Our Bodies, Ourselves (64 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
Trichomoniasis is the most common curable STI in young, sexually active women. An estimated 7.4 million new cases occur each year in women and men.
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Trichomoniasis is caused by the single-celled protozoan parasite
Trichomonas vaginalis
. The vagina is the most common site of infection in women (resulting in small open sores on the vaginal wall), and the urethra is the most common site of infection in men.
The parasite is transmitted through penis-to-vagina intercourse or vulva-to-vulva contact with an infected partner.
Pregnant women with trichomoniasis may have babies who are born early or with low birth weight.
Symptoms may include a frothy yellow-green vaginal discharge with a strong odor. The infection also may cause discomfort during intercourse and urination, as well as irritation and itching of the genital area. In rare cases, lower abdominal pain can occur.
Most men with trichomoniasis do not have apparent symptoms; however, some men may temporarily have an irritation inside the penis, mild discharge, or slight burning after urination or ejaculation. The symptoms may disappear within a few weeks without treatment. However, an infected man, even a man who has never had symptoms or whose symptoms have stopped, can continue to infect or reinfect a partner until he has been successfully treated.
Screening for trich is recommended for women with symptoms and as part of a comprehensive STI evaluation. Women with new or multiple sex partnersâespecially if not using condomsâare also recommended to have a screening test.
Diagnosis can be confirmed by looking at a sample of vaginal discharge or with newer tests that use rapid antigen detection and NAAT methods. The newer tests are more accurate.
Trichomoniasis can usually be cured with prescription drugs, either tinidazole, given by mouth in a single dose, or metronidazole (Flagyl),
which should not be used by pregnant women in the first trimester. Many women who take metronidazole experience unpleasant effects, such as nausea, headache, diarrhea, metallic taste, joint pain, and numbness of the arms or legs. Avoid alcohol while taking metronidazole, as the combination can make the effects of both worse.
Your partner or partners need to be treated before you have sex with them again so that you do not get reinfected.
Having trichomoniasis increases susceptibility to HIV, and may also increase the chance that an HIV-infected woman will pass HIV to her sex partner(s).
Vaginal infections can also be caused by bacterial vaginosis (BV), which is possibly sexually transmitted, and yeast, which can be sexually transmitted but
most often isn't
.
HERPES
Herpes is a very common infection caused by herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2).
Genital herpes can be caused by either virus, while oral herpes (fever blisters or cold sores around the mouth and lips) is almost always caused by HSV-1. Women with frequently recurrent genital herpes (more than two to three outbreaks a year) usually have an HSV-2 infection, while genital herpes due to HSV-1 outbreaks are usually milder and less frequent. More than 60 million people in the United States have genital herpes, about 50 million with HSV-2 and 10 to 20 million with HSV-1.
More than 80 percent of people infected with HSV-2 are unaware that they have genital herpes because they have no symptoms or only mild symptoms that have gone unnoticed or are attributed to other common genital conditions such as vaginitis, painful urination, or hemorrhoids.
Herpes is spread by contact of the mouth, genitals, or skin with either developed or developing herpes blisters. Transmission is also possible between outbreaks, when invisible or asymptomatic viral shedding occurs from the original site of infection. Both HSV-1 and HSV-2 are most often spread by people who are asymptomatic, meaning they are not experiencing any signs or symptoms at the time of transmission. Thus, you can get herpes, or give it, without you or your partner knowing there is an infection. The risk of transmission can be reduced if the partner with herpes takes a daily dose of antiviral medication on an ongoing basis, uses condoms, and refrains from sex at the first sign of an outbreak.
When HSV-1 is present around the mouth, it can be transmitted through oral secretions or sores and spread through kissing or sharing toothbrushes, drinking glasses, or eating utensils. If you have sores on your lips or in your mouth, avoid oral sex. Don't kiss anyoneâespecially not infants, young children, or pregnant women. If you touch the sores with your fingers, wash your hands with soap and hot water, especially before touching your eyes or putting in contact lenses.
HSV-1 infection of the genitals is usually caused by oral-to-genital contact with a person who has HSV-1 infection. It can also be caused by genital-to-genital contact, but this is less common than mouth-to-genital contact.
© Ali Price
BREAKING THE NEWS
JENNIFER BAUMGARDNER
When I was twenty-six, I got herpes from a lovely guy on our first real date. At first I held out hope that the searing pain in my vulva, fever, and chills were just signs of a bad urinary tract infection, but a trip to my gynecologist confirmed otherwise. I had HSV-1, more commonly known as oral herpes, but I had it on my genitals. Because of the popularity of oral sex, having this variety was becoming as common as having
genital
herpes on one's genitals.
To be honest, I was initially very depressed after diagnosis. I pored over my Mayo Clinic health book and
Our Bodies, Ourselves
for days, wondering what my future held. The books sort of scared me, actually, because (for good reason) they mention all of the more dangerous possibilities that might come with herpes. For instance, I might have many outbreaks each year, and it appeared likely that I would have to have a C-section if I ever got pregnant. If a lesion infected the baby during delivery, he or she could be made blind. I also felt sort of trapped in the relationship with the carrierâalthough I really did like himâbecause I feared telling other lovers or being rejected. As it turned out, I haven't had any other outbreaks in the eight years since diagnosis, and I'm currently seven months pregnant. My doctor says that most women can have vaginal births as long as they aren't having an active recurrence. She's putting me on a drug that suppresses outbreaks (acyclovir) for the last month or so of my pregnancy, as a precaution.
As for telling lovers, I have had three since that guy who gave me my gift of a lifetime. Breaking the news is a little excruciatingâand one person was really upset to hear itâbut it has never derailed my love life. I went on to have a long relationship with the guy who was so upset, so he eventually got over his fears. The worst thing that happened was that I did give it to someone once. I had no symptoms but must have been shedding the virus, and I have tended not to use condoms after a relationship gets serious and committed. He had one bad outbreak, the initial one, but has never had a problem since.
One thing that helped me to deal with having an STI was to realize that I was part of a mighty big club. Another thing that helped was telling my dad, a doctor in my hometown of Fargo, ND. The first thing he said was, “Hey, it's not going to be a big deal. Herpes is not one of the most serious medical conditions you are likely to have during your lifetime.” He was right.
[Update: Jennifer writes that she has had not one, but two, vaginal births without complications.]
Generally, the HSV-2 infection is contracted during penile-vaginal or penile-oral contact, or genital rubbing with someone who has a genital HSV-2 infection. It is very rare to acquire an oral infection with HSV-2 through oral sex with someone who has genital HSV-2.
If you or your partner has a genital herpes outbreak, avoid all contact with active sores or places where sores tend to occur. Do not have intercourseâeven with a condom. Wait until seven days after the sore heals. The virus can spread from areas not covered by the condom, and it can be transmitted in sweat or vaginal fluids to places the condom doesn't cover.
Tell your health-care provider if you have genital herpes flare-ups. Discuss the pros and cons of taking a daily antiviral medication for a month prior to delivery, in order to reduce the risk of transmission to the newborn during vaginal delivery. Pregnant women who don't have herpes should avoid unprotected sex with a partner who has herpes.
Recent research suggests that transmission from partners' oral herpes to the pregnant mother's genitals, and then on to the fetus, accounts for an increasing proportion of newborn herpes cases. Women with primary outbreaks of genital herpes during birth are at highest risk of transmitting it to the newborn. As a result, some clinicians recommend that women not receive oral sex in the last half of pregnancy.
If you have prodromal (early-warning) symptoms such as tingling or aching, or active sores at the time of labor and delivery, a cesarean delivery is usually recommended. After birth, take care not to infect the infant. Don't touch genital or oral herpes sores, and wash your hands thoroughly before touching the baby.
Most people with genital herpes have no noticeable signs or symptoms. For those with outbreaks during the initial episode, there may be pain at site of the sore(s), painful urination, vaginal discharge, swollen glands, fever, and body aches. Women with severe outbreaks may be unable to pass urine easily. The initial outbreak is usually the most painful and takes the longest time to heal. A health-care provider can give you prescription medication to lessen the severity.
Typically, another herpes episode can appear weeks or months after the first, but it is almost always less severe and shorter than the first outbreak. In the 20 percent of genital herpes infections when signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal. If you are unaware of typical herpes symptoms, you may attribute the sores to something else, such as a scratch or zipper cut. Genital herpes can also cause nonspecific symptoms such as genital or anal itching, rashes, burning on urination, or achinessâwhich could lead you to think you have vaginitis, a urinary tract infection, or hemorrhoids.
Recurrences may be triggered by stress or lowered resistance, getting your period, sex, certain foods, and sunburn. These episodes often decrease after the first year, but they can last in some cases for five to ten years or even longer. Some people with repeated genital herpes experience early-warning signs of an upcoming herpes episode: fever, malaise, or unusual sensations like tingling, itching, pain, burning, or pressure at the site of the original infection. The prodrome period can last up to two days and stops when the blisters appear.
LIVING WITH GENITAL HERPES
Herpes is an inconvenience and a pain, but it's something you learn to live with.
You may feel shocked when you first discover you have herpes. You may feel isolated, lonely, and angry, especially toward the person who you think may have infected you. You may become anxious about initiating or staying in long-term relationships or having children.
After the first big episode of herpes, I felt distant from my body. When we began lovemaking again, I had a hard time having orgasms or trusting the rhythm of my responses. I shed some tears over that. I felt my body had been invaded.
Most people find that over time they are able to adjust to and manage the emotional and health aspects of herpes. Learning the facts about the virus and seeking support when needed are important steps.
I contracted HSV-1 in the genital area when I was twenty-three. When I first found out I was infected by my boyfriend, who had a cold sore when he went down on me, I was angry. Why hadn't he known it could be spread by oral sex? Why didn't I know? Then I worried I'd have to stay in the relationship, and I wasn't so sure I wanted to. When we broke up a year later, it was hard at first telling new partnersâor knowing when to tell them. I'm now married, and while I worry about infecting my partner, he's never stressed over it. That helps me to relax.
It may be easier to cope with herpes if you are able to talk about it openly and let people close to you know when you're feeling run-down. Identifying what triggers your flare-ups and reducing stress, if you can, may lead to fewer outbreaks.
The National Herpes Resource Center, run by the American Social Health Association (ashastd.org/hrc), provides comprehensive information for people with herpes. You'll also find a list of herpes support groups (called HELP groups) in the United States and Canada; many of these groups also welcome people with HPV infections.