All states (and the District of Columbia) require that syphilis, gonorrhea, chancroid, chlamydia, the human immunodeficiency virus (HIV), and the acquired immune deficiency syndrome (AIDS) be reported to public health centers. In addition, many states require reporting cases of genital herpes and genital warts. Reporting these infec­tions helps to identify disease trends and communities that may be at high risk. However, because many states offer anonymous HIV testing and non-FDA-approved home tests may be used, it is nearly impossible to know the actual total of HIV infec­tions in the United States.

Overall, women tend to be more susceptible to gonorrhea, chlamydia, and HIV, al­though the spread of syphilis and genital warts is usually shared equally between the sexes (although the prevalence of HIV was higher in men in the late 1980s, women are still more susceptible if they have sexual intercourse with an infected male partner). Studies have found that women are at greater risk for long-term complications from STIs because the tissue of the vagina is much more fragile than the skin covering the penis. asymptomatic In addition, many more women are asymptomatic; therefore, they do not know that

Without recognizable symptoms. they are infected. Some infections, such as herpes and HIV, also have properties of

latency. A person can have the virus that causes the disease but not have symptoms, and latency tests may even show up negative. As a result, the person may be unaware that he or she

A period in which a person is infected with an

STI but does not test positive for it. is infecting others.

STIs can adversely affect pregnancy as well. In fact, certain untreated STIs, such as syphilis, gonorrhea, chlamydia, herpes, hepatitis B, and HIV, can cause problems such as miscarriage, stillbirth, early onset of labor, premature rupture of the amniotic sac, men­tal retardation, and fetal or uterine infection (Centers for Disease Control and Prevention, 2005d). From 30% to 40% of preterm births and infant deaths are due to STIs (Goldenberg et al., 1999). Some STIs, like syphilis, can cross the placenta and in­fect a developing fetus, whereas other STIs, such as gonorrhea, chlamydia, and herpes, can infect a newborn as he or she moves through the vagina during delivery. HIV can cross the placenta, infect a newborn at birth, or, unlike other STIs, can be transmitted during breast-feeding (Arias et al., 2003).

Bacterial STIs can be treated during pregnancy with antibiotics, and if treatment is begun immediately there is less chance the newborn will become infected. Viral infec­tions cannot be treated, but antiviral medications can be given to pregnant women to lessen the symptoms of these infections (Centers for Disease Control and Prevention, 2005d). If there are active vaginal lesions or sores from an STI, a healthcare provider may recommend a cesarean section delivery. Women who do not know their partner’s STI history should always use latex condoms during pregnancy.

CK SEXUALLY TRANSMITTED INFECTIONS^Question: How can you know whether your partners have any STIs before becoming sexual with them?

You should ask your partner, prior to any sexual involvement, whether or not he or she has had or currently has an STI. You can also check his or her genitals prior to engaging in sex. Look for open sores or scarring on the penis, lips, vulva, or anus. You can also get tested for STIs to de­termine whether or not you have been exposed. But keep in mind that many STIs do not have any symptoms and that there is no way to know for sure whether or not your partner has an STI. Making sure you are both tested, prior to sexual behavior, is the best bet.

There are also some racial/ethnic differences in STIs. Though STIs occur in all racial and ethnic groups, African Americans have higher rates of most STIs than whites and Hispanics. Gonorrhea and syphilis are as much as 44 times higher in African Americans than whites. These differences may partially be due to the fact that African

Figure 15.1

Подпись: & :! 25 и о 20 Подпись:Test positivity for gonorrhea, chlamy­dia, and HIV among men who have sex with men, by race/ethnicity, United States, 2004.

Source: Centers for Disease Control and Prevention, 2005d.

CK SEXUALLY TRANSMITTED INFECTIONS^

*Excludes persons previously known to be HIV-positive.

Americans are more likely to be treated in public clinics, which are more likely to report STIs. Even so, this can’t explain all of these ethnic and racial differences in STI rates. Other factors, such as access to health care, the ability to seek help, poverty, and sexual practices are also responsible for some of the rate disparities (Laumann & Youm, 2001).

Over the last several decades the rates of HIV infection have declined in men who have sex with men (MSM). However, there have been increased rates of gonorrhea, syphilis, and chlamydia reported in HIV-infected MSM (Centers for Disease Control and Prevention, 2005d). Researchers believe that STI increases in men who have sex with men are due to several factors, including a decreased fear of acquiring HIV; an in­crease in high-risk sexual behaviors, including oral sex; a lack of knowledge about STIs; increased Internet access to sexual partners; and the increased use of Viagra as a recre­ational drug (which would increase and prolong erection; Ciesielski, 2003). See Figure 15.1 for more information on STIs in men who have sex with men.

Although there have been few studies that have examined the incidence of STIs in women who have sex with women (WSW), we do know that several STIs can be trans­mitted during vulva-to-vulva sex, including hepatitis C (Fethers et al., 2000); herpes (Johnson et al., 1992); trichomoniasis (Kellock & O’Mahony, 1996); human papillo­mavirus (O’Hanlan & Crum, 1996); and HIV (Troncoso et al., 1995). In addition, bac­terial vaginosis (BV) was found to be more common in WSW (Fethers et al., 2000). Overall, however, lesbian couples are more likely to have fewer sexual partners and en­gage in less penetrative sex, which reduces their risk of STI infection. Bisexual women, on the other hand, are more likely to have multiple partners and an increased risk of STI infection (Koh et al., 2005; Morrow & Allsworth, 2000). Compared to heterosexuals and bisexuals, lesbians are less likely to obtain regular STI testing or yearly pelvic exams, probably because they believe they are both less at risk and do not need contraception (Bauer & Welles, 2001).

For those who do need contraception, birth control methods offer varying levels of pro­tection from sexually transmitted infections. In 1993, the FDA approved labeling contra­ceptives for STI protection. Barrier methods, such as condoms, diaphragms, or contracep­tive sponges, can decrease the risk of acquiring an STI. Although contraceptive-using African American women in the United States have been found to use effective birth control methods, they do not typically use methods that protect against the spread of disease (Wyatt et al., 2000).

As we discussed in Chapter 13, although we used to believe that nonoxynol-9 (N-9) spermicide was the most effective at reducing the risk of acquiring an STI, to­day there is good evidence that N-9 does not protect against STIs and may, in fact, increase the rate of genital ulceration, causing a higher risk of STI infection (Boonstra, 2005; Richardson, 2002; Wilkinson et al., 2002b). (See Chapter 13 for more information on nonoxynol-9.) N-9 may also increase the risk for HIV trans­mission during both vaginal and anal sex (Jain et al., 2005). The intrauterine device

Подпись:Подпись:Подпись:CK SEXUALLY TRANSMITTED INFECTIONS^Подпись:(IUD) offers no protection against STIs and increases the risk of pelvic inflammatory disease (PID) in those at risk for STIs (Steen & Shapiro, 2004).

Condoms are the most effective contraceptive method for reducing the risk of acquiring an STI. For example, one study found that there was a significant decrease in the incidence of bacterial STIs in Thailand after a 100% condom policy was in­stituted for its prostitutes (Steen, 2001). Condoms do have lim­itations, however; they cannot always protect the vulva or parts of the penis or scrotum that are not covered.

The role of oral contraceptives in preventing STIs is com­plicated. The increased hormones change the cervical mucus and the lining of the uterus, which can help prevent any infec­tious substance from moving up into the genital tract. In addi­tion, the reduced buildup of the endometrium decreases the possibility of an infectious substance growing (because there is less nutritive material for bacteria to survive). However, oral contraceptives may also cause the cervix to be more susceptible to infections because of changes in the vaginal environment.

Sexually transmitted infections can be caused by several different agents, some of which are bacterial, others viral. The causal agents are important in treating STIs. The most effective way of avoiding STI transmission is to abstain from oral, vaginal, and anal sex or to be in a long-term, mutually monogamous relationship with someone who is free from STIs.

Question: Can STIs be transmitted through oral sex?

If there are open sores on the penis or vulva, it is possible that an STI may be transmitted to the mouth through oral sex. If there are active cold sores on the mouth or lips and a person performs oral sex, it is possible to transmit the virus to the genitals. Oral sex with a partner infected with gonorrhea or chlamydia may cause an infection in the throat. As for the AIDS virus, some researchers have found that oral sex is an unlikely method of transmission for the virus (Kohn et al., 2002), whereas others have found that HIV transmission through oral sex is possible (Centers for Disease Control and Prevention, 2003a).