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25.06.2007 Technology

HIV/AIDS and other Sexually Transmitted Diseases

25.06.2007 LISTEN
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1. What is a sexually transmitted disease?
A sexually transmitted disease is an infection that can be passed from one person to another during sexual contact. The infections are commonly called STDs (sexually transmitted diseases) or VDs (venereal diseases). Some of the most familiar STDs include gonorrhea, syphilis, genital herpes, chlamydia, hepatitis B, genital warts and HIV, though there are many others.
2. What is the most common STD?
The most frequently reported STDs are gonorrhea and chlamydia; over a half million cases of each are reported to CDC each year. In 1995, CDC estimated 4 million Americans were suffering from chlamydia infections. Many STDs are undetected and untreated. As a result, many infections are transmitted unknowingly to others and are unreported. Cases of genital warts and genital herpes are not reported. In order to monitor treatment and/or prevention efforts, certain diseases are reported to the Oklahoma State Department of Health (OSDH) and the Centers for Disease Control and Prevention (CDC). In Oklahoma, reportable STDs include human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), chlamydia, gonorrhea, hepatitis B and syphilis.
3. Who is at risk for STDs?
Anyone who is sexually active is at risk for STDs. If you have sex with someone who is infected, the STD could be passed to you regardless of age, race, gender, or sexual orientation.
4. How many people have STDs?
An estimated 55 million people in the U.S. have an STD; about 12 million acquire an STD each year. Teenagers account for one-fourth of new STD infections in the U.S. each year.
5. What causes STDs?
STDs are caused by a variety of organisms including bacteria, protozoa's, viruses, and parasites (tiny insects). These organisms enter the body during sexual intercourse with an infected person.
6. Are STDs dangerous?
STDs are among the most important public health problems in the nation. STDs can cause infertility, premature and still births, infant pneumonia, eye infections leading to blindness, and even death. Some STDs are associated with certain types of cancer.
7. How do you get an STD?
In most instances, STDs are passed from an infected person to another person during sexual activities, through contact with the mucous membranes of the penis, vagina, mouth and rectum. Such activity includes vaginal, oral and anal intercourse. Gonorrhea and chlamydia also can be transmitted by fingers to eyes.
8. Can you get an STD without having sex?
Yes, some STDs can be transmitted without having sexual intercourse, but it is not common. For example, a baby could be infected by the mother before or during birth. Some parasites, like pubic lice (crabs) and scabies, can be passed by direct contact with an infected person or infested sheets, towels and clothing but this does not occur with bacteria or viruses such as HIV. STDs are not spread by touching doorknobs, toilet seats, drinking fountains, or eating utensils.
9. How will I know if I have an STD?
Many people do not notice any symptoms; some people may appear healthy even though they are infected. If you are unsure about your sexual health or suspect you may have been exposed to an STD, avoid sexual intercourse until you have been examined, and have been treated if necessary.
10. What are the symptoms of STDs?
Here are some common symptoms of STDs?

Both males and females:
Sores, bumps, or blisters near genitals or mouth
Burning or pain when you urinate
Slight sore throat
Fever, chills, achy feeling
Rectal itching, pain or discharge
Females:
Unusual discharge or smell from vagina
Burning or itching around vagina
Unusual bleeding from vagina
Pain in lower abdomen
Pain during sexual intercourse
Males:
Drip or discharge from penis
11. Can all STDs be cured?
Most STDs caused by bacteria, protozoa, or parasites can be treated and cured with antibiotics, other prescription medications, or clinic treatments. Common STDs in this group include gonorrhea, syphilis, and chlamydia. Treating symptoms of these infections with "over the counter" medications may only hide the symptoms, and make later treatment more difficult.

At this time, there are no cures for STDs caused by viruses. Genital herpes, genital warts and HIV infection are examples of STDs caused by viruses. Symptoms of these viral infections can be treated, but symptoms may return after treatment because the virus remains in the body. Viruses can be passed to a sexual partner even if there are no symptoms.
12. What should I do if I think I have an STD?
If you have symptoms of an STD or suspect you may have been exposed, you may be examined and treated at an STD clinic at a county health department, family planning clinic, or physician's office.

If you are diagnosed with an STD, avoid having sex while you are being treated; always inform your sex partners so they can be checked and treated. It is very important that you finish taking all medicine prescribed, even if you have no more symptoms. Never take medicine prescribed for someone else; your infection may not be the same as theirs and might require different medication.
13. How can I avoid having an STD?
The best way to avoid having an STD is to avoid having sexual intercourse, or to have intercourse only with one mutually faithful uninfected partner. There is no risk of transmitting an infection if both partners are uninfected and have intercourse only with each other. If you have more than one partner or do not know if your partner is infected, use a latex condom (not lambskin) every time you have intercourse to reduce the risk of infection. Birth control pills and other methods of contraception do not provide protection from STDs. Latex condoms used every time you have sexual intercourse may reduce the risk of HIV and some STD infections. Even a latex condom does not guarantee 100% protection.
14. What is chlamydia?
Chlamydia is a sexually transmitted disease caused by Chlamydia trachomatis bacteria. Symptoms include vaginal or urethral discharge; females also may have pelvic discomfort. Because symptoms may be mild or unnoticed, treatment is often delayed. Untreated chlamydia may result in a female's infertility due to scarring of fallopian tubes. Infants of females with untreated chlamydia may have eye infections or pneumonia. Chlamydia is curable with antibiotics, usually doxycycline. All partners should be treated at the same time as the person who has chlamydia.
15. What is genital herpes?
Genital herpes is caused by herpes simplex virus (HSV) that causes multiple lesions on the genitals or perineum and anus. The lesions are usually painful and may last several weeks if untreated. Infection with HSV is lifelong with recurring outbreaks of lesions possible. Herpes can be spread even if no lesions are present. Depending upon the location of the infection, herpes can be spread even if latex comdoms are used. The risk of passing HSV to a baby during pregnancy should be discussed with a doctor or clinic nurse.
16. What are genital warts?
Infection with human papilloma virus (HPV) causes genital warts. Some strains of HPV are strongly associated with cancer of the cervix, penis, anus, and vulva. Warts may be removed by freezing, laser surgery, or prescribed medications which are placed directly on the warts; however, there is no cure or treatment to rid the body of HPV. Depending upon the location of the infection the virus can be transmitted to sexual partners, even if latex condoms are used; warts also can be transmitted to infants by infected mothers.
17. What is gonorrhea?
Gonorrhea is a bacterial infection caused by Neisseria gonorrhoeae. The infection can be transmitted during sexual intercourse, and during birth if the mother is infected. Symptoms include painful urination, discharge from penis, vagina or anus, low abdominal pain, and/or mild sore throat. Some people experience no symptoms. Gonorrhea is curable with antibiotics. All partners should be treated at the same time as the person who has been found to have gonorrhea. It is important to follow instructions about treatment since some strains are resistant to penicillin and tetracycline. Effects of untreated gonorrhea include infertility, blindness, a type of arthritis, skin rash, and damage to the heart and kidneys.
18. What is hepatitis B?
Hepatitis B is a virus (HBV) which enters the bloodstream and infects the liver. HBV is most often spread from person to person through contact with infected semen, vaginal secretions, or blood. Having sex with an infected person and sharing injection drug equipment are two very common ways people get infected. Babies born to infected mothers and people who live in a household with a "carrier" of HBV are also at risk. Hepatitis B can cause serious liver damage, cirrhosis, and cancer of the liver. Some people who get HBV will die from the infection. There is no cure, but there is a vaccine to prevent infection.
19. What is hepatitis C?
Hepatitis C is a virus (HCV) that enters the bloodstream and infects the liver. HCV may cause chronic liver disease or liver cancer. HCV is most often spread through contact with infected blood, and less often through semen and vaginal secretions. Sharing needles for injecting drugs is a very common way to become infected. It is possible, but not likely, to be infected by having sex with an infected person or living in the household of a hepatitis C "carrier." An infected mother may rarely pass the virus to her baby. There is a blood test to detect HCV infection; there is no vaccine to prevent infection.
20. What are pubic lice and scabies?
Pubic lice (crabs) and scabies are tiny insects that bite or burrow into skin. Both are more of a nuisance than a significant threat to health. In addition to being transmitted during close contact with an infected person, pubic lice and scabies can be passed by sharing infested clothing or bed linens. Treatment includes washing with medicated soap and shampoo, medications applied to the skin, and laundering bed linens and clothing.
21. What is syphilis?
Syphilis is a complex disease caused by Treponema pallidum. If untreated, syphilis progresses through three distinct stages (primary, secondary and tertiary) with periods of inactive infection in-between (latent stages).

Syphilis is transmitted through direct contact with a lesion, and from infected mother to baby during pregnancy. Babies can become infected during a latent stage. Usually, the first sign of primary syphilis is a single painless sore called a chancre ("shan' - ker") on the genitals or other part of the body where the treponeme entered. Primary lesions heal without treatment.

Symptoms of secondary syphilis may include new lesions, swollen glands, flu-like symptoms, and patchy hair loss. Skin rashes cover the whole body or appear in only a few areas. In time, symptoms disappear without treatment. A person with secondary syphilis is infectious.

Tertiary syphilis occurs 1-20 years after infection. Symptoms include meningitis, loss of reflexes, clumsy walk, pins and needles pain, joint disease, tumors and heart disease.

Many pregnancies of infected females result in miscarriage or stillbirth. Babies born with syphilis may develop skin rash, "snuffles" (heavy nasal discharge), failure to thrive, multiple organ failure, meningitis, and bone and dental malformations.
22. What is trichomoniasis?
Trichomoniasis ("trich") is a common infection in both females and males, many of whom have no symptoms. Females often have a large amount of yellow, green or gray vaginal discharge and may have itching and painful urination. Males may have painful urination and/or a clear discharge from the penis. Trichomoniasis is curable; symptoms will probably continue if untreated.
23. What is AIDS?
AIDS (acquired immune deficiency syndrome) is a diagnosis based on symptoms and illnesses resulting from infection by the human immunodeficiency virus (HIV). The virus invades and damages certain white blood cells called T4 cells (also called CD4+ cells.) T4 cells are responsible for recognizing infections and coordinating an immune response. When the T4 cells are damaged, the immune system cannot respond properly to viruses, bacteria, parasites, or other invaders that cause disease. This allows persons with HIV to become ill with unusual infections or cancers that do not pose a threat to persons whose immune systems are working properly.
24. What is HIV?
HIV stands for human immunodeficiency virus. HIV is often called "the AIDS virus." HIV was identified in 1984 as the cause of AIDS. The virus has also been called HTLV III, ARV and LAV. As the result of international agreement, this virus is now called HIV by scientists throughout the world. Once exposed to HIV, a person may or may not become infected.
25. What is the difference between HIV infection and AIDS?
Infection with HIV is the beginning of a process that usually results in the development of AIDS. People with HIV infection may not show any symptoms for many years. It is not yet clear whether everyone with HIV will develop AIDS. It is clear that once infected with HIV, a person will remain infected for life and may infect other people through sexual contact, direct blood contact, and through pregnancy (an infected mother may infect her baby).

A person infected with HIV is diagnosed with AIDS when they develop one or more specific diseases or cancers and/or a laboratory test reports a CD4 count of less than 200. The diagnosis of AIDS must be made by a physician.
26. How does HIV infection lead to AIDS?
The disease process begins at the time of infection and continues through various stages: Asymptomatic infection when an HIV-infected individual looks and feels healthy but is able to infect others; HIV-Related Symptoms (sometimes called AIDS Related Complex or ARC) when the immune system has been damaged to a point where the HIV-infected individual develops vague symptoms which persist; and Acquired Immune Deficiency Syndrome (AIDS) with severe infections, possibly leading to death. It is not known whether all HIV-infected individuals will progress to an AIDS diagnosis. Some people with HIV have remained well for ten years or longer. Preventive treatments also can help people with HIV remain symptom-free longer.
27. What are the earliest symptoms of HIV infection?
About 50-70% of HIV-infected people will experience flu-like illness within two months. HIV antibodies are usually not detected until after this time. For some, it may take up to six months for HIV antibodies to be detected. (This period, during which one is infected and infectious but does not yet test positive, is called the "window period" for HIV infection.) There may be no other symptoms for years.
28. How long does it take for AIDS to develop?
Once infected with HIV, a person may go through a long period when the virus is reproducing inside the body but there are no symptoms (asymptomatic infection). Later a person may develop vague or mild symptoms, called HIV-related symptoms or AIDS Related Complex (ARC). Some people call all of this the incubation period for AIDS. Studies have shown this stage may last 10 years or longer. It is important to remember that an HIV-infected person can pass this virus to others, even if they have no symptoms.
29. What are the symptoms of HIV infection?
HIV-related symptoms or ARC may include:
Unexplained weight loss (more than 10% of usual body weight)
Night sweats
Prolonged fevers
Prolonged unexplained diarrhea
Extreme tiredness/fatigue
Prolonged swollen glands in the neck, groin, and armpits
Skin rash
White spots in mouth (thrush)
Vaginal yeast infections
These symptoms are common to many other conditions and should be checked by a physician if they persist longer than two weeks, regardless of your risk for HIV infection.
30. What are the symptoms of AIDS?
The symptoms people with AIDS usually develop are related to the diseases or infections that result from not being able to fight off infection. In addition to HIV-related symptoms, a person may experience combinations of the following:
Extreme weight loss which is not due to dieting or increased physical activity
Purple or discolored growths on the skin or mucous membranes
Prolonged or continual dry cough that is not related to smoking, colds or flu
Progressive shortness of breath
Chronic yeast infections of throat (thrush) or vagina
Recurrent pneumonia or unusual infections
Cervical cancer
Tuberculosis
Confusion, loss of memory, inability to concentrate, and loss of coordination
31. How is AIDS diagnosed?
Since there is no single laboratory test to determine AIDS, diagnosis by a physician is based on the confirmation of HIV infection, plus either a CD4+ T-lymphocyte count less than 200, or less than 14% of total lymphocytes, or any of the clinical conditions, specific infections, and cancers described by the CDC as indicator diseases.
32. What are some of the indicator diseases that affect persons with AIDS?
Some of the more common indicator diseases are: Pneumocystis Carinii Pneumonia (PCP), a parasitic infection of the lungs; Kaposi's Sarcoma (KS), a condition affecting blood vessels that can occur both internally and externally, most commonly producing disfiguring purplish or brownish growths on the surface of the skin and in the mouth; extensive yeast infections resulting in painful swallowing, extreme weight loss and dehydration; many infections caused by bacteria, virus or parasites; and dementia resulting from infections involving the brain. In 1993, the criteria was expanded to include HIV-infected persons with pulmonary tuberculosis, invasive cervical cancer, recurrent bacterial pneumonia and/or a CD4+ T-lymphocyte count less than 200 or less than 14% of total lymphocytes. Many individuals experience more than one of these conditions at the same time. The diagnosis criteria for AIDS must be interpreted by a physician.
33. How contagious is HIV?
Unlike common diseases like colds, flu, measles or chicken pox, HIV is not highly contagious. It is not transmitted through touching, hugging, sneezing, coughing, eating or drinking from common utensils, or being around an infected person. It is now clear that casual contact with a person with HIV infection does not place others at risk. No cases have been reported in which HIV has been transmitted through casual (non-sexual) contact to a household member, relative, co-worker, friend, teammate or student.

HIV is NOT transmitted through air, food, water, insects, or by contact with an object touched or breathed on by a person with HIV. There is no reason to fear becoming infected with HIV by using a public rest room or telephone, eating in a restaurant, riding in a taxi or bus, shopping, swimming in a pool or lake, sharing an office or a classroom.
34. How is HIV transmitted?
HIV can be transmitted during direct contact with semen, vaginal secretions, or blood of an infected person in the following ways:
Sexual Activity: anal, vaginal, oral intercourse (male to male, male to female, female to male, female to female)
Direct Blood Contact: sharing needles or other injection drug equipment, occupational exposures such as needle sticks or cuts, transfusion of blood or blood products
Perinatally: infected mother to baby before, during, or following birth through breast-feeding.
HIV must enter the body through a cut, puncture, or other break in the skin or through a mucous membrane such as the vagina, anus, opening in the penis, or mouth. There continues to be no evidence that HIV can be transmitted through air, water, food, or casual body contact.
35. Who is at risk for HIV infection?
Anyone who comes in contact with HIV-infected semen, vaginal secretions, and/or blood is at risk of becoming infected. The risk is increased because most people who have HIV feel fine (are asymptomatic), have not been tested, and do not realize they can infect others. Any form of unprotected sex could be risky, including oral sex; anal sex is especially risky for both males and females. Sharing injection drug equipment is also risky.

Nationally, reported cases of AIDS continue to be highest among males who have sex with other males and among injection drug users. However, cases due to heterosexual contact have been increasing. AIDS is increasing among racial and ethnic groups, among females, and in smaller cities and rural areas. About 15-30% of babies born to HIV-infected mothers are infected.
36. How have most females gotten infected with HIV?
In the U.S., most females have become infected either by being an injection drug user and sharing equipment, or having sexual intercourse with an injection drug user. Worldwide, most females have become infected through heterosexual sex.
37. How can I reduce my risk of HIV infection?
HIV is transmitted through direct contact with semen, vaginal secretions, and blood through a break in the skin or a mucous membrane, most commonly by sexual contact and by sharing injection drug equipment.

To eliminate your risk:
Abstain from all sexual activity and injection drug use.
Maintain a sexual relationship with only one uninfected person who has no other sexual partner and does not share injection drug equipment.
To reduce your risk:
Reduce the number of sexual partners to decrease the risk of exposure to HIV and other STDs.
Avoid unprotected anal, vaginal, and oral intercourse or other sexual practices that may result in contact with semen, vaginal secretions, or blood.
Avoid sharing needles and other equipment used for injecting drugs.
Use a latex condom every time you have intercourse.
Clean drug injection needles and syringes as explained in question 67.
Practice Universal Precautions whenever you may have contact with semen, vaginal secretions, blood, or internal body fluids of another person. Universal Precautions have been described by CDC and the Occupational Safety and Health Administration (OSHA) for health care workers, laboratory personnel, emergency responders, and other individuals who may come in contact with body fluids as a part of their job-related duties.
Avoid using alcohol or drugs that may impair your ability to make healthy decisions.
38. How can a pregnant female with HIV infection or AIDS reduce the chance of her baby being infected before it is born?
A doctor can treat a pregnant female with HIV infection or AIDS with zidovudine (AZT) during pregnancy and labor to reduce the risk of transmission to her baby. In a study of pregnant females who were infected with HIV but did not have AIDS, some females were given AZT by mouth starting between the 14th and 34th weeks of their pregnancy and given AZT intravenously during labor and delivery. Their babies were given AZT orally for six weeks after birth. About 25% of the females in the study who did not receive AZT passed the infection to their babies. Only about 8% of the females treated with AZT passed the infection to their babies. As a result of this study, CDC recommends offering HIV antibody testing to all pregnant females; if they are infected with HIV, they may be treated with AZT to reduce the number of children born with HIV infection.
39. What is the relationship between HIV and other STDs?
Other STDs do not cause HIV or AIDS. However, infection with some STDs causes sores on the skin or mucous membranes of the penis, vagina, anus, or mouth. These sores or openings in the skin allow HIV to enter the body more easily.

People who have many sexual partners are at increased risk for all STDs. Any sexual behavior that allows semen, vaginal secretions, or blood from one person to enter the body of another person is a risky behavior. The more sexual partners a person has, the greater the chance that at least one of those partners has an STD, possibly HIV.
40. Are some people immune to HIV?
There is no medical evidence at this time that anyone is immune to HIV. The risk of HIV infection exists for anyone who participates in behaviors that expose them to semen, vaginal secretions, or blood.
41. Is there a vaccine to prevent HIV infection?
At this time there is no vaccine to protect a person from HIV or AIDS. However, there is a vaccine to prevent hepatitis B, another STD. Contact your employer, physician, or county health department for information about hepatitis B vaccine.
42. How can I find out if I am infected?
There are laboratory tests that can detect HIV antibodies in blood samples. Antibodies are produced by the immune system in response to disease organisms. The presence of HIV antibodies in a blood sample means a person is infected with HIV and can pass it to another person. Call the Oklahoma HIV/AIDS Hotline at 1-800-535-AIDS for information about test sites where you can be tested at no cost.
43. What is meant by the "window period?"
The "window period" is the period of time from infection until the body's immune system produces enough antibodies to be detected by laboratory tests. This may take up to six months. In the "window period" a person is infected but has a negative blood test because their body has not yet made HIV antibodies.
44. What does a positive test for HIV antibodies mean?
The presence of antibodies in the blood means the person has been infected with HIV. A positive test means HIV antibodies were in the blood that was tested. It does not necessarily mean the person has AIDS or will develop AIDS in the future. It does mean the person could spread the virus to sexual partners, needle-sharing partners, and, if female, to a child either before birth, during the birth process, or through breast-feeding.
45. What does a negative test for HIV antibodies mean?
A negative test result means there were no HIV antibodies detected in the blood that was tested. Remember, it may take a person six months to produce enough HIV antibodies to be detected by laboratory test. A person who has been exposed to semen, vaginal secretions, or blood from another person in the past six months may want to be tested again to make sure they were not in the window period. If blood tests negative six months after the last risk, a person is not infected with HIV.
46. Where can I get tested for HIV antibodies?
Free HIV antibody testing is provided at sites throughout the state. For current information, call the Oklahoma HIV/AIDS Hotline at 1-800-535-AIDS.
47. What is the difference between confidential testing and anonymous testing?
OSDH provides funds to maintain test sites across the state. All positive results are reported to the OSDH HIV/STD Service for statistical purposes. This count helps track the epidemic in Oklahoma, secure HIV/AIDS funds for treatment and prevention, and provides vital information for planning future services and prevention programs. Positive test results from anonymous sites are not included in the Oklahoma case count, because of retesting the same individual.

At a confidential test site, you will be asked to provide your name, ZIP code and birth date that will be held in strictest confidentiality. If your test result is positive, you will be offered assistance in notifying previous sex and/or needle-sharing partners who may have been exposed to HIV so they may be offered testing. Health department staff will NOT give your name to partners being notified of their possible exposure, or to anyone else.

At an anonymous site, you will be asked to provide a ZIP code and birth date only. An identification number will be assigned to you and must be presented to get your result. If your test result is positive, you may wish to ask OSDH to notify some previous partners whom you may have exposed to HIV, so they can be offered testing. Partner notification is not available following anonymous testing. You would be referred to a confidential test site for retesting by name, and could then use the confidential partner notification service.

Call the Oklahoma HIV/AIDS Hotline at 1-800-535-AIDS for specific information about test sites.
48. Is there a test that looks for HIV instead of HIV antibodies?
Yes. However, at the end of 1995, tests that look for the virus (antigen tests) had not yet been approved by the FDA. Until that occurs, an antigen test is used in research to resolve the infection status of some people, for example babies born to HIV-infected mothers.
49. Why doesn't the government isolate or quarantine everyone with HIV infection and AIDS to prevent the spread of HIV?
Quarantine would require mandatory testing of our entire population. About one million Americans are infected already. Since many people are sexually active and/or inject drugs, this testing would have to be repeated on a regular basis. Some people would test negative even though they are actually infected, because they would be tested during the "window period" and unknowingly could infect others. This would make a quarantine useless. Many people believe the money spent on testing everyone would be more wisely spent on prevention education or treatment of individuals who are infected.

Persons infected with HIV do not pose a risk to the public through casual contact. Information shows that HIV is spread only through direct contact with semen, vaginal secretions and blood. Oklahoma law does allow for quarantine of individuals who knowingly and deliberately put others at risk through their behavior. This law is taken very seriously by public health officials and is enforced only after careful and deliberate investigation.
50. Who should be tested?
The decision to be tested should be based on whether or not an individual has participated in behaviors or situations that involve risk of transmission. Anyone who has been exposed to semen, vaginal secretions, or blood of another person may consider being counseled and tested. A counselor at the test site will help you look at your personal risk based on sexual practices, drug use, and other personal risk factors.

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