Our Bodies, Ourselves (63 page)

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Reporting requirements:
Health-care providers are required by law to report to the public-health department certain STIs, including, but not limited to, chlamydia, gonorrhea, syphilis, chancroid, and HIV/AIDS.
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Public-health departments use reported information about STI diagnoses to help identify risk factors for disease, detect and respond to outbreaks, interrupt the spread of infection, and plan prevention programs. Although names are included with case reports, individual information is confidential and by law cannot be disclosed by the health department to anyone else. HIV cases diagnosed by anonymous (as opposed to confidential) testing do not get reported to health departments.

If you are diagnosed with gonorrhea, syphilis, HIV/AIDS, or (sometimes) chlamydia, a public-health official or social worker may ask you for the name(s) of anyone you may have caught the infection from or have given it to. The official or social worker may contact these people, without using your name, to encourage them to seek testing and treatment. You may also choose to contact sex partners yourself. Doing so may save their fertility or even their lives, as well as that of their other or future sex partners.

Bacterial STIs and trich (caused by a parasite) are spread by sexual activity. They cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

The good news is that these STIs are curable through treatment with antibiotics. Curable, that is, as long as you see a health-care provider, get tested and treated, follow through on all the medication, avoid sexual contact until cured, and make sure that your sexual partner(s) will get testing and treatment as well.

There's bad news, too. Like viral STIs, bacterial STIs often give no warning signs or symptoms. This means you can get infected and infect your sexual partner(s) without knowing it. Serious complications that cause irreversible damage can progress silently before you ever recognize a problem; these complications include pelvic inflammatory disease, infertility and life-threatening ectopic pregnancy. The longer that bacterial STIs go untreated, the more damage they can do. Medication will stop these infections, but it will not repair any permanent damage done before treatment begins.

If you are being treated for a bacterial STI or trich, you'll be at high risk for reinfection unless you avoid sex until you and your sex partner(s) complete successful treatment. Reinfection rates among women diagnosed with and treated for chlamydia and gonorrhea are high, in many cases because their partners do not receive treatment. Having multiple infections increases a woman's risk of serious reproductive health complications, including infertility.

Chlamydia is caused by the bacterium
Chlamydia trachomatis
. In the United States, about 1.2 million cases of chlamydia were reported in 2009,
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but chlamydia often goes undetected and undiagnosed; over 2.8 million new cases, more than double the number of reported cases, are estimated to occur each year.

Chlamydia can be transmitted during vaginal, anal, or oral sex. If there is infected vaginal fluid on your fingers, or discharge from the penis of an infected man, touching your hand to your eye can also infect your eye. If you have receptive anal intercourse, you can get a chlamydial infection in the rectum. Chlamydia can also be found in the throats of women and men who have had oral sex with an infected partner.

Chlamydia can be passed from an infected mother to her baby during vaginal childbirth. Chlamydia is a leading cause of early infant pneumonia and conjunctivitis, or pinkeye, in newborns.

Most women with chlamydia have no apparent symptoms. The bacteria initially infect the cervix and the urethra. Women who have symptoms sometimes have an abnormal vaginal discharge or a burning sensation when urinating. If the infection spreads from the cervix to the fallopian tubes, some women may still have no signs or symptoms; others may have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. If it spreads to the rectum, chlamydia can cause rectal pain, discharge, or bleeding, or may be present with no symptoms at all.

Men's symptoms include discharge from the penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis.

Yearly chlamydia testing is recommended for all sexually active women age twenty-five or younger, older women who have a new sex partner or multiple sex partners, and all pregnant women.
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As chlamydia can be confused with gonorrhea, you may want to get tested for both.

The presence of
Chlamydia trachomatis
can be confirmed by lab tests done using a swab from cervix or vagina or using urine. If you've had receptive anal intercourse, a rectal swab for chlamydia is recommended.

Oral antibiotics. Be sure your partner(s) will be treated as well, to avoid reinfection. In some states, a clinician can legally provide antibiotics or a prescription for antibiotics for you to give to your sex partner or partners. Retesting is recommended three months after being diagnosed with chlamydia to detect new infections, which can be due to sex with undiagnosed and untreated sex partners.

Chlamydia can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). This happens in about 10–15 percent of women with untreated chlamydia. PID can lead to internal abscesses (pus-filed pockets of infection and inflammation that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy.

Chlamydia can also increase the chances of becoming infected with HIV, if you're exposed.

Gonorrhea is caused by
Neisseria gonorrhoeae
, a bacterium that can grow and multiply easily in the warm, moist areas of a woman's reproductive tract, including the cervix, uterus, and fallopian tubes. It can also multiply in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.

Gonorrhea is the second most commonly reported infectious disease, with more than 301,000 cases reported to the CDC in 2009,
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but it's estimated that more than half of all new infections go undiagnosed.
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Gonorrhea is spread through contact with the penis, vagina, mouth, or anus.

Gonorrhea can be passed from an infected mother to her baby during childbirth and cause blindness, joint infection, or a life-threatening blood infection.
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Treatment of gonorrhea as soon as it is detected in pregnant women reduces the risk of transmission during childbirth.

Most women who are infected with gonorrhea have no noticeable symptoms. If symptoms do appear, they can include increased vaginal discharge, vaginal bleeding between periods, or a painful or burning sensation when urinating. Since these symptoms are nonspecific, they can be mistaken for a bladder or vaginal infection.

Men's symptoms can include a burning sensation during urination or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles.

Rectal infection in both men and women can occur without symptoms or may include discharge, anal itching, soreness, bleeding, or painful bowel movements. Infection in the throat may cause a sore throat.

It's recommended that clinicians screen all sexually active women, including those who are pregnant, for gonorrhea infection, particularly those at increased risk for infection (that is, if they are young or have other individual or population risk factors).

A urine sample or a swab of your vagina, rectum, throat, or urethra is used to collect bacteria that can be identified in a laboratory for gonorrhea confirmation. The nucleic acid amplification DNA test (NAAT) is the most accurate type of test and is widely available.

Antibiotics can successfully cure gonorrhea. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, complicating treatment. Because many people with gonorrhea also have chlamydia, antibiotics for both infections are usually given together. In some states, a clinician can legally provide antibiotics for you to give to your sex partner or partners. Retesting is recommended three months after being diagnosed with gonorrhea to detect new infections, which can be due to sex with undiagnosed and untreated sex partners.

In women, gonorrhea is a common cause of pelvic inflammatory disease (PID; see above, under chlamydia). More rarely, advanced gonorrhea can spread to the blood or joints. The most common symptoms are aching and swelling in the joints (usually in the hands or feet), but gonorrhea can spread, causing skin lesions and infections of the heart, the bones, and the sheaths
that cover the nervous system (meninges). In very rare cases, it can be fatal.

Syphilis is caused by the bacterium
Treponema pallidum
. After being greatly reduced in the United States in the twentieth century, syphilis rates have increased. In 2009, reported syphilis cases increased 5 percent over the previous year, for a 39 percent increase since 2006.
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Most of the increase is in men who have sex with other men.

Syphilis is transmitted through direct contact with a syphilis sore. Sores occur mainly on the external genitals, or in the vagina, anus, or rectum. Sores also can occur on the lips and in the mouth.

Transmission of the organism most often occurs during unprotected vaginal, anal, or oral sex. Barrier methods such as the male or female condom or dental dam are important tools to prevent the spread of infection. They do not, however, offer protection from sores outside the area covered by the barrier.

Genital sores caused by syphilis make it easier to transmit and acquire HIV infection. Syphilis-type sores are usually painless and can bleed easily. When they come into contact with oral and rectal mucosa during sex, this contact increases the infectiousness of and susceptibility to HIV. There is an estimated two-to fivefold increased risk of acquiring HIV if you are exposed to HIV when syphilis is present.

Because syphilis can pass from a woman to her fetus, pregnant women are routinely screened for syphilis. If syphilis treatment is given early in the pregnancy, the fetus probably won't be affected, since syphilis often takes a few months to cause damage to a fetus. Later on, since medication can stop the disease but cannot repair damage already done, a baby may be stillborn or have serious abnormalities at birth.

An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may become developmentally delayed, have seizures, or die. In most states, prenatal testing is required by law.

Untreated syphilis typically goes through several stages. Primary syphilis is characterized by a (usually) painless sore, or chancre, at the spot where the bacterium entered the body; the chancre heals on its own, but syphilis remains active if untreated. Individuals with untreated primary syphilis usually develop secondary syphilis, usually at about two to eight weeks after the appearance of the original sore. In secondary syphilis, the bacteria have spread into the bloodstream.

Secondary syphilis is often characterized by a skin rash, which may appear as rough, red, or reddish-brown spots on areas including, but not limited to, the palms of the hands and bottoms of the feet. Lesions may also appear on mucous membranes, and individuals may experience fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. Rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements, but may not have obvious symptoms at all. Infection in the throat can cause a sore throat.

Screening is recommended for all pregnant women and anyone at increased risk for syphilis infection, including sex workers, people who exchange sex for drugs, people diagnosed with HIV, carriers of other STIs, and those who have
had contact with someone who has active syphilis.
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Individuals living in communities with increased levels of syphilis are often offered screening.

Syphilis can be diagnosed based on physical examination findings, microscopic identification of syphilis bacteria, and blood testing. A second test is usually required to confirm the diagnosis.

Syphilis is easy to cure in its early stages. A single shot of an antibiotic generally cures a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. Be sure to abstain from sexual contact until the syphilis sore or rash is completely healed or a follow-up test shows that you have been cured.

Symptoms of secondary syphilis resolve with or without treatment, but without treatment the infection can silently progress and cause damage to the body's internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This occurs in about 15 percent of cases. By the late stage, this damage can be serious enough to cause paralysis, numbness, gradual blindness, dementia, and death.