Myth: If you have gonorrhea, you’ll have symptoms,so you’ll knowyou need to get treated.

Fact: Eighty percent of women and a large percentage of men with gonorrhea have no symptoms, so both you and your partner can spread the disease without knowing it.

Sexually transmitted diseases are almost as common as the common cold. Every year an estimated 15 million Americans contract a disease that is transmitted by intercourse or other sexual activity. Worldwide, 340 million people annually contract curable sexually transmitted infections; in addition, an estimated 5 million new cases of human immunodeficiency virus arise each year.

Although we like to think of sexually transmitted diseases as happening to other people, they can appear in anyone who is sexually active, since the viruses and bacteria that cause them are blind to social and cultural distinctions. They do not discriminate according to education or economic status; they are indifferent to race and to religious, cultural, and political persuasions. While teenagers account for about 25 percent of new cases, teenagers and people younger than 25 for perhaps as many as 67 percent, young people are not especially vulnerable to sexually transmitted diseases except in their behavior, in that they are more likely than their elders to have unprotected sex with several partners.

Some sexually transmitted diseases do discriminate along gender lines. These diseases in general are more easily transmitted from men to women than from women to men, and several have more serious consequences for women, causing permanent reproductive damage in women who are undiagnosed or untreated.

It would be comforting to think that sexually transmitted diseases are succumbing to the advances of modern medicine, but unfortunately that is not entirely true. Of the three major diseases tracked in the United States by the Centers for Disease Control and Prevention, two are generally under control. From 1975 to 1997, gonorrhea declined by almost 74 percent, reflecting a national program for detection and treatment. The rate has risen slightly since then but is holding steady. Syphilis, after increasing dramatically in the late 1980s and early 1990s during the height of the Acquired immunodeficiency syndrome epidemic, decreased until 2000, when 5,979 cases were reported, the fewest since 1941, the year the government began keeping statistics. In 2001, however, there were 6,103 new cases mainly among gay and bisexual men, raising concern that these groups are becoming less careful about practicing safe sex.

Chlamydia, a disease that was barely known a generation ago, is now the most prevalent sexually transmitted disease in the country. The 702,093 cases reported in 2000 are almost double the number of cases of gonorrhea (358,995). Furthermore, chlamydia is on the rise, reported cases increasing from 48 per 100,000 people in 1987 to 257.5 per 100,000 in 2000, with women having a rate of infection four times greater than that of men. Although better screening and better reporting account for part of the increase (and the number of reported cases is probably lower than the number of actual cases), the burden of disease is extremely high.

It is important to remember that sexually transmitted diseases travel in groups. If you have one of these diseases, you are at increased risk for others. In part this is because the behavior that exposed you to one disease puts you at risk for others.

The most widespread sexually transmitted diseases are chlamydia, gonorrhea, syphilis, herpes, human papilloma virus, human immunodeficiency virus, and hepatitis B. Some of these diseases, notably gonorrhea, chlamydia, and syphilis, are caused by bacteria and often can be completely cured with medication. Other diseases, caused by viruses, remain with you permanently, though they may lie dormant and not show symptoms. Among these are human immunodeficiency virus, human papilloma virus (which causes genital warts), and herpes simplex virus, which causes painful blisters on the genitals and elsewhere.

The bacteria responsible for several common sexually transmitted diseases can also cause pelvic inflammatory disease, which can affect your uterus, fallopian tubes, or ovaries. pelvic inflammatory disease can cause scarring, and the scar tissue may block the entrance to your fallopian tubes or distort their shape, impeding the journey of the egg from ovary to uterus. pelvic inflammatory disease can also cause chronic infection, pelvic pain, or tenderness in the abdomen, and a foul-smelling vaginal discharge. Sometimes, however, the symptoms are so mild that they are not noticed.

Pelvic inflammatory disease can cause scar tissue to develop between organs and cause persistent pain. It can also distort the shape of the tubes or block the entrance to them, causing infertility

Figure: Pelvic inflammatory disease can cause scar tissue to develop between organs and cause persistent pain. It can also distort the shape of the tubes or block the entrance to them, causing infertility

How can you protect yourself from sexually transmitted diseases?

The only 100-percent protection against sexually transmitted diseases is sexual abstinence. Short of that, the best protection is to use a condom plus a spermicide, unless you are absolutely certain you are in a mutually monogamous relationship with an uninfected partner.

Trichomoniasis in Women

Genital Herpes in Women

Diagnosing Herpes

The Social Consequences of Herpes

Human Papilloma Virus in Women

Gonorrhea in Women

Chlamydia in Women

Syphilis in Women

Hepatitis B in Women

HIV / AIDS in Women

Lesbians and Sexually Transmitted Diseases

Lesbians are less at risk for certain sexually transmitted diseases (HIV / AIDs, gonorrhea, and syphilis) than heterosexual women. Perhaps the microorganisms responsible for these diseases are less easily spread through oral sex and other sexual activities practiced by lesbians than by heterosexual vaginal, oral, or anal sex. Nevertheless, there are risks.

Not much research has specifically focused on woman-to-woman transmission of human immunodeficiency virus. A few studies have shown that women who have had sex only with other women (and have not used intravenous drugs) are at low risk for human immunodeficiency virus. Still, it is well known that women can spread human immunodeficiency virus to men through contact with vaginal secretions and menstrual blood, so it is certainly possible that women can infect one another. Bisexual women (like heterosexual women) should use a condom each and every time they have sexual contact with men or use sex toys. The FDA has not approved as effective any barrier methods for use during oral sex, but women can use dental dams, cut-open condoms, or plastic wrap to help protect themselves from contact with body fluids. Lesbian women, like heterosexual women, should know their own human immunodeficiency virus status and that of their partners.

Lesbians frequently have herpes and human papilloma virus (genital warts) infections. Herpes and human papilloma virus can be spread by skin-to-skin, genital-to-genital, or mouth-to-genital contact, and thus can be spread from woman to woman. Further, many lesbian women have had sexual contact with men at some time in their lives. The viruses causing herpes and human papilloma virus remain in the body forever, so it is possible for a woman to get herpes or human papilloma virus from a male partner and at a later time pass it on to a female partner. Since human papilloma virus can lead to cervical cancer, lesbians and bisexual women, like heterosexual women, should have regular Pap tests.

Chlamydia, gonorrhea, and syphilis are only rarely transmitted between women, though occasional cases have been reported.

Bacterial vaginosis, which is associated with sexual activity but is not strictly an sexually transmitted disease, occurs frequently among lesbians, even those who have not had sexual activity with a man for at least a year. It seems to spread easily between monogamous partners. Trichomoniasis can also be spread from woman to woman.

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