School Science Lessons
Sexuality education
Updated: 2012-01-28
Please send comments to: J.Elfick@uq.edu.au
Table of contents
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.
10.7.0 Contraception
10.10.0 Genital diseases
10.8.0 Sex safety, reproductive health, sexual health
10.9.0 Sexually transmitted infections, STIs, HIV and AIDS
10.7.0 Contraception
10.7.0 Contraception - "Natural" methods of contraception
10.7.1 Abstinence
10.7.3 "Rhythm method"
10.7.2 Withdrawal
Contraception - Mechanical and barrier methods of contraception
10.7.6 Condom, male latex condom
10.7.5 Diaphragms and cervical caps
10.7.7 Female condom
10.7.4 Intra-uterine devices (IUDs)
Contraception - Chemical methods of contraception
10.7.8 Oral contraceptives
10.7.9 Depo-Provera
Contraception - Surgical methods of contraception
10.7.12 Abortion
10.7.11 Tubal ligation
10.7.10 Vasectomy
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 9.213: Viruses
10.9.1 Chlamydial pelvic inflammatory disease (PID) Chlamydia trachomatis
10.9.2 Chancroid
10.9.3 Genital herpes, Herpes Simplex Virus (HSV) type 2
10.9.4 Genital warts (condyloma acuminata) Human Papilloma Virus (HPV)
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)
10.9.8.1.1 Description of infection by 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)
10.10.0 Genital diseases
10.5.10 Pediculosis, lice, Phthirus pubis
10.5.11 Scabies, Sarcoptes scabiei
10.5.12 Syphilis, Treponema pallidum
10.5.13 Trichomoniasis, Trichomonas vaginalis
10.10.1 Bacterial vaginosis, Gardnerella vaginalis, non-specific vaginitis (not associated with STDs), watery discharge
10.10.2 Candidiasis (Thrush) Candida albicans
10.10.3 Cystitis, "honeymoon disease", Escherichia coli (E. coli)
10.10.4 Genital growths, Balanitis, Molluscum contagiosum
10.10.5 Endometriosis
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%. Some herbal preparations and antibiotics can decrease the effectiveness of contraceptive methods that use hormones.
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 natural method, 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.
However, proponents of the above "method" have commented as follows: The
"Rhythm method" is a particular method of fertility regulation and not a
generic name, and therefore should not be used to describe a group of individual
methods, each having their own distinct guidelines and rates of effectiveness.
A far more accurate title would be “Natural Methods” with individual listings
for Rhythm, Billings Ovulation Method™, SymptoThermal, and similar methods.
The use of the Billings name with the term “Rhythm” is largely outdated.
The failure to differentiate between distinct methods also fails to provide
sufficient information for a proper judgement to be made regarding their
suitability. The Billings Ovulation Method™ has been scientifically validated
and been extremely effective in avoiding pregnancy in many studies around
the world. From the earliest trials, the first being conducted by the World
Health Organization, method-related pregnancy rates were as low as 0-4%.
As teaching methods have been refined and updated, these rates have fallen
close to zero. Proponents of the method who have conducted programs for training
Billings Ovulation Method™ teachers in developing countries claim that when
women hear this information they are very enthusiastic about it and want
to spread it to other women. They say that the method is suitable for developing
countries because: 1. There are no side effects – the IUD very often causes
prolonged inter-menstrual bleeding, 2. It is inexpensive – practically free,
3. Women with irregular menstrual cycles can safely use the method, 4. Trials
have shown that its simplicity makes it suitable for all women, including
those who have had very little education, 5. It is commonly available because
there are thousands of trained teachers of the Billings Ovulation Method™
in countries around the world, including the Philippines, China, India, most
African countries, Timor Leste, many South American countries and USA, UK
and Europe. 6. It empowers women with the knowledge to manage their reproductive
lives to their own satisfaction. 7. Once a woman knows what is normal for
her, her chart will alert her to any abnormalities that should then lead
to early medical treatment, 8. It is very effective either to avoid pregnancy
or assist couples with sub-fertility to conceive, 9. Once learned, the Method
can be used right throughout the woman’s reproductive life. 10. Sexual intercourse
can occur only on "non-fertile" days, assuming that the woman has only one
or two fertile days per month. So while this method is natural the woman
must make a very accurate determination about when she has fertile
days and use self-control. Fertility days tracked with urine samples
is much more accurate than using body temperature cycles and subtracting
15 days from the expected date of next menstruation. The iPhone
Menstrual Period Tracker allows women to use the internet to keep track
of their fertility status.
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). Women
using the IUD need never worry about forgetting to take it.
Nuvaring
is a soft plastic ring containing oestrogen and progesterone to be inserted
into the vagina each month to supply contraception for for three out of four
weeks per month. It is an expensive method of contraception.
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. Coconut oil
can be used as a sexual lubricant, but not for lubricating condoms. 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. Some people are allergic to latex.
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.
The contraceptive pill came as a result research on the use of hormones in
contraception by Gregory Pincus, working with John Rock in Puerto Rico. The
first actual pill was created by Carl Djerassi in Mexico City. They contain
synthetic female sex hormones, either progesterone or combined progesterone
and oestrogen. . 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, (RU486), and Misoprostol. The side effects may
be nausea and irregular bleeding.
A study published in 2010 of
40.000 women followed for 40 years concluded that women who take "the pill"
are less likely to die from any cause, including cancer and heart disease
but some women still question whether the health risks outweigh the benefits.
This hormone pill is usually taken every day for 21 days with a break of
seven days. Side effects may include headaches, weight gain, loss of libido,
breast tenderness, mood changes and anxiety. Some women switch to other methods after
some years of using oral contraceptives because they tire of taking pills
almost every day and prefer a more "natural" method of contraception.
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, weight gain and reduced periods. This method is comparatively expensive.
Implanon is a 4 cmm X 2 cm plastic rod to be inserted under the skin of
the upper arm. to provide contraception for up to three years. It may cause
periods to change pattern and length.
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.
10.8.1 Health-seeking behaviours to avoid unwanted outcomes
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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 diseases (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, (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.
10.9.1 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 Chancroid
The bacterium Haemophilus ducreyi causes soft chancres and inflammation of the inguinal lymph nodes.
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 the following:
1. Ulcers that increase the risk of infection by HIV
2. Pelvic inflammatory disease (PID)
3. Infertility of women
4. 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 your 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, breast milk, 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.
10.9.8.1.1 Description of infection by HIV
After infecting a new host, HIV starts rapidly reproducing itself inside
the host's cells to produce new viruses that infect additional cells. The
viral replication may be so intensive that within a month after infection
the infected individuals may have 100 million viral copies per mL of blood
plasma. The first line of natural immune defence is the non-specific immune
system consisting of cells that patrol the body to destroy any virus-infected
cell they encounter. However, in most HIV-infected individuals the non-specific
immune system may be overwhelmed by the initial onslaught of replicating
HIV. However, antigen-presenting cells of the non-specific immune system
engulf some viral proteins so that they can later show them to more specialized
immune system components with the aim of producing a specify response to
the HIV. The antigen-presenting cells include the helper T cells and killer
T cells. When the killer Y cells have received a description of the infecting
virus intruder and a chemical signal from helper T cells, they multiply,
then start destroying the infecting virus approximately three weeks after
the initial infection. The killer T cells do destroy most virus-infected
cells and drive down the virus levels. However, usually the response is not
enough to prevent lifelong chronic infection.
The helper T cells direct the activities of other immune cells but from
the start of the infection, the HIV infects helper T cells themselves to
replicate inside them and destroying them. The HIV destroys the so-called
memory helper T cells that hold the immune system's memory of past exposures
to pathogens. A few weeks after the initial infection, so many memory helper
T cells are destroyed that the control of the immune system is destroyed
and never fully recovers.
Meanwhile, the HIV has a method of evading the killer T cells. After entering
a cell, the HIV copies its RNA genetic material into DNA in an inexact procedure
that result in mutations in the viral copy. These mutations are passed to
the next generation every time the next generation of viruses copy themselves.
Also, if two viruses infect the same cell, they can swap genetic material
by recombination and produce another virus variant for the next generation.
The increasing genetic diversity of HIV proteins causes them to become increasingly
unrecognizable to immune cells that can only remember the original version
of the virus. As the killer T cells destroy all the cells displaying recognizable
antigens, the virus infected cells carrying mutant proteins take over. Similarly,
the antibodies produced by the immune system, weeks after the initial infection
cannot recognize many of the HIV proteins in the host later in the infection.
Immune defences are usually unable to recognize variant versions of HIV.
So even a strong vaccine-evoked memory response against one strain of HIV
might be ineffective against the strain that later enters the body or might
become useless as the virus mutates. HIV mutates so rapidly that the diversity
of proteins on the surface of HIV particles in a single person after six
years of infection is estimated to be greater than the diversity of all the
human flu viruses stains world wide in a given year.
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 the following
1.1 Fusion inhibitors (entry inhibitors), e.g. Enfuvirtide, that interferes with the HIV ability to enter cells
1.2 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
1.3 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.
Current drug regimens can suppress HIV but no treatments
can completely eliminate the virus from the patient's body because places
where the virus can hide are still being discovered.
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, Phthirus pubis
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, redness and
dermatitis. 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.
Day 0 Egg laid on hair shaft
Day 6 -7 Louse hatches
Day 8-9 First moult
Day 11-12 Second moult
Day 17-18 Adult lice mate and female lays first eggs 1-2 days after mating
Day 19-32 Females lay 3-8 eggs each day for the next 16 days
Day 33-35 Louse dies
10.5.11 Scabies, Sarcoptes scabiei
Scabies is caused by the itch mite Sarcoptes scabiei.
It burrows into the skin often between the fingers and on the wrists and
causes intense itching that is worse at night. The entrances to the burrows
have small scale-like swellings that become red and itchy. 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, Treponema pallidum
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, Trichomonas vaginalis
Trichomoniasis is caused by the flagellated 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.
10.10.1 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), Candida albicans
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 albicans 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, Escherichia col, (E. coli)
Escherichia coli, (E. coli)
causes inflammation of the urethra (urethritis) and bladder (cystitis). Cystitis
is probably not an STI because it is probably caused by poor toilet hygiene
before sexual intercourse. 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, (E. coli).
The symptoms are a scalding feeling when passing urine (dysuria) 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. Untreated cystitis
can result in inflammation in the kidneys, pyelitis, and pyloneohritis leading
to blood cells and pus in the urine.
10.10.4 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.
10.10.5 Endometriosis
This condition that can lead to infertility, occurs when cells lining the
uterus begin to grow elsewhere , e.g. on the ovaries, fallopian tubes, bladder
and bowel. Research has identified two regions of DNA close to gene WNT4,
strongly associated with this disorder and this may lead to a diagnostic
test for this painful gynaecological condition. Environment factors may also
be important for the development of this disease.