School Science Lessons
Biology experiments
Contraception, Sex safety, HIV and AIDS, Genital diseases
Updated: 2008-07-02
Please send comments to: J.Elfick@uq.edu.au
WARNING!
Before planning to teach any of the topics or content below, get permission from the head of your school science department OR the principal of your school.
Table of contents
10.7.0 Contraception
10.8.0 Sex safety, reproductive health, sexual health
10.9.0 Sexually transmitted infections, STIs, HIV and AIDS
10.10.0 Genital diseases
10.7.0 Contraception
"Natural" methods of contraception
10.7.1 Abstinence
10.7.2 Withdrawal
10.7.3 Rhythm method
Mechanical and barrier methods of contraception
10.7.4 Intra-uterine devices (IUDs)
10.7.5 Diaphragms and cervical caps
10.7.6 Condoms, male condom
10.7.7 Female condom
Chemical methods of contraception
10.7.8 Oral contraceptives
10.7.9 Depo-Provera
Surgical methods of contraception
10.7.10 Vasectomy.
10.7.11 Tubal ligation.
10.7.12 Abortion
10.8.0 Sex safety, reproductive health, sexual health
10.8.1 Health-seeking behaviours to avoid unwanted outcomes
10.8.2 STIs and "venereal disease"
10.8.3 Treatment of STIs
10.9.0 Sexually transmitted infections, STIs, HIV and AIDS
See also 9.213: Viruses
10.9.1 Chlamydial pelvic inflammatory disease (PID), Chlamydia trachomatis
10.9.2 Genital growths, Balanitis, Candida, Molluscum contagiosum
10.9.3 Genital herpes, Herpes Simplex Virus (HSV) type 2
10.9.4 Genital warts, Human Papilloma Virus (HPV), Condyloma acuminata
10.9.5 Gonorrhoea, urethral / vaginal discharge, "the clap", Neisseria gonorrhoeae
10.9.6 Hepatitis B, Hepatitis B Virus (HBV)
10.9.7 Hepatitis C, Hepatitis C Virus (HCV)
10.9.8 Human Immunodeficiency Virus, HIV, and AIDS (acquired immune deficiency syndrome)
10.9.8.1 Causes of infection by the Human Immunodeficiency Virus (HIV)
10.9.8.2 Diagnosis of HIV/AIDS
10.9.8.3 Symptoms of AIDS
10.9.8.4 Treatment of HIV/AIDS
10.9.8.5 The effects of HIV/AIDS
10.9.8.6 The ABC of protection against HIV and the development of AIDS
10.9.9 Non-specific urethritis (NSU), non-gonococcal urethritis (NGU), non-specific genital infection (NSGI)
10.9.10 Pediculosis, lice, Phthirus pubis
10.9.11 Scabies, Sarcoptes scabiei
10.9.12 Syphilis, Treponema pallidum
10.9.13 Trichomoniasis, Trichomonas vaginalis
10.10.0 Genital diseases
10.10.1 Bacterial Vaginosis, Gardnerella vaginalis.
10.10.2 Candidiasis (Thrush) Candida albicans
10.10.3 Cystitis, "honeymoon disease", Escherichia coli (E. coli)
10.7.0 Contraception
Contraception is the prevention of pregnancy as the result of sexual intercourse. In developed countries, the method of contraception used is approximately combined oral contraceptives pills (Combined O.C.) 36%, condoms 20%, diaphragms 2%, interuterine devices (IUDs) 6%, natural family planning 16%, female sterilization 10%.
10.7.1 Abstinence
For young adults, this is the only way to guarantee safety against pregnancy and transmission of sexual disease. It is best for young people to delay sexual intercourse until married to a partner who is free of sexual disease and whom they know will help to take care of any children born as a result of sexual intercourse.
10.7.2 Withdrawal
Withdrawal, "pulling out on time", coitus interruptus, is when the man withdraws his penis from the vagina before he ejaculates, "comes". Withdrawal is not a safe way to prevent pregnancy because some sperm may be in fluid at the opening of the erect penis. Even if the man ejaculates outside the vagina, some sperm may get inside and cause a pregnancy. Some men get too excited to withdraw the penis in time before ejaculating. Also, with this method of contraception there is a risk of passing on STIs. The following methods do not work as contraceptives: sexual intercourse while standing up, putting things into the vagina after having sex, e.g. Coca Cola or aspirins, taking a hot bath, Girls can get pregnant the first time they have sex. They do not have to have an orgasm, "climax", "come", to get pregnant. The use of douches or spermicides inserted into the vagina after sexual intercourse are unreliable methods of preventing pregnancy and may be damaging.
10.7.3 Rhythm method
The rhythm method is also called the body temperature method, natural birth control, fertility awareness, natural family planning, Billings method, "safe period". These methods help a woman to know the times in the month when she is most likely to get pregnant. This is done either by taking her temperature every day or by checking the secretions on her vulva (the opening of the vagina). These secretions vary from a sticky mucous to stretchy wet secretions. During her fertile time, a woman who relies on natural methods only must not have any penis / vagina contact. Cycle lengths do not have to be regular for this method to be effective. Some women find natural methods work for them but others consider these natural methods are not very reliable contraception. It is quite unreliable for teenage girls who have irregular menstrual cycles. The method has no side-effects and provides no protection against sexually transmitted infections.
10.7.4 Intra-uterine device (IUDs)
See diagram 10.7.4: Barrier methods
An IUD or IUCD, is an intrauterine contraceptive device made of plastic or metal, usually copper, inserted into the uterus. It prevents the fertilized ovum implanting in the wall of the uterus, but how it does this is not well understood. To get it fitted a woman must visit a doctor or family planning clinic. It can remain in position for a long time but it can fall out by itself. A doctor or a health worker should check that it is properly inserted and remains in place. An IUD can be left in place for up to five years and it nearly always stops the woman getting pregnant. The IUD is not suitable for women who experience pain or discomfort when it is inserted and in place. IUD users may experience heavier periods with more cramps. Pelvic infection caused by IUD use can lead to future infertility. A doctor or a family planning clinic worker should show women how to check each month to see if the IUD is still in place. When an IUD is removed, the woman can usually to get pregnant immediately. Nowadays, the plastic and exposed copper surface Multiload IUD (Cu-375) is preferred to Copper 7 (Cu-7), Nova T and T Cu-200 IUDS. The IUD is a very effective contraceptive but it will not protect against sexually transmissible diseases, e.g. Chlamydia and gonorrhoea. Some doctors do not prescribe it because of the danger of inflammatory reactions and even Pelvic Inflammatory disease (PID).
10.7.5 Diaphragms and cervical caps
A diaphragm is a soft rubber cap with a metal spring, shaped like a hemisphere, that fits against the wall of the vagina near the cervix, neck of the uterus. It should be applied with a chemical spermicide. A new diaphragm of the right size must be fitted by a doctor or a family planning nurse. Then the woman must be taught how to use it so that she can insert it herself each time she needs to use it. Diaphragms must be used every time a woman has sexual intercourse. It can be inserted at any convenient time beforehand. It should be taken out about eight hours after intercourse, washed with warm soapy water, dried with a towel and kept in a clean safe place. Be sure to read and follow all the instructions on the packet. Diaphragms must be placed inside the vagina to cover the cervix each time a woman has sexual intercourse so the man's sperm cannot get through. Women should check the size again after a pregnancy, a vaginal operation, or if they feel the fit has changed and the diaphragm feels loose in the vagina or is uncomfortable. A cervical cap is a dome-shaped barrier made of soft rubber or silicone that can be fitted closely over the cervix. They should remain in place after sexual intercourse for about eight hours then washed, as with a diaphragm. It should be replaced after two years. Both diaphragms and cervical cups are vaginal barrier contraceptives that prevent the sperm from contacting the ovum. To ensure that no sperm can pass them they should be inserted with some water-based lubricant and some spermicide that kills sperm. Spermicides can be purchased as creams, jellies, and foams. They must be placed inside the vagina before a couple has sexual intercourse. Spermicide creams, foams and jellies are not effective contraceptives on their own. They should be used with a diaphragm or condom. However, women should not rely on this protection by itself, a condom should be used. Some women and men do like spermicide cream because they think it is irritating or messy or smelly.
10.7.6 Condom, male latex condom
See diagram 10.47.1: Condom 1 and 2 | See diagram 10.47.2: Condom 3 and 4 | See diagram 10.47.3: Condom 5 and 6 | See diagram 10.47.4: Condom 7 and 8
A condom is a sheath, usually made of latex rubber, that fits over the erect penis during sexual intercourse. It must be rolled on to the man's penis before it is put into the woman's vagina. It collects the man's sperm in a bulb-shaped reservoir at the end and prevents the sperm from entering the vagina. Condoms should have a complete close fit on the erect penis. The most common reason for condom failure is improper use so read the instructions on the packet and follow them. Check the expiry date on the packet. A new condom must be used each time a couple has sexual intercourse. Never use two condoms at the same time. Use plenty of water-based lubricant to ensure that the condom will not break. Never use petroleum jelly, Vaseline, baby oil, or hand lotion as a lubricant because these substances weaken the latex rubber so much that the condom may break during intercourse. Use a spermicide cream or jelly in the vagina to kill any sperm that may escape. Never use plastic film instead of a condom. Store condoms in a cool, dry place. Do not store them in the glove compartment of a car because heat damages condoms. Men should be prepared by carrying new condoms with them if they think they will need them. However, condoms may be damaged if carried in a wallet or pocket for a long period. Make sure the condom is not too old by checking the expiry date on the package. Male latex condoms may be up to 95% effective for preventing pregnancy and the transmission of sexually transmitted infections. However, condoms can break during intercourse and they only protect the immediate area they cover and so may not protect against infection with genital herpes or genital warts.
How to use a condom
Men have to get used to using condoms. If they have never used a condom for sexual intercourse, they should practise putting them on and taking them off in private.
1. Open the packet very carefully with the fingers, not with scissors. 2. Make sure the condom is the right way on, so it rolls down easily. Squeeze the air out of the bulb-shaped reservoir at the tip of the condom so that it is empty. 3. Keep hold of the tip (reservoir) of the condom, then unroll the condom down to the base of the erect penis before starting sexual intercourse. Put some water-based lubricant, e.g. "K Y Jelly", outside the condom to make sure it will not break 4. During sexual intercourse, check that the condom is still on. 5. Immediately after ejaculating, hold the condom firmly and withdraw the penis while it is still erect. When removing the penis from the vagina, the condom must not come off the penis or tear and leave sperm in the vagina. 6. After removing the condom, wipe the rest of the semen from the penis with a tissue. 7. Carefully wrap the used tissue and condom in paper and dispose of it in a plastic bag. Put it in the rubbish tin, not down the toilet.
10.7.7 Female condom
Female condoms were made of polyurethane but are now made of nitrile, synthetic rubber. They are designed to be inserted into the vagina and stay in place during sexual intercourse. They are not easy to insert and may make distracting noises during sexual intercourse. However, a woman can insert them at a convenient time long before sexual intercourse. By contrast the male has to wait until the penis is erect before using the male condom. As they are not made of natural latex rubber, oil-based lubricants can be used. They are still much more expensive than the male condom but they are a fairly effective barrier to pregnancy and STIs.
10.7.8 Oral contraceptives
See diagram 10.7.8: Oral contraceptives
Oral contraceptives are also called the contraceptive pill, "the pill", birth control pill, hormonal birth control, emergency contraception, "morning after" pill. They contain synthetic female sex hormones. Oestrogen hormone blocks ovulation so no egg is released from the ovary and thickens the cervical mucus so it is difficult for the sperm to contact the egg. Oestrogen may produce side-effects, e.g. weight gain, blood clots. Progesterone hormone blocks the normal menstrual cycle and prevents implantation of a fertilized ovum in the uterus wall by thinning the lining of the uterus. Synthetic progesterone is called progestin. The pills must be taken every day for three weeks and then not taken for one week when menstruation occurs. The combined oral contraceptive pill (combined O.C.) contains both oestrogen and progesterone. It stops ovulation occurring so it stops the woman's ovaries from releasing an egg each month. Some women taking the pill may experience side-effects, e.g. nausea or mood swings. They should report any side-effects to a doctor. The progesterone-only pill, "mini pill" contains only progesterone. It works differently from the combined pill by changing the mucus at the cervix the opening into the uterus so sperm cannot get through and meet the egg. It has less side-effects but it is not as safe to prevent pregnancy. Both pills are very effective contraceptives, but they will not protect against STIs or AIDS. Some women cannot take oral contraceptives because they are heavy smokers or have high blood pressure or are taking other medications. For emergency contraception, EC and ECPS, the "morning after" pill (MAP) can each be effective after failed contraception to prevent ovulation and implantation. However, it is for emergencies, e.g. unprotected sexual intercourse, broken condoms, date rape, forced sexual intercourse, and should not be used as a regular form of female contraception. It may contain high doses of progestin and oestrogen, the Yuzpe Regimen, or the "abortion drug" mifepristone. The side-effects may be nausea and irregular bleeding.
10.7.9 Depo-Provera
Depo-Provera is a type of injectable synthetic hormone medroxyprogesterone acetate that is similar to progesterone and is part of the natural menstrual cycle. After injection deep into the muscles of the back or buttocks its contraceptive effect lasts for three months. After ceasing its use it might take nine months to get pregnant. It prevents pregnancy by preventing ovulation and by thinning the lining of the uterus and preventing the growth of a fertilized egg. In early stages of using Depo-Provera a change in the menstrual cycle occurs After two or three injections most women will have no periods at all. Depo-Provera is a very effective form of contraception. There is none of the risk of forgetting to take it. It can reduce the risk of cancer of the ovary and womb, thrush and pelvic inflammatory disease (PID). However, it gives no protection from STIs and it introduces chemicals into the body. Up to 2% of women report long term side-effects, e.g. erratic and excessive bleeding.
10.7.10 Vasectomy
See diagram 10.7.10: Vasectomy
Vasectomy is a method of male sterilization. It is not castration. The vas deferens connecting the testis to the urethra is cut and tied. It is safe method that does not affect sexual activity. When a vasectomized man ejaculates during sexual intercourse, the semen is still ejaculated but it contains no sperm. Vasectomy must be done by a doctor under local anaesthetic in the doctor's surgery. Usually, the operation is not reversible. People who have been sterilized should still use condoms if there is any risk of STIs. Doctors advise two sperm tests during the three months after the operation to check that no sperm is still contained in the ejaculate.
10.7.11 Tubal ligation
See diagram 10.7.11: Tubal ligation
Tubal ligation, "tubes tied", is a method of female sterilization where the fallopian tubes are clipped or cut and the cut ends tied. A more modern method called tubal occlusion closes the lower half of the Fallopian tubes. This method is irreversible. If the operation is done correctly, the woman can never become pregnant again. The Fallopian tubes that carry eggs to the uterus are blocked by surgical procedure done by a doctor, usually in a hospital.
10.7.12 Abortion
Conception occurs in two stages, fertilization then implantation. Abortion terminates pregnancy by removing the implanted foetus before it can survive outside the uterus. In most countries only qualified medical staff can legally do abortions. Many people and religious groups strongly oppose abortion on ethical and moral grounds. They may believe that foetus has the rights of a living person so abortion is a form of murder. Other people, e.g. "Pro choice" groups, believe that it is a woman's right to choose when to become pregnant. The medical procedure is quick and safe if done by a competent doctor. However, some women feel guilty and depressed after the abortion. Most women do not suffer from any long-term physical consequences. Abortion in the first 14 days after conception, interception, is done with a syringe to removes the content of the uterus. It is a quick and reasonably safe method. However, some doctors prefer to delay the operation until they can be more sure of achieving a successful abortion. Abortion up to 14 weeks after conception is done with a suction machine that draws out the contents of the uterus. Abortion 14 to 18 weeks after conception is done by stretching the cervix and the removing the contents of the uterus. This method is called dilation and evacuation, "D and E" (dilation and curettage, "D and C"), and is very safe. The drug RU486 is very effective for emergency abortions.
Abortion 18 to 20 weeks after conception, is done by injections to cause contractions that push out the contents of the uterus. This form of "later termination" is rare because it is dangerous if uncontrollable bleeding from the uterus occurs. Another procedure to terminate a late pregnancy involves cutting through the abdomen and the wall of the uterus to remove the contents. However, it is also a dangerous procedure and it may cause a scar that interferes with later pregnancies.
10.8.0 Sex safety, reproductive health, sexual health.
10.8.1 Health-seeking behaviours to avoid unwanted outcomes
(a) Safer sexual intercourse means avoiding sexual contact where body fluids can pass into the body of another person. Disease can be carried in all the body fluids, e.g. blood menstrual blood, semen, vaginal fluids, breast milk, amniotic fluid, pre-ejaculate. The safest way to prevent body fluids passing between sexual partners is always to use a condom for all forms of sexual activity. Condoms used with a water-based lubricant act as a barrier to prevent sexual fluids passing from one person to another. However, anal sexual intercourse is always dangerous.
(b) Never share injecting equipment because needles, syringes, spoons, filters, water and glasses may have traces of blood in them that contain STIs. Do not share personal toiletry items, e.g. toothbrushes, dental floss and razors because they also may have traces of blood on them that contain STIs. Always use disposable or properly sterilized needles for skin and body piercing or tattooing.
(c) Avoid having many sexual partners. Be true to one person. The safest sexual choice is to have sexual intercourse with only one uninfected person who also has no other sexual partner and does not share injecting equipment.
(d) Alcohol and other drugs impair judgement and can affect decisions about sexual behaviour, so avoid sexual intercourse while under the influence of alcohol or other drugs.
(e) Both sexual partners should have healthy and clean bodies. Many people use a shower with hot water and soap before sexual intercourse and wash thoroughly between the legs.
(f) There are many alternatives to penetrative sex that allow partners to enjoy life together and not put the other partner at risk of STIs. People can enjoy each other sexually by dancing, playing games, hugging, massage and many kinds of fun activities without passing body fluids between partners.
10.8.2 STIs and "venereal disease"
Sexually transmitted diseases (STIs) are infectious diseases that spread from person to person during intimate sexual contact, direct body contact or contact with infected body fluids. A person can become infected through having vaginal, oral or anal sexual intercourse with an infected sexual partner. An individual can become infected with more than one STI at the same time. It is unlikely that STIs can be transmitted from objects unless the object has fresh and wet infected body fluid on it. Toilet seats are a very unlikely source of infection. Formerly, STIs were called "venereal disease or VD". STIs usually infect the genitals, rectum, throat, and conjunctiva of the eye. Several STIs spread from an initial site and produce sores in many parts of the body. People with one sexually transmitted infection are usually at high risk for other diseases common in the same environment. Many clients attending a clinic solely "for an AIDS test" are usually found to have one or more STIs although their AIDS test is usually negative. However, the statistics on sex differences may not reflect the actual situation because infected women often do not show any symptoms and are more difficult to diagnose than men. The fact that many infected women show no symptoms of STIs is especially unfortunate since the complications can be quite serious in pregnant women. They may pass infections to the foetus during pregnancy or to the baby during childbirth. Females who have an infection, such as genital Chlamydia, gonorrhoea, or NSGI, are at risk of inflammation of the uterus and Fallopian tubes, if specific infections are not diagnosed or treated early. Symptoms may be lower abdominal pain, a vaginal discharge, pain during sex, or abnormal vaginal bleeding or spotting. One or more attacks of PID may damage the Fallopian tubes. This damage can prevent fertilization from occurring, or if fertilization does occur, the growing fertilized egg may be unable to pass along to the uterus causing the egg to implant in the Fallopian tube. This is called an ectopic pregnancy that is very serious and requires emergency medical care.
10.8.3 Treatment of STIs (STDs)
The management of STIs involves treatment, counselling, and follow-up. The doctor or health worker should always explain the disease and its treatment to the patient. A person may remain infected when symptoms disappear, or may become reinfected immediately after treatment, so a follow-up visit is important. The infected person should not have sexual intercourse until the follow-up visit has confirmed the cure of the disease. Sexual partners of people with STI infection should also seek medical examination to avoid "ping-pong infection", i.e. passing disease back and forth between two sexual partners. People who learn they are infected with STIs can fell guilty, depressed, anxious or angry, so they should discuss their feelings with a doctor, a counsellor or others who have the same problem. The notifiable diseases (reportable diseases) that must be reported to governmental authorities by doctors may include Gonorrhoea, Syphilis, Hepatitis B, Hepatitis C and Chlamydia trachomatis.
10.9.0 Sexually transmitted infections, STIs
10.9.1 Chlamydial pelvic inflammatory disease (PID) is caused by the bacterium Chlamydia trachomatis.
In some countries many people are infected with Chlamydia but they are unaware of the infection. They do not see or feel anything wrong so they can unknowingly pass on Chlamydia to their sexual partners if they are not using condoms. Chlamydia can also be passed on by oral or anal sex. Females may have symptoms of a burning sensation when passing urine, an unusual vaginal discharge, itch or irritation, lower abdominal pain, pain during sexual intercourse, abnormal bleeding or spotting between periods. Males may have symptoms of a clear whitish or yellow discharge from the penis, burning or pain on passing urine, irritation or itching around the urethra, pain in the rectum or testicles, pain with ejaculation. Chlamydia may cause pelvic inflammatory disease, PID, in women if left untreated. A pregnant woman with a Chlamydia infection has an increased risk of having a stillborn or premature baby. Chlamydia infection can make them infertile. Laboratory tests can identify Chlamydia and the infection is easily treated with antibiotics. The prescribed treatment must be completed. Otherwise, the infection will not be cured. The sexual partners should also get tested and treated. Patients should not have sexual intercourse while they and the sexual partner are taking the treatment, as they could reinfect each other. Chlamydia may cause infertility due to salpingitis, infection and inflammation in the Fallopian tubes.
10.9.2 Genital growths, Balanitis, Molluscum contagiosum
Balanitis is inflammation, redness and soreness, of the head of the penis. It is not an STI but sexual intercourse may irritate the head of the penis and lead to balanitis. Men with foreskins are more likely to get this condition. Treat the symptoms by keeping the head of the penis and the foreskin clean and dry. Sexual partners do not require treatment.
Molluscum contagiosum is a virus skin infection and appears on the genitals and adjacent areas as round, pearly lumps with a central white core. It is a harmless condition and is treated by freezing with carbon dioxide. It spreads by sexual and non-sexual contact.
10.9.3 Genital herpes, genital ulcers
Genital herpes is caused by herpes viruses. The herpes simplex virus can cause "cold sores" if the mouth is infected or genital ulcers if the sexual organs are infected. The symptoms include clusters of small painful blisters that become ulcers then in two weeks. People infected with the herpes virus may never develop any symptoms and so remain unaware of the infection. The first infection of genital herpes has usually the worst symptoms. The symptoms may recur when people are tired or tense or never recur. Once a person has genital herpes, the virus stays in specific nerve cells and may be passed on to other people by sexual contact even if the infected person does not have an outbreak of herpes blisters or ulcers. There is no cure for herpes but it can be managed to ease the symptoms by bathing the sores in saltwater. An ice block wrapped in a towel may stop blisters forming.
10.9.4 Genital warts, Condyloma
Genital warts are caused by the Human Papilloma Virus, HPV. Genital warts are very common in sexually active people with many sexual partners but the warts may not be visible, e.g. warts on the cervix. People who see or feel unusual lumps on the genitals should see a doctor. Treat with paints, freezing or burning. Repeat treatments are usually necessary. Different strains of the wart virus affect different parts of the body. Genital warts are different from warts seen on the hands and knees. Genital warts are probably spread by sexual contact but may not appear until months after infection. Untreated genital warts are infectious and can be passed on to the sexual partners.
10.9.5 Gonorrhoea, urethral / vaginal discharge, "the clap"
Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae. People get infected by having sexual intercourse without a condom, oral sex, or touching infected genitals or anus. After infection they may have no symptoms until 2-10 days after infection. Symptoms include a cream yellow discharge from the penis or vagina, pain on intercourse, sore throat if infected in the throat, anus itch if infected in the anus. Even if the symptoms clear up, the infection may still be there and cause problems later. Treat the disease with antibiotics. Untreated gonorrhoea can cause (a) ulcers that increase the risk of infection by HIV (b) pelvic inflammatory disease (PID) (c) infertility of women (d) infection in the eyes of the baby. All the sexual partners of a person infected with gonorrhoea should be checked by a doctor. Gonorrhoea may cause infertility due to salpingitis, inflammation of the Fallopian tubes.
10.9.6 Hepatitis B
This disease is caused by is a virus that affects the liver. The virus is spread by blood to blood contact, e.g. sharing needles, or by sexual intercourse, vaginal, oral or anal. People who are infected may have no symptoms at all or they may become ill with fever, nausea, dark urine or jaundice, yellow skin and eyes. After infection, most adults recover, develop antibodies to the virus and cannot spread the virus to others. A few people retain the virus, become carriers, may infect other people, and have an increased risk of developing liver disease. A vaccine for Hepatitis B is available. It is not effective for Hepatitis B carriers.
10.9.7 Hepatitis C
This disease is caused by another virus that affects the liver. At this stage, there is no test to show whether a person has completely cleared the virus from the body or if the person remains a carrier and can infect others. It is suspected that more people remain carriers than with Hepatitis B disease. Long-term carriers may develop liver problems years after infection. Hepatitis C is spread by blood to blood contact. It does not appear to spread easily by sexual contact. Currently, it would appear that many patients with Hepatitis C have been infected by sharing needles or other drug using equipment or by infected blood transfusions. In some countries blood is routinely screened for Hepatitis C before transfusion. In 2006 there is no vaccine available for Hepatitis C disease. People with Hepatitis C disease should be checked by a doctor every few years.
10.9.8 Human Immunodeficiency Virus, HIV and Acquired Immunodeficiency Syndrome, AIDS
The acquired immunodeficiency syndrome, AIDS, is a range of medical conditions, a syndrome, that occurs when a person's immune system is seriously weakened by infection from the human immunodeficiency virus, HIV. So there is no such thing as an "AIDS virus". HIV is called a retrovirus because it can change its own RNA (ribonucleic acid) genetic material into DNA (deoxyribonucleic acid) to cause the host cell's DNA to produce more HIV. Blood contains three types of cells, erythrocytes, thrombocytes, and leucocytes. Erythrocytes, red blood cells, contain haemoglobin and are responsible for transporting oxygen. Thrombocytes, platelets, are essential for blood clotting to stop bleeding. Leucocytes, white blood cells, are responsible for the defence of the body against disease. One type of white cell, the T-lymphocyte, T-helper cell, is essential for immunity because it recognizes foreign antigens from its memory of previous infections and alerts other white cells to destroy the foreign antigen. HIV attacks the helper-T cells, reproduces inside them and kills them, causing a gradual deterioration of immune functions following the initial HIV infection. A person with not enough T-helper cells to respond to infection will become ill and develop AIDS. The infected person loses resistance to diseases and may die of opportunistic infections or AIDS-related illnesses, e.g. tuberculosis or bronchitis. The opportunistic infections that occur in a person infected with HIV are caused first by destruction of immune defences by the virus and secondly by infections in our everyday environment. These infections can often be treated, but there is no successful treatment for the immune deficiency caused by the virus.
10.9.8.1 Causes of infection by the Human Immunodeficiency Virus (HIV)
Infection can occur from any activity that allows body fluids infected with HIV to enter the bloodstream through a break in the skin, e.g. a cut or open sore. Body fluids include blood, menstrual blood, bleeding gums, semen, vaginal secretions, breastmilk, amniotic fluid, and pre-ejaculate. Infection can occur in the following circumstances:
1. Unprotected sexual contact with an infected person, i.e. sexual intercourse without using a condom. The virus can enter the body through the lining mucosa of the vagina, penis and rectum, especially if these linings are already damaged by STIs that cause ulcers or inflammation.
2. Using needles and / or syringes drug injections contaminated with minute quantities of blood containing the virus.
3. Transfusion of infected blood or blood clotting factors. This should not occur when blood is properly screened in hospitals for HIV antibodies.
4. Babies being born to HIV-infected mothers becoming infected before or during birth or through breast feeding.
5. Cutting the skin without sterilizing between persons, e.g. tattooing, piercing, circumcision, female genital cutting.
There is no scientific evidence to support transmission of AIDS by mosquitoes, shaking hands, drinking from the same glass, sharing clothes, sitting on toilet seats, swimming, hugging, or looking after AIDS-positive adults or children living with AIDS.
10.9.8.2 Diagnosis of HIV/AIDS
You cannot tell just by looking if someone is infected with HIV because some HIV positive people can stay healthy and look healthy for many years. A person who has the HIV infection has antibodies in the blood to the virus but may not have developed any of the illnesses of AIDS. The only sure way of knowing is to get tested with the ELISA blood tests then confirm the result with the Western blot blood tests. Also, saliva tests are used. Voluntary testing for HIV before marriage is recommended. Antibodies are proteins that attack and remove any foreign organisms and toxins, antigens, in the blood. HIV is an antigen. The antibodies produced by HIV infection cannot get rid of it but the existence of "marker" antibodies show that HIV infection has occurred. Receiving pre-test and post-test counselling is important. People may be infected without knowing it and transmit HIV to others during this time. However, the tests that identify the antibodies to HIV usually give a negative result for the first one to three months after initial infection, called the "window period". So a person who has been at risk of recent infection who receives a negative test result should get a repeat of the test after three to four months. Counselling should be given before and after the tests to ensure that the patient understands the implications of either a positive or negative result. The doctor should give the test results face-to-face and ensure that all information about the test remains confidential.
10.9.8.3 Symptoms of AIDS
As the virus continues to attack the immune system, a person will develop symptoms of the disease, e.g. persistent fatigue, swollen lymph glands, rapid weight loss, night sweats, memory loss, persistent diarrhoea. When the immune system is severely damaged, certain cancers, infections and brain disorders can occur. For example, the appearance of purple blotches on the skin may indicate Kaposi's Sarcoma (KS). This stage of the illness is called AIDS.
10.9.8.4 Treatment of HIV/AIDS
In 2006, HIV infection can be treated but not cured. There are three types of treatment that can be very effective if early diagnosis occurs:
1. Antiretroviral medication is used to slow the reproduction of the virus but not cure AIDS. There is no such thing as an "AIDS vaccine". HIV targets the immune system and it is a retrovirus that can insert itself into the genetic material, replicate quickly and often mutate. The first anti-HIV drug, AZT, was licensed in 1987. It inhibits the HIV enzyme reverse transcripts that the virus uses to convert its single strand of RNA into double strand DNA before splicing itself into the genome of the host cell. However, the high rate of mutation by the HIV virus allowed resistance to the drug to develop. So medical researchers developed many other "anti-retroviral" drugs to be taken in different combinations, e.g. Lamivudine, Viread and Ziagen. Other types of anti-HIV drugs are (a) fusion inhibitors (entry inhibitors), e.g. Enfuvirtide, that interferes with the HIV ability to enter cells (b) integrase inhibitors, e.g. Raltegravir, that block the enzyme integrase that the HIV virus uses to integrate its genetic material into the host cell's DNA (c) maturation inhibitors, e.g. Bevirimat, that block replication of the HIV virus. HIV positive patients living in counties where these drugs are available and who have a healthy lifestyle and can afford the treatment have lived an almost normal lifestyle for over 15 years since the initial infection.
2. The opportunistic infections and AIDS-related illnesses can be treated with medications.
3. AIDS is a life threatening illness but people with HIV can improve their lifestyle to help them live healthy lives for many years. AIDS is more likely to be appear when the person suffers from other infections, drug and alcohol abuse, poor nutrition, and stress. All the medications must be taken together and consistently.
10.9.8.5 The effects of HIV/AIDS
The effects include loss of fathers or mothers, economic loss, extra burden on medical facilities, accepting HIV positive people in the community. To many patients with HIV/AIDS, loneliness is more fearsome than the illness itself, and they say that while they could face death straight on, few think they can bear being abandoned by their family and society. However, people are showing concern and health workers should be ready to give them medical and psychological care.
10.9.8.6 The ABC of protection against HIV and the development of AIDS
A is for abstinence from engaging in sexual intercourse or delaying sexual activity until marriage.
B is for being faithful to your sexual partner. Both partners must be consistently faithful to each other
C is for correct and consistent condom use for all sexually active people to control size of families and to protect against sexually transmitted diseases.
10.9.9 Non-specific urethritis (NSU), non-gonococcal urethritis (NGU), non-specific genital infection (NSGI)
Non-specific urethritis (NSU) is a common infection among young sexually active people who have sexual intercourse without using a condom. Many people do not have any symptoms. In males it is called non-gonococcal urethritis (NGU) or non-specific urethritis (NSU) or non-specific genital infection (NSGI). Urethritis is an inflammation of the urethra. The symptoms are a watery, white discharge from the urethra in the penis or pain on passing urine. In females, NSGI is often cervicitis, inflammation of the cervix. The symptoms are lower abdominal pain, vaginal discharge, pain on sexual intercourse or a burning sensation on passing urine. People with these symptoms should be tested for STI infection. The most common cause is Chlamydia trachomatis, although often the specific organism causing the symptoms cannot be identified. Non-gonococcal urethritis is caused by a primitive bacterium, a mycoplasma. Antibiotic treatment cures these infections. Sexual partners of patients should be tested and treated whether or not they appear to have symptoms. Sexual intercourse should be avoided until the treatment is complete. If NSGI infections are not treated without delay, there is a danger in females of pelvic inflammatory disease (PID), damaged Fallopian tubes and infertility. In males there is danger of prostatitis (inflammation of the prostate gland), epididymitis (inflammation of the epididymis) and infertility.
10.5.10 Pediculosis, lice
Pediculosis or louse infestation. is caused by the arthropod pubic louse, "crabs", crab louse, Phthirus pubis. The louse attaches to coarse body hair and causes irritation. Lice usually spread by close body contact, sharing combs and rarely by contact with unwashed bed linen or towels. Treatment is by DDT powder or lotions or gamma benzene hexachloride to kill the lice and eggs. Pubic lice move from person to person by close contact, often during sex. They can be infected by pubic lice from sharing soiled clothes, bed sheets, or towels. Other kinds of lice, the head louse Pediculus humanus capitus and the body louse Pediculus humanus corporis can be quite common in schools. If infestation occurs, all the children in the school should be treated. The eggs of lice, "nits", become attached to hairs but may be removed with a special fine comb, "nit comb". Trench fever, relapsing fever, that affects soldiers confined in warfare trenches, is transmitted by the faeces of lice.
10.5.11 Scabies
Scabies is caused by the itch mite Sarcoptes scabiei. It burrows into the skin and causes intense itching that is worse at night. Transmission is by close body contact during sexual intercourse and sharing clothes and bed linen with an infected person. Treat it with a benzyl benzoate lotion applied externally to kill the mites and eggs. Also, prescription-strength permethrin 5%, ("Elimite", Lyclear") kills the scabies mite. Wash all bedding and clothes used by the infected person.
10.5.12 Syphilis
Syphilis is caused by the bacterium Treponema pallidum. The infection causes a painless sore on the mouth or genitals that disappears after two weeks. The sore feels like a button under the skin. Treat the infection with antibiotics, e.g. penicillin. Months after infection symptoms include a skin rash, patchy loss of hair, moist lumps around the genitals or anus. If not treated, these symptoms may disappear and then recur over the next two years. An untreated person may infect sexual partners during sexual intercourse. Without treatment, the disease may become latent with but reappear years later with fatal consequences due to infection of the brain, heart, large blood vessels, the spinal cord, skin and bones. People infected with syphilis are infectious and should avoid all sexual contact until advised by a doctor. A pregnant woman who has syphilis can pass it on to her unborn baby that may be born dead or badly damaged as a consequence.
10.5.13 Trichomoniasis
Trichomoniasis is caused by the protozoan Trichomonas vaginalis. It causes an unpleasant discharge and irritation of the vagina and painful urination. Treat the infection with antibiotics. It is mainly spread by sexual intercourse. The infection poses no great threat to health but it often occurs along with other STIs, e.g. gonorrhoea. Women with trichomoniasis infection may become more easily infected with AIDS. So an infected person should be checked for other STI infections.
10.10.0 Genital diseases
10.10.1 Bacterial Vaginosis, Gardnerella vaginalis.
This is probably not an STI because women who are not sexually active, or have never been sexually active, can be infected. Women develop bacterial vaginosis soon after intercourse with a new sexual partner. Bacterial vaginosis is an overgrowth of various bacteria that are normally present in the vagina. Gardnerella is one bacterium that may be involved so sometimes the condition is called "Gardnerella". The reason this change in the vaginal bacteria occurs is not known. It is not a serious disease and may require treatment only if symptoms cause distress or inconvenience. Symptoms are irritation and vaginal discharge with an unpleasant odour. To prevent Gardnerella, wipe from the front to the back, from vaginal area to the anus after going to the toilet, not from anus to vaginal area. Keep wiping until the toilet paper is clean or wash the area. The treatment is usually metronidazole tablets, "Flagyl".
10.10.2 Candidiasis (Thrush)
Candidiasis, thrush, is caused by the fungus Candida albicans, a yeast that normally occurs in the mouth, vagina and intestines without causing any symptoms. It is not an STI but sexual intercourse may irritate the vagina and allow Candida to grow. It causes an itchy white vaginal discharge with a yeasty smell, swelling and redness of the vagina, discomfort during intercourse, and stinging when passing urine. Repeated attacks may cause women to feel depressed and lose interest in sex. Thrush is more likely to occur during pregnancy, by taking the contraceptive pill after taking antibiotics that kill normal bacteria, during the week before and after the period of the menstrual cycle, and because of diabetes when the immune system is suppressed. When symptoms are noticed, the woman should see a doctor to have a swab taken for testing whether it is Candida albicans or another infection. Doctors usually prescribe vaginal cream or pessaries. It is important to complete the course of treatment. The same cream should be applied to the penis under the foreskin. Women patients should wear cotton underpants or loose flowing skirts. They should not wear nylon pants, pantyhose or tight jeans. Eating natural yoghurt with the course of antibiotics may help the bacteria in the intestines return to normal when possible. To avoid infection, after toilet wipe from front to back with toilet paper to prevent risk of bowel bacteria contaminating the vaginal area. After washing, women should gently wipe the vulva area dry. Most soaps are alkaline and can neutralize the natural acidity of the body so it is better to wash with water only in that area. Avoid using heavily perfumed soaps or sprays in the genital area, as they may cause irritation. Thrush can be spread by sexual contact. Men may also be affected, but usually less severely and do not necessarily require treatment. The symptoms for men are red spots on the penis, scrotum or groin. Candida albicans may live under the foreskin of an uncircumcised male, but he might be unaware of it if no discomfort. To avoid thrush, uncircumcised men should wash under the foreskin daily.
10.10.3 Cystitis.
This is probably not an STI because it is probably caused by poor toilet hygiene. It used to be called the "honeymooner's disease". Cystitis is an inflammation of the bladder caused by an infection of the urinary tract by bacteria that normally live in the bowel. The symptoms are a scalding feeling when passing urine, a desire to pass urine frequently, and a persistent dull ache above the pelvic bone after passing urine. Untreated cystitis can cause serious kidney infection. Prevention includes better toilet hygiene as with Gardnerella, drinking large quantities of water, washing the vulva with soft soap, wearing cotton underpants and avoiding tight jeans. If cystitis is suspected, see a doctor who will prescribe antibiotics and perhaps conduct a pelvic examination to ensure the vagina is healthy. STIs also cause infection of the urethra. People who learn they have cystitis can feel embarrassed, depressed and anxious. Cranberry juice is said to help deal with this disease.