Our Bodies, Ourselves (65 page)

While asymptomatic adolescents and adults are not routinely given blood tests for herpes antibodies, the CDC recommends that health-care providers include HSV-2 antibody testing of the blood as part of a comprehensive evaluation for STIs.

If you have lesions, your health-care provider will likely be able to diagnose genital herpes by sight, but clinical diagnosis should be confirmed by laboratory testing. It can be helpful to know which type of herpes you have, as recurrences and virus shedding without symptoms are much less frequent for genital HSV-1 infection.

There is no treatment that can cure herpes, and the infection can stay in the body indefinitely.

You can take a course of antiviral medications to treat individual outbreaks, though the medication is not as effective during recurrences as during the initial infection.

If you experience frequent outbreaks, talk to your health-care provider about taking a daily low dose of antiviral medications to help reduce the frequency and duration. This is called suppressive therapy, and daily use can reduce the likelihood that you will you infect your partner(s) and, if you are pregnant, transmit herpes to your baby during birth. It can also reduce the psychological distress associated with herpes outbreaks.

If you are having an outbreak, avoid using over-the-counter creams or ointments, as they can interfere with the healing process. Keep the area clean and as dry as possible and wear comfortable loose clothing that allows the area to get air. Avoid underwear made from synthetic material.

Some people recommend taking a supplement of the amino acid lysine (L-lysine). While some research has suggested that lysine supplements can reduce the frequency of recurrences or reduce healing time, other studies have not found this to be true.

Genital herpes can cause recurrent painful genital sores, and infection can be especially severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress in people who know they are infected (see “Living with Genital Herpes,” above).

HSV-2 infection increases the risk for HIV infection by at least twofold. This is likely because even microscopic ulcerations can provide an entry for HIV. The immune response to HSV-2 can also make HIV-infected individuals more infectious.

Human papillomavirus (HPV) is the most common STI in the United States. The CDC estimates that more than 50 percent of women will become infected sometime in their lifetime, though most will never know it. About 20 million people—men and women—are thought to have an active HPV infection at any given time, with 6 million new cases each year.
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There are more than one hundred types of HPV; about thirty of them can be transmitted through sexual contact. Most people who have HPV do not develop any symptoms or health problems from it. HPV infection often goes away without any treatment within two years, as the body's immune system clears the infection on its own. However, because this infection is so common, even those infections that clear on their own cause a large number of genital warts and abnormal Pap tests while the infections exist.

However, some HPV infections persist for many years. Some types of HPV cause warts to appear on or around the genitals and anal area. These genital warts, technically known as condylomata acuminata, are most commonly associated with two HPV types, HPV-6 and HPV-11. Other HPV types can cause cancer of the cervix in women and, less frequently, vaginal, vulvar, anal, and throat cancer, as well as penile cancers in men. The HPV types associated with warts, however, are not generally associated with cancer.

Two types of HPV in particular, types 16 and 18, together cause about 70 percent of cervical cancers. There are about twelve thousand cases of cervical cancer diagnosed in the United States each year, and more than four thousand deaths. There are now two vaccines that can prevent infection with these specific types of HPV. (For more information, see “Vaccinations
to Prevent STIs.”
)

HPV is spread by skin-to-skin contact (most often genital-to-genital), not through an exchange of bodily fluids.
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Barrier protection, such as condoms, can reduce the risk of infection, but HPV can be spread by skin contact in places the condom doesn't cover. Even after the warts have been removed, it is possible for the virus to be shed from the area originally infected; this means the infection can be transmitted without either sexual partner being aware of it.

HPV can be contracted from one partner, remain dormant, and then later be unknowingly transmitted to another sexual partner. People do not know they have been infected by HPV unless they see genital warts or have an abnormal Pap test.

Warts may appear within several weeks after sexual contact with a person who is infected with HPV, or they may take months or years to appear, or they may never appear. Genital warts can cause itching, irritation, and bleeding. Around the anus, where they are more likely to be discovered by touch rather than sight, warts can be mistaken for hemorrhoids.

Some HPV infections cause flat, abnormal growths in the genital area and on the cervix; however, HPV infections of the cervix usually do not cause any symptoms.

Genital warts may grow during pregnancy or in women with weakened immune systems; they appear cauliflowerlike as they grow. During pregnancy, they can make the vaginal wall less elastic and delivery more difficult, although this rarely occurs.

Genital warts can be diagnosed by a visual inspection. Sometimes, ordinary skin tags and moles in the genital area can look like warts. Infrequently, the clinician may need to biopsy the area to determine if there is a wart present.

The most common way of finding out if you have one of the two cancer-associated types of HPV infection is through a Pap test—a small sample of cells is scraped from your cervix and examined in a lab for signs of abnormal cell changes. Pap tests can detect cell changes that may need to be monitored with more frequent exams or, in some cases, treated. (For more information, see
“Pap Tests.”
)

For women age thirty and older, a Pap test may be done in combination with an HPV DNA test. Your health-care provider takes a swab of cells from the cervix, just as for the Pap test, and the cells are analyzed in a laboratory. Currently available tests may identify fourteen of the high-risk HPV types associated with cervical cancer, or may focus on just a couple of high-risk types.
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A negative Pap test and negative HPV test may mean the time before the next Pap test can be extended.

DNA tests currently are approved for use with women over age thirty (for whom HPV is less likely to clear naturally) and as a follow-up test for adult women who have unclear Pap test results. This test is rarely used for women under thirty because HPV exposure is so common and our bodies typically clear the infection without treatment.

Screening for cervical cancer is recommended for women who have been sexually active and who have a cervix. The U.S. Preventive Services Task Force recommends against routine screening of women older than sixty-five if they have had regular normal Pap tests and are not otherwise at increased risk (i.e., have a new sex partner or multiple sex partners).

Tests may take several weeks to complete. If you are infected with HPV, keep in mind that it doesn't mean that you will develop cancer.

Genital warts can be treated by a health-care provider or by oneself. Health-care providers use mild acids (trichloroacetic acid), freezing (cryotherapy), burning with an electrical current (electrocauterization), or lasers. There are three prescription genital wart treatments that can be used at home. These treatments usually require repeated applications from a few weeks to a few months.

In some cases, warts return, so you may need repeated treatment. Talk with your health-care provider to decide which treatment might be best for you.

Genital warts are seldom dangerous, but they can be uncomfortable and can cause embarrassment with a new sexual partner. Some women report discomfort during sex at the place of infection even after warts have been removed.

HPV is the most common cause of cervical cancer, which affects about twelve thousand women in the United States each year. It can also cause vulvar, vaginal, anal, penile, and throat cancer.

For more information, resources, and support groups, visit the National HPV and Cervical Cancer Prevention Resource Center, created by the American Social Health Association, at ashastd.org.

Hepatitis B is a viral infection that affects the liver. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness.

In 1990, routine hepatitis B vaccination of children was implemented; it has dramatically decreased the rates of the disease in the United States, particularly among children. In 2007, there were an estimated 43,000 new infections in the United States, though the official number is much lower.
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Hepatitis B can be acute or chronic. Acute hepatitis B virus infection is a short-term illness that occurs within the first six months after someone is exposed to the virus. Most adults will clear the infection on their own, but 10 percent of people who are infected will become carriers who develop long-term health problems, including serious liver damage and liver cancer. There are an estimated 800,000 to 1.4 million people in the United States who have chronic hepatitis B.
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The best way to prevent hepatitis B is by getting vaccinated. For more information, see
“Vaccinations to Prevent STIs.”

Hepatitis B is fifty to one hundred times more infectious than HIV. It is usually spread by sexual contact through the exchange of bodily fluids such as blood or semen. Among adults in the United States, sexual activity accounts for nearly two-thirds of acute hepatitis B cases.
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Infection can spread among drug users who share needles, syringes, and other drug-injection equipment. Individuals can also become infected through direct contact with the blood or open sores of an infected person, by sharing razors or toothbrushes, or through exposure to blood from needles or other sharp instruments used in tattooing and body piercing.

Many people with chronic hepatitis B virus infection do not know they are infected, since they do not feel or look sick. However, they still can spread the virus to others and are at risk of serious health problems themselves.

Hepatitis B can be passed from mother to baby during pregnancy and childbirth. Most new-borns who become infected with hepatitis B virus do not have immediate acute symptoms, but they have up to a 90 percent chance of developing chronic hepatitis B.
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This can eventually lead to serious health problems, including liver damage, liver cancer, and even death. Maternal screening for hepatitis B and early immunization of the baby right after birth, as well as follow-up immunization for those not vaccinated at birth, can prevent transmission.

Often people who have hepatitis B have no symptoms. When symptoms do occur, they can include loss of appetite, weakness, muscle pain, headache, fever, dark urine, and yellowing of the whites of the eyes.

Pregnant women should be screened at their first prenatal visit. Talk to your health-care provider about screening for hepatitis B infection if you live with a person who has hepatitis B, have had sex with a person who has hepatitis B, are HIV-positive, or use injection drugs.

Blood tests are used to diagnose infection and to determine whether you have antibodies to hepatitis B, which would mean you're not at risk. If you have chronic hepatitis B, your household members and sex partner(s) should be immunized against it.

If your hepatitis B infection is acute—meaning it is short-lived and may go away on its own—your health-care provider will likely work with you to reduce any symptoms you experience while your body fights the infection. Follow-up blood tests may be needed to ensure the virus has left your body.

If you've been diagnosed with chronic hepatitis B infection, your health-care provider can suggest which antiviral medication may be most appropriate for you. If your liver has been severely damaged, a liver transplant may be an option.

Chronic hepatitis B is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. People with untreated hepatitis B can become chronic carriers and spread the infection.

HIV is the human immunodeficiency virus, which can lead to acquired immune deficiency syndrome, or AIDS. HIV damages a person's body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases.

In the United States, women and adolescent girls now account for 27 percent of annual new HIV infections, up from 7 percent in 1985.
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This translates to more than 278,000 women and adolescent girls living with the infection.
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Women and girls of color—especially African-American women—are disproportionately affected compared with white women.

The HIV prevalence rate for African-American women (1,122.4 per 100,000) is nearly four times the rate for Hispanic/Latina women (263 per 100,000) and nearly eighteen times the rate for white women (62.7 per 100,000).
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Approximately one in thirty African-American women will be diagnosed with HIV at some point (as will approximately one in sixteen African-American men).
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Relatively fewer cases have been diagnosed among Asian, American Indian/Alaska Native, and Native Hawaiian/other Pacific Islander females.