails to decrease the replication of the virus, the effects can become life
threatening, and the infection can progress to AIDS.
Even with treatment, some people seem to naturally experience a more rapid
course towards AIDS. However, the majority of HIV patients who receive
appropriate treatment do well and live healthy lives for years.