Teens and health

Talk to your teenager about sexually transmitted diseases

Sexually transmitted diseases (STDs), once called venereal diseases, are among the most common infectious diseases in the United States today. More than 20 STDs have been identified and they affect more than 13 million Americans each year. Most of the cases occur among 15- to 24-year-olds, so it's important to talk to your teenager about STDs early, before they become sexually active. They need to understand what STDs are, how they spread, how to recognize the symptoms and how they can be prevented.

Knowledge is power
It is up to each individual to learn more about STDs and then make choices about how to reduce the risk of acquiring these diseases and spreading them to others. Knowledge of STDs, as well as honesty and openness with your children can be very important in reducing the incidence and complications of sexually transmitted diseases.

Hotlines to call
The American Social Health Association (ASHA) provides free information and keeps lists of clinics and private doctors who provide treatment for people with STDs. The ASHA national toll-free phone number is (800) 227-8922, and their Herpes Hotline is (919) 361-8488. Callers can get information from the ASHA hotline without leaving their names.

More information

Basic facts about STDs
How to prevent STDs
If you have an STD
Chlamydial infection
Genital herpes
Genital warts
Gonorrhea
HIV and AIDs
Pelvic Inflammatory Disease
Syphilis
Vaginitis

Basic facts about STDs

STDs affect men and women of all backgrounds and economic levels. They are most common among teenagers and young adults. Nearly two-thirds of all STDs occur in people younger than 25.

The incidence of STDs is rising. Sexually active people today are more likely to have multiple sex partners, which increases their risk for catching a STD. Young people have become sexually active earlier, marry later and divorce more often.

STDs can be prevented by refraining from sexual relations. If sexually active, the risk of becoming infected can be dramatically reduced by the proper use of latex or plastic condoms.

Most of the time, STDs cause no symptoms, particularly in women. When symptoms do develop, they may be confused with those of other diseases not transmitted through sexual contact. Even when an STD causes no symptoms, an infected person may pass the disease to a sex partner.

Health problems caused by STDs tend to be more severe and more frequent for women than men, in part because women have fewer symptoms and may not seek care until serious problems develop.

• Some STDs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), a major cause of both infertility and ectopic (tubal) pregnancy.
• STDs in women also may be associated with cervical cancer. One STD, human papillomavirus infection (HPV), causes genital warts and cervical and other genital cancers.
• STDs can be passed from a mother to her baby before, during or immediately after birth; some of these infections of the newborn can be cured easily, but others may cause a baby to be permanently disabled or even die.

When diagnosed and treated early, most STDs can be cured. Home remedies are not effective. STDs need to be treated by a professional. Some infections have become resistant to the drugs used to treat them and now require newer types of antibiotics. Experts believe that having STDs increases one's risk for becoming infected with the AIDS virus.

What can you do to prevent STDs?

The best way to prevent STDs is to avoid sexual contact with others. If your child decides to be sexually active, there are things that he or she can do to reduce the risk of developing an STD.

• Delay having sexual relations as long as possible. The younger people are when having sex for the first time, the more susceptible they are to developing an STD. The risk of acquiring an STD also increases with the number of partners over a lifetime.
• Have a mutually monogamous sexual relationship with an uninfected partner.
• Correctly use a condom every time you have sex.

Anyone who is sexually active should:

• Have regular checkups for STDs even if they don't have symptoms, and especially if having sex with a new partner. These tests can be done during a routine visit to the doctor's office.
• Learn the common symptoms of STDs. Seek medical help immediately if any suspicious symptoms develop, even if they are mild.
• Avoid having sex during menstruation. HIV-infected women are probably more infectious, and HIV-uninfected women are probably more susceptible to becoming infected during that time.
• Avoid anal intercourse, but if practiced, use a condom.
• Avoid douching because it removes some of the normal protective bacteria in the vagina and increases the risk of getting some STDs.

Anyone diagnosed as having an STD should:

• Be treated to reduce the risk of spreading the disease to someone else.
• Notify all recent sex partners and urge them to get a checkup.
• Follow the doctor's orders and complete the full course of medication prescribed. A follow-up test to ensure that the infection has been cured is often an important step in treatment.
• Avoid all sexual activity while being treated for an STD.

Sometimes people are too embarrassed or frightened to ask for help or information. Most STDs are readily treated, and the earlier a person seeks treatment and warns sex partners about the disease, the less likely the disease will do irreparable physical damage, be spread to others or, in the case of a woman, be passed on to a newborn baby.

Chlamydial infection

Chlamydial ("kla-mid-ee-uhl") infection is the most common bacterial sexually transmitted disease (STD) in the United States today with estimates topping four million new cases each year. The highest rates of chlamydial infection are in 15- to 19-year-olds.

What causes it?
Chlamydial infection is caused by bacteria, Chlamydia trachomatis.

How do you catch it?
Chlamydia can be transmitted during vaginal, oral or anal sexual contact with an infected partner. A pregnant woman may pass the infection to her newborn during delivery, which may result in eye infection or pneumonia in the newborn.

What are the symptoms?
Most chlamydial infections cause no symptoms. Some people experience abnormal genital discharge or pain during urination. These early symptoms may be mild. If symptoms do occur, they usually appear within one to three weeks after exposure. Two of every three infected women and one or two of every four infected men have no symptoms whatsoever. As a result, often the disease may not be diagnosed and treated until complications develop.

Doctors estimate as many as one-third of women with chlamydial infections develop pelvic inflammatory disease (PID), a major cause of infertility. In men, rarely, chlamydial infections may lead to pain or swelling in the scrotal area. Left untreated, this condition, like PID in women, can cause infertility.

How can I tell if I have it?
Chlamydial infection can be confused with gonorrhea because the symptoms are similar. A variety of laboratory tests are available to detect chlamydia using secretions from the genital area or urine. These inexpensive tests can be performed during a routine checkup, and results may be available within 24 hours.

How is it treated?
Doctors usually prescribe antibiotics such as azithromycin, doxycycline, erythromycin or ofloxacin. Pregnant women can be treated with azithromycin or erythromycin. Amoxicillin is also a safe alternative for treating pregnant women. Penicillin, which is often used for treating other STDs, is not effective against chlamydia.

A person with chlamydial infection should be sure to take all of the prescribed medication, even after symptoms disappear. If the symptoms do not disappear within one to two weeks after finishing the medicine, the patient should go back to the doctor or clinic. All sex partners of a person with chlamydial infection should be tested and treated to prevent reinfection and further spread of the disease.

How about complications?
Each year up to one million women in the United States develop PID, a serious infection of the reproductive organs. PID can result in scarring of the fallopian tubes, which can block the tubes and prevent fertilization from taking place. An estimated 100,000 women each year become infertile as a result of PID.

In other cases, scarring may interfere with the passage of the fertilized egg down into the uterus. When this happens, the egg may implant in the fallopian tube—called ectopic or tubal pregnancy. The condition is life-threatening for the mother and results in the loss of the fetus. PID is the most common cause of pregnancy-related death among poor teenagers in the inner cities and rural areas of the United States.

How to lower your risk of getting chlamydia?
Using condoms or diaphragms during sexual intercourse may help reduce the transmission of chlamydia. Because chlamydial infection often occurs without symptoms, people may unknowingly infect their sex partners. Many doctors recommend all persons who have more than one sex partner, especially women younger than 25, be tested for chlamydial infection regularly, even if they have no symptoms.

Genital herpes

Genital herpes is a contagious viral infection that affects an estimated one out of four (or 45 million) Americans. Doctors estimate that as many as 500,000 new cases occur each year.

What causes it?
The infection is caused by a virus called the herpes simplex virus (HSV). There are two types of this virus. Type 1 most commonly causes sores on the lips (known as fever blisters or cold sores), but it can cause genital infections as well. Type 2 most often causes genital sores, but it also can infect the mouth.

How do you get it?
Genital herpes is usually acquired by sexual contact with someone who is having an outbreak of herpes sores in the genital area. People with oral herpes can transmit the infection to the genital area of a partner during oral-genital sex. Herpes infections also can be transmitted by a person who is infected with HSV who has no noticeable symptoms. The virus is spread only rarely, if at all, by contact with objects such as a toilet seat or hot tub.

What are the symptoms?
Eighty percent of people with genital herpes are unaware of their disease because they never develop any symptoms or do not recognize them. When symptoms do occur, they vary widely from person to person.

Symptoms of a first episode of genital herpes usually appear within two to 10 days of infection. First episodes last about two to three weeks. Early symptoms can include an itching or burning sensation; pain in the legs, buttocks or genital area; vaginal discharge or a feeling of pressure in the abdomen.

Within a few days, sores (also called lesions) appear at the site of infection. Lesions also can occur inside the vagina and on the cervix in women, or in the urinary passage of women and men. Small red bumps appear first, develop into blisters, and then become painful open sores. Over a period of days, the sores become crusted and then heal without scarring. Other symptoms can include fever, headache, muscle aches, painful or difficult urination, vaginal discharge and swollen glands in the groin.

The herpes sores usually disappear within two to three weeks, but the virus remains in the body for life and lesions may recur from time to time.

After the first outbreak, how often can do you have herpes symptoms?
Some people experience only one or two recurrences in a lifetime, others may experience several outbreaks a year. The symptoms of later episodes usually are milder than those of the first and typically last about a week.

Later outbreaks may be signaled by a tingling or itching in the genital area, or pain in the buttocks or down the leg. Sometimes these are the only symptoms and no visible sores develop. At other times, blisters appear that may be very small and barely noticeable, or they may break into open sores that crust over and then disappear.

Some people with herpes report their recurrences are brought on by other illnesses, stress or menstruation. In some cases, exposure to sunlight is associated with recurrences.

How is it diagnosed?
The sores of genital herpes may be visible to the naked eye. Several laboratory tests may be needed, however, to distinguish herpes sores from other infections. The most accurate way to tell if you have herpes is to go to your doctor and have a sample taken from an active sore for laboratory testing.

A blood test cannot determine whether someone has active genital herpes. A blood test, however, can detect antibodies to the virus, which indicate that the person has been infected with HSV at some time.

How is it treated?
During an active herpes episode, it is important to follow a few simple steps to speed healing and avoid spreading the infection to other sites of the body or to other people:

• Keep the infected area clean and dry to prevent spreading the infection to other parts of your body.
• Avoid touching the sores; wash hands after contact with the sores.
• Avoid sexual contact from the time symptoms are first recognized until the sores are completely healed, i.e., the scab has fallen off and new skin has formed over the area.

Researchers have shown that the oral form of acyclovir (Zovirax^®) is an effective, safe treatment that helps patients with first or recurrent episodes. It shortens the length of the first episode and reduces the severity of subsequent infections, particularly if it's taken within 24 hours of the onset of symptoms. Acyclovir is not a cure for herpes; the virus remains in the body for life, but when taken regularly, it may interfere with the virus' ability to spread. It also may reduce the risk of transmission to sexual partners.

The U.S. Food and Drug Administration recently approved two new drugs, famciclovir (Famvir^®) and valacyclovir (Valtrex^®), to treat recurrent episodes of genital herpes.

How can you prevent it?
People with early signs of a herpes outbreak or with visible sores should not have sexual intercourse until the sores have healed completely. Between outbreaks, use condoms during sexual intercourse.

Are there complications?
Usually, genital herpes infections do not cause long-term damage in healthy adults. In people with suppressed immune systems, however, infections can be long-lasting and unusually severe.

Women who acquire genital herpes during pregnancy can transmit the virus to their babies. Untreated genital herpes infections in newborns can result in serious complications, including mental retardation and death. Acyclovir can greatly improve the outcome for babies, particularly if they are treated immediately. With early detection and treatment, most of these serious complications can be lessened.

Genital warts

Genital warts infect about one million Americans each year. Also called venereal warts, they are caused by a virus, human papillomavirus (HPV), which is related to the virus that causes common skin warts.

What are the symptoms?
Genital warts usually first appear as small, hard painless bumps in the vaginal area, on the penis or around the anus. If untreated, they may grow and develop a fleshy, cauliflower-like appearance.

How are they diagnosed?
A doctor can usually diagnose genital warts in an examination. Women with genital warts should also be examined for HPV infection of the cervix. A Pap smear, a microscopic examination of cells scraped from the cervix, may also reveal the presence of HPV infection.

How are they treated?
Genital warts are treated with a topical drug (applied to the skin), by freezing, or if they recur, with injections of a type of interferon. If the warts are very large, they can be removed by surgery.

What are the complications?
Low-risk HPV infections cause warts but not cervical cancer. High-risk viruses, however, do cause cervical cancer. Regular Pap smears are essential for sexually active women who may have been exposed to HPV.

Gonorrhea

Approximately 1.5 million people in the U.S. are infected with gonorrhea. Most cases occur in people 15 to 24 years old.

What are the symptoms?
The most common symptoms of gonorrhea are a discharge from the vagina or penis and painful or difficult urination. Many women who are infected have no symptoms until the disease is advanced, when they may experience abdominal pain, bleeding between menstrual periods, vomiting and fever.

How is it spread?
Unprotected intercourse with an infected person causes gonorrhea. It can also be transmitted to a baby during birth and may cause blindness in infants.

What are the complications?
The most common and serious complications occur in women and, as with chlamydial infection, these complications include pelvic inflammatory disease (PID), ectopic pregnancy and infertility.

How is it diagnosed?
A variety of lab tests of discharge from the vagina or penis are used to detect the bacteria that causes gonorrhea.

How is it treated?
Historically, penicillin has been used to treat gonorrhea, but in the last decade, four types of antibiotic resistance have emerged. New antibiotics or combinations of drugs must be used to treat these resistant strains. All sexual partners of an infected person should be tested and treated whether or not they have symptoms.

HIV infection and AIDS

AIDS (acquired immunodeficiency syndrome) was first reported in the United States in 1981. It is caused by the human immunodeficiency virus (HIV), which destroys the body's ability to fight off infection. An estimated 900,000 people in the United States are currently infected with HIV.

People who have AIDS are very susceptible to many life-threatening diseases, called opportunistic infections, and to certain forms of cancer. Transmission of the virus primarily occurs during sexual activity and by sharing needles used to inject intravenous drugs. If you have any questions about HIV infection or AIDS, call the AIDS Hotline confidential toll-free number: (800) 342-AIDS. Also see the hospital's AIDS care program.

Pelvic Inflammatory Disease

Aside from AIDS, the most common and serious complication of sexually transmitted diseases (STDs) among women is pelvic inflammatory disease (PID), an infection of the upper genital tract. PID can affect the uterus, ovaries and fallopian tubes. Untreated, PID causes scarring and can lead to infertility, tubal pregnancy, chronic pelvic pain and other serious consequences.

Each year in the United States, more than 1 million women experience an episode of acute PID, with the rate of infection highest among teenagers. More than 100,000 women become infertile each year as a result of PID, and a large proportion of the 70,000 ectopic (tubal) pregnancies occurring every year are due to the consequences of PID.

What causes PID?
PID occurs when disease-causing organisms migrate upward from the urethra and cervix into the upper genital tract. Many different organisms can cause PID, but most cases are associated with gonorrhea and genital chlamydial infections, two very common STDs.

What are the symptoms?
The major symptoms of PID are lower abdominal pain and abnormal vaginal discharge. Other symptoms such as fever, pain in the right upper abdomen, painful intercourse, and irregular menstrual bleeding can occur as well. PID, particularly when caused by chlamydial infection, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs.

Who is at risk of developing PID?

• Women with STDs, especially gonorrhea and chlamydial infection, are at greater risk of developing PID.
• A prior episode of PID increases the risk of another episode because the body's defenses are often damaged during the initial illness.
• Sexually active teenagers are more likely to develop PID than are older women.
• The more sexual partners a woman has, the greater her risk of developing PID.

Recent data indicate that women who douche once or twice a month may be more likely to have PID than those who douche less than once a month. Douching may push bacteria into the upper genital tract. Douching also may ease discharge caused by an infection, so the woman delays seeking health care.

How is it diagnosed?
PID can be difficult to diagnose. If you are experiencing symptoms such as lower abdominal pain, see your doctor. He or she will perform a physical exam to determine the nature and location of the pain. The doctor also should check for fever, abnormal vaginal or cervical discharge, and evidence of cervical chlamydial infection or gonorrhea.

If more information is necessary, the doctor may order other tests, such as a sonogram, endometrial biopsy or laparoscopy to distinguish between PID and other illnesses that have similar symptoms.

Laparoscopy is a surgical procedure in which a tiny, flexible tube with a lighted end is inserted through a small incision just below the navel. This procedure allows the doctor to view the internal abdominal and pelvic organs, as well as take specimens for cultures or microscopic studies, if necessary.

How is PID treated?
Your doctor may prescribe at least two antibiotics that are effective against a wide range of infectious agents. The symptoms may go away before the infection is cured. Even if symptoms do go away, patients should finish taking all of the medicine. Patients should be re-evaluated by their physicians two to three days after treatment is begun to be sure the antibiotics are working.

About one-fourth of women with suspected PID must be hospitalized. The doctor may recommend this if the patient is severely ill, pregnant, adolescent, HIV positive, cannot take oral medication and needs intravenous antibiotics or if the diagnosis is uncertain and may include an abdominal emergency such as appendicitis.

Many women with PID have sex partners who have no symptoms, although their sex partners may be infected with organisms that can cause PID. Because of the risk of reinfection, however, sex partners should be treated even if they do not have symptoms.

What are the consequences of PID?
Women with recurrent episodes of PID are more likely to suffer scarring of the fallopian tubes that leads to infertility, tubal pregnancy or chronic pelvic pain. Infertility occurs in approximately 20 percent of women who have had PID.

A woman who has had PID has a six-to-tenfold increased risk of tubal pregnancy, in which the egg can become fertilized but cannot pass into the uterus to grow. Instead, the egg usually attaches in the fallopian tube, which connects the ovary to the uterus. The fertilized egg cannot grow normally in the fallopian tube. This type of pregnancy is life-threatening to the mother, and almost always fatal to her fetus.

Syphilis

Incidence of syphilis has decreased dramatically in recent years. More than 11,000 cases were reported in 1996.

What are the symptoms?
The initial symptom is a painless open sore that usually appears on the penis or around or in the vagina. It can also occur near the mouth, anus or on the hands. The first symptoms of syphilis may go undetected because they are very mild and disappear spontaneously. If untreated, syphilis may go on to more advanced stages. Weeks after the sore disappears, a rash that spreads all over the body, including the palms of the hand and soles of the feet, gets many people to their doctor. If the person is still untreated, syphilis may advance to the third stage with serious involvement of the heart and central nervous system. The full course of the disease can take years. Since the discovery of antibiotics, advanced syphilis is seldom seen.

What causes it?
Syphillis is a bacterial infection that is spread through sexual contact with an infected person.

How is it diagnosed?
A blood test called the Wasserman test is used to detect syphilis.

How is it treated?
Penicillin remains the most effective drug to treat people with syphilis.

What are the complications?
It can spread from mother to child during pregnancy and birth, causing birth defects or even death to the infant. A syphilis test is part of routine prenatal care.

Vaginitis

When a woman gets an irritation in the vagina it is called vaginitis. The symptoms of this are:

• itching,
• redness,
• burning with urination, or
• unusual vaginal discharge.

This irritation can be caused by many different things. Douches and feminine sprays can irritate the vagina; so can tampons or certain soaps. Sometimes chemicals such as Nonoxynol-9 in birth control foams, jellies or lubricants can be irritating. Sexually transmitted diseases and yeast infections frequently cause vaginitis, too.

Women who are pregnant, or are on certain kinds of birth control medicines, are very prone to vaginitis. So are women who have gone through menopause, diabetics and women with HIV. Since there can be so many causes, in order to treat it, the health care provider must find out what is causing it. A sample of the vaginal secretions can help in discovering the cause. Sometimes, the health care provider will treat a woman and her sexual partner. Do not use over-the-counter medications without the approval of your health care provider. It could be the wrong treatment.

Learn more
• YNHH Health Library: Sexually transmitted diseases

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Last revised: June 6, 2007 (dh)

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.