Adolescent Health
What is acne?
Acne is a disorder that causes outbreaks of skin lesions commonly called pimples. It is caused by the skin’s oil glands making too much sebum, an oily substance, which leads to plugged pores. It also can be caused by the rapid production of a bacteria P. acnes.
Acne lesions occur mostly on the face, neck, back, chest, and shoulders. It is the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring and permanent scarring.
How does acne affect women?
Most young women and men will have at least a few pimples over the course of their lives. But acne seems to affect men and women in different ways. Young men are more likely to have a more serious form of acne. Acne in young women tends to be more random and linked to hormone changes, such as the menstrual cycle.
As women get older, acne often gets better. But some women have acne for many years. Some women even get acne for the first time at age 30 or 40.
For many women, acne can be an upsetting illness. Women may have feelings of depression, poor body image, or low self-esteem. But you don’t have to wait to outgrow acne or to let it run its course. Today, almost every case of acne can be resolved. Acne also can, sometimes, be prevented. Talk with your doctor or dermatologist (a doctor who specializes in treating skin problems) about how you can help prevent acne and if treatment would help you.
What are the different types of acne lesions?
- Comedo (whiteheads or blackheads) or papules. The comedo is the basic acne lesion, which is a plugged pore. If the plugged pore stays under the skin, it’s called a closed comedo and forms a white bump or whitehead. Blackheads are comedos that open up and appear blackish on the surface of the skin. This black color is not due to dirt, but because the air reacts with the excess oil.
- Pustules or pimples. Pustules or pimples are acne lesions that contain pus and are red at the base.
- Nodules. These are more serious acne lesions. They lodge deeper in the skin, are painful, and can cause scarring.
- Cysts. Like nodules, these lesions are deep within in the skin, are painful, and are filled with pus, and can cause scarring.
What triggers acne in women?
Many things can trigger acne in women:
- Hormone changes during puberty. During puberty, girls have an increase in male sex hormones called androgens. This increase causes the glands to get larger and make more sebum.
- Hormone changes as an adult. The menstrual cycle is one of the most common acne triggers. Acne lesions tend to form a few days before the cycle begins and go away after the cycle is completed. Other hormone changes, such as pregnancy and menopause, improve acne in some women. But some women have worse acne during these times. Stopping use of birth control pills can play a role as well.
- Medicines. Certain medicines, such as those used to treat epilepsy and types of depression.
- Make-up.
- Pressure or friction on the skin. Friction caused by bike helmets or backpacks can make acne worse.
- Family history. If other people in your family have acne, there is a greater chance you will have it.
Does poor hygiene cause acne?
It is a myth that women get acne because they don’t wash enough. Too much washing or scrubbing the skin harshly can make acne worse. And washing away surface oils doesn’t do much to prevent or cure acne, because it forms under the skin. The best way to clean the face is to gently wash it twice a day with a mild soap or cleanser. Be careful to remove make-up without harsh scrubbing.
Can stress cause acne?
Stress does not cause acne. But, acne may be a side effect of some medicines used to treat stress or depression. And in some cases, the social and emotional impact of acne lesions causes stress. Talk with your doctor if you have concerns.
Can eating chocolate or greasy foods cause acne?
While many women feel that eating chocolate or greasy foods causes acne, experts have not found a link between the diet and acne. Foods seem to have little effect on acne in most people. But, it’s important to eat a healthy diet for good health.
How is mild acne treated?
There are many treatments for mild acne. Mild acne can consist of whiteheads, blackheads and small pustules. At home, you can wash your face twice per day with warm water and a gentle cleanser or soap. Your doctor may suggest you also try an over-the-counter lotion or cream. These medicines may make your skin dry if you use them too much. Be sure to follow the directions.
If these medicines don’t work, your doctor may prescribe a cream or lotion with benzoyl peroxide, resorcinol, salicylic acid, or sulfur.
- Benzoyl peroxide works to reduce oil made by the glands.
- Resorcinol, salicylic acid, and sulfur help breakdown whiteheads and blackheads.
If your acne does not get better after six to eight weeks, talk with your doctor about changing your treatment.
Can more serious forms of acne be treated?
Yes. Work with your doctor to find the best treatment for you.
Moderate to moderately severe acne. This type of acne consists of several whiteheads, blackheads, papules and pustules that cover from ¼ to ¾ of the face and/or other parts of the body. It can be treated with antibiotic lotions or gels, as well as retinoic acid. Retinoic acid is an altered form of vitamin A. It helps prevent whiteheads and blackheads. Your doctor may also prescribe an antibiotic pill, such as erythromycin. If you take birth control pills to prevent pregnancy, antibiotics can affect how well they work. Be sure to use a second method of birth control with the pill, such as a condom. Retinoic acid and antibiotic pills can make the skin sensitive to the sun. So, wear sunscreen and stay in the shade while using them.
Severe acne. Severe acne consists of deep cysts, redness, swelling, extreme damage to the skin and scarring. You should see a dermatologist to care for this type of acne. Scarring can be prevented with appropriate treatments. Your dermatologist can prescribe oral antibiotics and oral contraceptives. Large inflamed cysts can be treated with an injection of a drug that lessens the redness, swelling, and irritation, and promotes healing.
Your dermatologist may prescribe Accutane®, if other treatments have not worked. This is a strong medicine that can help prevent scarring and treat active disease. But, Accutane also can cause birth defects. It is important that you are not pregnant and do not plan to get pregnant while taking this medicine. You must use two methods of birth control at the same time. This is done for one month before treatment begins, during treatment, and for a full month after stopping the drug. Talk with your dermatologist about when it’s safe to get pregnant. Other side effects of this drug may include dry eyes, itching, mood changes, and changes in the blood and liver. You and your dermatologist can decide whether this medicine is right for you based on the pros and cons. Use any prescribed medicine exactly as you are advised. Taking more medicine than you are supposed to take may make acne or your general health worse. Ask your doctor what to do if you miss a dose.
Some large cysts do not respond to medication and may need to be drained or removed. Your dermatologist is the only person who should drain or remove these. You should never try to drain or remove your acne by squeezing or picking. This can lead to infection, worsen your acne, and cause scarring.
Overall, if you don’t see a change in your skin in six to eight weeks, talk with your doctor about your treatment plan.
Can birth control pills help treat acne?
For women who break out mainly around their menstrual cycle, some birth control pills can help. Research shows that these pills can clear acne by slowing down overactive oil glands in the skin. Sometimes, birth control pills are used along with a drug called spironolactone to treat acne in adult females. This medication lowers levels of the hormone androgen in the body. Androgen stimulates the skin’s oil glands. Side effects of this drug include irregular menstruation, breast tenderness, headache and fatigue. Spironolactone is not appropriate therapy for all patients.
When is surgery used for acne scarring?
If you have scarring, your dermatologist may suggest surgery to help heal acne lesions and remove scarring. A laser can reshape scar tissue and reduce redness. Dermabrasion is a type of surgery that can remove surface scars and reduce the depth of deep scars. Another option is to transfer fat from one part of the body to the face. In some cases, a single treatment can help scarring. But for lasting results, several are often needed. There are also topical treatments for acne scarring.
Photodynamic therapy is a new acne treatment. It begins with light microdermabrasion. This is used to remove dead skin cells on the face’s surface. Then, an acid is put on the skin for 30 to 60 minutes. After this period, the acid is taken off. Lastly, the skin is treated with a laser. This treatment is still being researched, but seems to give positive long-term results.
How can I help prevent acne and acne scars?
You can help prevent acne flare-ups and scars by taking good care of your skin:
- Clean your skin gently with a mild soap or cleanser twice a day―once in the morning and once at night. You should also gently clean the skin after heavy exercise. Avoid strong soaps and rough scrub pads. Harsh scrubbing of the skin may make acne worse. Wash your entire face from under the jaw to the hairline and rinse thoroughly. Remove make-up gently with a mild soap and water. Ask your doctor before using an astringent.
- Wash your hair on a regular basis. If your hair is oily, you may want to wash it more often.
- Do not squeeze or pick at acne lesions. This can cause acne scars.
- Avoid getting sunburned. Many medicines used to treat acne can make you more prone to sunburn. Many people think that the sun helps acne, because the redness from sunburn may make acne lesions less visible. But, too much sun can also increase your risk of skin cancer and early aging of the skin. When you’re going to be outside, use sunscreen of at least SPF 15. Also, try to stay in the shade as much as you can.
- Choose make-up and hair care products that are “non-comedogenic” or “non-acnegenic.” These products have been made in a way that they don’t cause acne. You may also want to use products that are oil-free.
- Avoid things that rub the skin as much as you can, such as backpacks and sports equipment.
- Talk with your doctor about what treatment methods can help your acne. Take your medicines as prescribed. Be sure to tell your doctor if you think medicines you take for other health problems make your acne worse.
Is rosacea the same as acne?
Rosacea (ro-ZAY-she-ah) is a common skin problem often called “adult acne.” Faired skinned and menopausal women are more likely to have rosacea. Rosacea also seems to run in families. It causes redness in the center parts of the face and pimples. Blood vessels under the skin of the face may enlarge and show through the skin as small red lines. The skin may be swollen and feel warm.
Women with rosacea don’t have the same lesions as seen with common acne. They may have flushing of the face, when they are hot, drink alcohol or hot drinks, or eat spicy foods. This flushing causes the face to appear red. In the most severe form, this redness does not go away. The eyes may become swollen and nodules in the skin may be painful.
You can help keep rosacea under control by keeping a record of things that cause it to flare up. Try to avoid or limit these triggers as much as you can. Antibiotic lotions or gels can also help. Sometimes, you may need to take antibiotic pills. Your dermatologist may treat you with laser surgery. If you think you have rosacea, talk with your doctor about these treatments.
What is menstruation?
Menstruation (men-STRAY-shuhn) is a woman's monthly bleeding. When you menstruate, your body sheds the lining of the uterus (womb). Menstrual blood flows from the uterus through the small opening in thecervix and passes out of the body through the vagina (see how the menstrual cycle works below). Most menstrual periods last from 3 to 5 days.
What is the menstrual cycle?
When periods (menstruations) come regularly, this is called the menstrual cycle. Having regular menstrual cycles is a sign that important parts of your body are working normally. The menstrual cycle provides important body chemicals, called hormones, to keep you healthy. It also prepares your body for pregnancy each month. A cycle is counted from the first day of 1 period to the first day of the next period. The average menstrual cycle is 28 days long. Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens.
The rise and fall of levels of hormones during the month control the menstrual cycle.
What happens during the menstrual cycle?
In the first half of the cycle, levels of estrogen (the “female hormone”) start to rise. Estrogen plays an important role in keeping you healthy, especially by helping you to build strong bones and to help keep them strong as you get older. Estrogen also makes the lining of the uterus (womb) grow and thicken. This lining of the womb is a place that will nourish the embryo if a pregnancy occurs. At the same time the lining of the womb is growing, an egg, or ovum, in one of the ovaries starts to mature. At about day 14 of an average 28-day cycle, the egg leaves the ovary. This is called ovulation.
After the egg has left the ovary, it travels through the fallopian tube to the uterus. Hormone levels rise and help prepare the uterine lining for pregnancy. A woman is most likely to get pregnant during the 3 days before or on the day of ovulation. Keep in mind, women with cycles that are shorter or longer than average may ovulate before or after day 14.
A woman becomes pregnant if the egg is fertilized by a man’s sperm cell and attaches to the uterine wall. If the egg is not fertilized, it will break apart. Then, hormone levels drop, and the thickened lining of the uterus is shed during the menstrual period.
See how the menstrual cycle works below.
Having trouble viewing the tool above? Take a look at our menstruation diagram.
What is a typical menstrual period like?
During your period, you shed the thickened uterine lining and extra blood through the vagina. Your period may not be the same every month. It may also be different than other women's periods. Periods can be light, moderate, or heavy in terms of how much blood comes out of the vagina. This is called menstrual flow. The length of the period also varies. Most periods last from 3 to 5 days. But, anywhere from 2 to 7 days is normal.
For the first few years after menstruation begins, longer cycles are common. A woman's cycle tends to shorten and become more regular with age. Most of the time, periods will be in the range of 21 to 35 days apart.
What kinds of problems do women have with their periods?
Women can have a range of problems with their periods, including pain, heavy bleeding, and skipped periods.
- Amenorrhea (ay-men-uh-REE-uh) — the lack of a menstrual period. This term is used to describe the absence of a period in:
- Young women who haven't started menstruating by age 15
- Women and girls who haven't had a period for 90 days, even if they haven't been menstruating for long
Causes can include:- Pregnancy
- Breastfeeding
- Extreme weight loss
- Eating disorders
- Excessive exercising
- Stress
- Serious medical conditions in need of treatment
As above, when your menstrual cycles come regularly, this means that important parts of your body are working normally. In some cases, not having menstrual periods can mean that your ovaries have stopped producing normal amounts of estrogen. Missing these hormones can have important effects on your overall health. Hormonal problems, such as those caused by polycystic ovarian syndrome (PCOS) or serious problems with the reproductive organs, may be involved. It’s important to talk to a doctor if you have this problem.
- Dysmenorrhea (dis-men-uh-REE-uh) — painful periods, including severe cramps. Menstrual cramps in teens are caused by too much of a chemical called prostaglandin (pros-tuh-GLAN-duhn). Most teens with dysmenorrhea do not have a serious disease, even though the cramps can be severe. In older women, the pain is sometimes caused by a disease or condition such as uterine fibroids or endometriosis.
For some women, using a heating pad or taking a warm bath helps ease their cramps. Some over-the-counter pain medicines can also help with these symptoms. They include:- Ibuprofen (eye-byu-PROH-fuhn) (for instance, Advil, Motrin, Midol Cramp)
- Ketoprofen (key-toh-PROH-fuhn) (for instance, Orudis KT)
- Naproxen (nuh-PROK-suhn) (for instance, Aleve)
If these medicines don’t relieve your pain or the pain interferes with work or school, you should see a doctor. Treatment depends on what’s causing the problem and how severe it is.
- Abnormal uterine bleeding — vaginal bleeding that’s different from normal menstrual periods. It includes:
- Bleeding between periods
- Bleeding after sex
- Spotting anytime in the menstrual cycle
- Bleeding heavier or for more days than normal
- Bleeding after menopause
Abnormal bleeding can have many causes. Your doctor may start by checking for problems that are most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. Treatment for abnormal bleeding depends on the cause.
In both teens and women nearing menopause, hormonal changes can cause long periods along with irregular cycles. Even if the cause is hormonal changes, you may be able to get treatment. You should keep in mind that these changes can occur with other serious health problems, such as uterine fibroids, polyps, or even cancer. See your doctor if you have any abnormal bleeding.
When does a girl usually get her first period?
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In the United States, the average age for a girl to get her first period is 12. This does not mean that all girls start at the same age. A girl can start her period anytime between the ages of 8 and 15. Most of the time, the first period starts about 2 years after breasts first start to develop. If a girl has not had her first period by age 15, or if it has been more than 2 to 3 years since breast growth started, she should see a doctor.
How long does a woman have periods?
Women usually have periods until menopause. Menopause occurs between the ages of 45 and 55, usually around age 50. Menopause means that a woman is no longer ovulating (producing eggs) or having periods and can no longer get pregnant. Like menstruation, menopause can vary from woman to woman and these changes may occur over several years.
The time when your body begins its move into menopause is called the menopausal transition. This can last anywhere from 2 to 8 years. Some women have early menopause because of surgery or other treatment, illness, or other reasons. If you don’t have a period for 90 days, you should see your doctor. He or she will check for pregnancy, early menopause, or other health problems that can cause periods to stop or become irregular.
When should I see a doctor about my period?
See your doctor about your period if:
- You have not started menstruating by the age of 15.
- You have not started menstruating within 3 years after breast growth began, or if breasts haven't started to grow by age 13.
- Your period suddenly stops for more than 90 days.
- Your periods become very irregular after having had regular, monthly cycles.
- Your period occurs more often than every 21 days or less often than every 35 days.
- You are bleeding for more than 7 days.
- You are bleeding more heavily than usual or using more than 1 pad or tampon every 1 to 2 hours.
- You bleed between periods.
- You have severe pain during your period.
- You suddenly get a fever and feel sick after using tampons.
How often should I change my pad and/or tampon?
You should change a pad before it becomes soaked with blood. Each woman decides for herself what works best. You should change a tampon at least every 4 to 8 hours. Make sure to use the lowest absorbency tampon needed for your flow. For example, use junior or regular tampons on the lightest day of your period. Using a super absorbency tampon on your lightest days increases your risk for toxic shock syndrome (TSS). TSS is a rare but sometimes deadly disease. TSS is caused by bacteria that can produce toxins. If your body can’t fight the toxins, your immune (body defense) system reacts and causes the symptoms of TSS (see below).
Young women may be more likely to get TSS. Using any kind of tampon puts you at greater risk for TSS than using pads. The Food and Drug Administration (FDA) recommends the following tips to help avoid tampon problems:
- Follow package directions for insertion.
- Choose the lowest absorbency for your flow.
- Change your tampon at least every 4 to 8 hours.
- Consider switching between pads and tampons.
- Know the warning signs of TSS (see below).
- Don't use tampons between periods.
If you have any of these symptoms of TSS while using tampons, take the tampon out, and contact your doctor right away:
- Sudden high fever (over 102 degrees)
- Muscle aches
- Diarrhea
- Vomiting
- Dizziness and/or fainting
- Sunburn-like rash
- Sore throat
- Bloodshot eyes
What is a sexually transmitted infection (STI)?
It is an infection passed from person to person through intimate sexual contact. STIs are also called sexually transmitted diseases, or STDs.
How many people have STIs and who is infected?
In the United States about 19 million new infections are thought to occur each year. These infections affect men and women of all backgrounds and economic levels. But almost half of new infections are among young people ages 15 to 24. Women are also severely affected by STIs. They have more frequent and more serious health problems from STIs than men. African-American women have especially high rates of infection.
How do you get an STI?
You can get an STI by having intimate sexual contact with someone who already has the infection. You can’t tell if a person is infected because many STIs have no symptoms. But STIs can still be passed from person to person even if there are no symptoms. STIs are spread during vaginal, anal, or oral sex or during genital touching. So it’s possible to get some STIs without having intercourse. Not all STIs are spread the same way.
Can STIs cause health problems?
Yes. Each STI causes different health problems. But overall, untreated STIs can cause cancer, pelvic inflammatory disease, infertility, pregnancy problems, widespread infection to other parts of the body, organ damage, and even death.
Having an STI also can put you at greater risk of getting HIV. For one, not stopping risky sexual behavior can lead to infection with other STIs, including HIV. Also, infection with some STIs makes it easier for you to get HIV if you are exposed.
What are the symptoms of STIs?
Many STIs have only mild or no symptoms at all. When symptoms do develop, they often are mistaken for something else, such as urinary tract infection or yeast infection. This is why screening for STIs is so important. The STIs listed here are among the most common or harmful to women.
| STI | Symptoms |
|---|---|
| Bacterial Vaginosis (BV) | Most women have no symptoms. Women with symptoms may have:
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| Chlamydia | Most women have no symptoms. Women with symptoms may have:
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| Genital Herpes | Some people may have no symptoms. During an “outbreak,” the symptoms are clear:
Symptoms may go away and then come back. Sores heal after 2 to 4 weeks. |
| Gonorrhea | Symptoms are often mild, but most women have no symptoms. If symptoms are present, they most often appear within 10 days of becoming infected. Symptoms are:
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| Hepatitis B | Some women have no symptoms. Women with symptoms may have:
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| HIV/AIDS | Some women may have no symptoms for 10 years or more. About half of people with HIV get flu-like symptoms about 3 to 6 weeks after becoming infected. Symptoms people can have for months or even years before the onset of AIDS include:
Women also might have these signs of HIV:
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| Human Papillomavirus (HPV) | Some women have no symptoms. Women with symptoms may have: |
| Pubic Lice (sometimes called "crabs") | Symptoms include:
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| Syphilis | Syphilis progresses in stages. Symptoms of the primary stage are:
If the infection is not treated, it moves to the secondary stage. This stage starts 3 to 6 weeks after the sore appears. Symptoms of the secondary stage are:
In the latent stage, symptoms go away, but can come back. Without treatment, the infection may or may not move to the late stage. In the late stage, symptoms are related to damage to internal organs, such as the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Some people may die. |
| Trichomoniasis (sometimes called "trich") | Many women do not have symptoms. Symptoms usually appear 5 to 28 days after exposure and can include:
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How do you get tested for STIs?
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There is no one test for all STIs. Ask your doctor about getting tested for STIs. She or he can tell you what test(s) you might need and how it is done. Testing for STIs is also called STI screening. Testing (or screening) for STIs can involve:
- Pelvic and physical exam — Your doctor can look for signs of infection, such as warts, rashes, discharge.
- Blood sample
- Urine sample
- Fluid or tissue sample — A swab is used to collect a sample that can be looked at under a microscope or sent to a lab for testing.
These methods are used for many kinds of tests. So if you have a pelvic exam and Pap test, for example, don’t assume that you have been tested for STIs. Pap testing is mainly used to look for cell changes that could be cancer or precancer. Although a Pap test sample also can be used to perform tests for HPV, doing so isn’t routine. And a Pap test does not test for other STIs. If you want to be tested for STIs, including HPV, you must ask.
You can get tested for STIs at your doctor’s office or a clinic. But not all doctors offer the same tests. So it’s important to discuss your sexual health history to find out what tests you need and where you can go to get tested.
Who needs to get tested for STIs?
If you are sexually active, talk to your doctor about STI screening. Which tests you might need and how often depend mainly on your sexual history and your partner’s. Talking to your doctor about your sex life might seem too personal to share. But being open and honest is the only way your doctor can help take care of you. Also, don’t assume you don’t need to be tested for STIs if you have sex only with women. Talk to your doctor to find out what tests make sense for you.
How are STIs treated?
The treatment depends on the type of STI. For some STIs, treatment may involve taking medicine or getting a shot. For other STIs that can’t be cured, like herpes, treatment can help to relieve the symptoms.
Only use medicines prescribed or suggested by your doctor. There are products sold over the Internet that falsely claim to prevent or treat STIs, such as herpes, chlamydia, human papillomavirus, and HIV. Some of these drugs claim to work better than the drugs your doctor will give you. But this is not true, and the safety of these products is not known.
What can I do to keep from getting an STI?
You can lower your risk of getting an STI with the following steps. The steps work best when used together. No single strategy can protect you from every single type of STI.
- Don’t have sex. The surest way to keep from getting any STI is to practice abstinence. This means not having vaginal, oral, or anal sex. Keep in mind that some STIs, like genital herpes, can be spread without having intercourse.
- Be faithful. Having a sexual relationship with one partner who has been tested for STIs and is not infected is another way to lower your risk of getting infected. Be faithful to each other. This means you only have sex with each other and no one else.
- Use condoms correctly and every time you have sex. Use condoms for all types of sexual contact, even if intercourse does not take place. Use condoms from the very start to the very end of each sex act, and with every sex partner. A male latex condom offers the best protection. You can use a male polyurethane condom if you or your partner has a latex allergy. For vaginal sex, use a male latex condom or a female condom if your partner won’t wear a condom. For anal sex, use a male latex condom. For oral sex, use a male latex condom. A dental dam might also offer some protection from some STIs.
- Know that some methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs. If you use one of these methods, be sure to also use a condom correctly every time you have sex.
- Talk with your sex partner(s) about STIs and using condoms before having sex. It’s up to you to set the ground rules and to make sure you are protected.
- Don’t assume you’re at low risk for STIs if you have sex only with women. Some common STIs are spread easily by skin-to-skin contact. Also, most women who have sex with women have had sex with men, too. So a woman can get an STI from a male partner and then pass it to a female partner.
- Talk frankly with your doctor and your sex partner(s) about any STIs you or your partner has or has had. Talk about symptoms, such as sores or discharge. Try not to be embarrassed. Your doctor is there to help you with any and all health problems. Also, being open with your doctor and partner will help you protect your health and the health of others.
- Have a yearly pelvic exam. Ask your doctor if you should be tested for STIs and how often you should be retested. Testing for many STIs is simple and often can be done during your checkup. The sooner an STI is found, the easier it is to treat.
- Avoid using drugs or drinking too much alcohol. These activities may lead to risky sexual behavior, such as not wearing a condom.
How do STIs affect pregnant women and their babies?
STIs can cause many of the same health problems in pregnant women as women who are not pregnant. But having an STI also can threaten the pregnancy and unborn baby’s health. Having an STI during pregnancy can cause early labor, a woman’s water to break early, and infection in the uterus after the birth.
Some STIs can be passed from a pregnant woman to the baby before and during the baby’s birth. Some STIs, like syphilis, cross the placenta and infect the baby while it is in the uterus. Other STIs, like gonorrhea, chlamydia, hepatitis B, and genital herpes, can be passed from the mother to the baby during delivery as the baby passes through the birth canal. HIV can cross the placenta during pregnancy and infect the baby during the birth process.
The harmful effects to babies may include:
- Low birth weight
- Eye infection
- Pneumonia
- Infection in the baby’s blood
- Brain damage
- Lack of coordination in body movements
- Blindness
- Deafness
- Acute hepatitis
- Meningitis
- Chronic liver disease
- Cirrhosis
- Stillbirth
Some of these problems can be prevented if the mother receives routine prenatal care, which includes screening tests for STIs starting early in pregnancy and repeated close to delivery, if needed. Other problems can be treated if the infection is found at birth.
What can pregnant women do to prevent problems from STIs?
Pregnant women should be screened at their first prenatal visit for STIs, including:
- Chlamydia
- Gonorrhea
- Hepatitis B
- HIV
- Syphilis
In addition, some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis (BV) at the first prenatal visit. Even if a woman has been tested for STIs in the past, she should be tested again when she becomes pregnant.
Chlamydia, gonorrhea, syphilis, trichomoniasis, and BV can be treated and cured with antibiotics during pregnancy. Viral STIs, such as genital herpes and HIV, have no cure. But antiviral medication may be appropriate for some pregnant woman with herpes to reduce symptoms. For women who have active genital herpes lesions at the onset of labor, a cesarean delivery (C-section) can lower the risk of passing the infection to the newborn. For women who are HIV positive, taking antiviral medicines during pregnancy can lower the risk of giving HIV to the newborn to less than 2 percent. C-section is also an option for some women with HIV. Women who test negative for hepatitis B may receive the hepatitis B vaccine during pregnancy.
Do STIs affect breastfeeding?
Talk with your doctor, nurse, or a lactation consultant about the risk of passing the STI to your baby while breastfeeding. If you have chlamydia or gonorrhea, you can keep breastfeeding. If you have syphilis or herpes, you can keep breastfeeding as long as the sores are covered. Syphilis and herpes are spread through contact with sores and can be dangerous to your newborn. If you have sores on your nipple orareola, stop breastfeeding on that breast. Pump or hand express your milk from that breast until the sore clears. Pumping will help keep up your milk supply and prevent your breast from getting engorged or overly full. You can store your milk to give to your baby in a bottle for another feeding. But if parts of your breast pump that contact the milk also touch the sore(s) while pumping, you should throw the milk away.
If you are being treated for an STI, ask your doctor about the possible effects of the drug on your breastfeeding baby. Most treatments for STIs are safe to use while breastfeeding.
| If you have HIV, do not breastfeed. You can pass the virus to your baby. |
Is there any research being done on STIs?
Yes. Research on STIs is a public health priority. Research is focused on prevention, diagnosis, and treatment.
With prevention, researchers are looking at strategies such as vaccines and topical microbicides (meye-KROH-buh-syds). One large study is testing a herpes vaccine for women. Topical microbicides could play a big role in protecting women from getting STIs. But so far, they have been difficult to design. They are gels or creams that would be put into the vagina to kill or stop the STI before it could infect someone. Researchers are also looking at the reasons some people are at higher risk of STIs, and ways to lower these risks.
Early and fast diagnosis of STIs means treatment can start right away. Early treatment helps to limit the effects of an STI and keep it from spreading to others. Researchers are looking at quick, easy, and better ways to test for STIs, including vaginal swabs women can use to collect a sample for testing. They also are studying the reasons why many STIs have no symptoms, which can delay diagnosis.
Research also is underway to develop new ways to treat STIs. For instance, more and more people are becoming infected with types of gonorrhea that do not respond well to drugs. So scientists are working to develop new antibiotics to treat these drug-resistant types. An example of treatment research success is the life-prolonging effects of new drugs used to treat HIV.
Cosmetics and Your Health
What are cosmetics? How are they different from over-the-counter (OTC) drugs?
Cosmetics are products people use to cleanse or change the look of the face or body.
Cosmetic products include:
- skin creams
- lotions
- perfumes
- lipsticks
- fingernail polishes
- eye and face make-up products
- permanent waves
- hair dyes
- toothpastes
- deodorants
Unlike drugs, which are used to treat or prevent disease in the body, cosmetics do not change or affect the body's structure or functions.
What's in cosmetics?
Fragrances and preservatives are the main ingredients in cosmetics. Fragrances are the most common cause of skin problems. More than 5,000 different kinds are used in products. Products marked “fragrance-free” or “without perfume” means that no fragrances have been added to make the product smell good.
Preservatives in cosmetics are the second most common cause of skin problems. They prevent bacteria and fungus from growing in the product and protect products from damage caused by air or light. But preservatives can also cause the skin to become irritated and infected. Some examples of preservatives are:
- paraben
- imidazolidinyl urea
- Quaternium-15
- DMDM hydantoin
- phenoxyethanol
- formaldehyde
The ingredients below cannot be used, or their use is limited, in cosmetics. They may cause cancer or other serious health problems.
- bithionol
- mercury compounds
- vinyl chloride
- halogenated salicyanilides
- zirconium complexes in aerosol sprays
- chloroform
- methylene chloride
- chlorofluorocarbon propellants
- hexachlorophene
What is the role of the Food and Drug Administration (FDA) in the cosmetic industry?
A cosmetic maker can sell products without FDA approval. FDA does not review or approve cosmetics, or their ingredients, before they are sold to the public. But FDA urges cosmetic makers to do whatever tests are needed to prove their products are safe. Cosmetics makers must put a warning statement on the front labels of products that have not been safety testing, which reads, "WARNING―The safety of this product has not been determined."
FDA does require safety testing for color additives used in cosmetics. Cosmetics may only contain approved and certified colors. You'll find FD&C, D&C, or external D&C listed on cosmetic labels.
- FD&C – color that can be used only in foods, drugs, and cosmetics
- D&C – color that can be used only in drugs and cosmetics
- external D&C – color that can be used only in drugs applied to the surface of the skin and cosmetics
A cosmetic maker also does not have to report product injuries. FDA collects this information on a voluntary basis only. Cosmetic makers that want to be a part of this program send reports to the FDA.
Product recalls are voluntary actions taken by cosmetic makers too. FDA cannot require cosmetics recalls. But FDA does monitor cosmetic makers that do a recall. FDA must first prove in court that a cosmetic product is a danger or somehow breaks the law before it can be taken off the market.
Product recalls are voluntary actions taken by cosmetic makers too. FDA cannot require cosmetics recalls. But FDA does monitor cosmetic makers that do a recall. FDA must first prove in court that a cosmetic product is a danger or somehow breaks the law before it can be taken off the market.
Are cosmetics safe?
Yes, for the most part. Serious problems from cosmetics are rare. But sometimes problems can happen.
The most common injury from cosmetics is from scratching the eye with a mascara wand. Eye infections can result if the scratches go untreated. These infections can lead to ulcers on the cornea (clear covering of the eye), loss of lashes, or even blindness. To play it safe, never try to apply mascara while riding in a car, bus, train, or plane.
Sharing make-up can also lead to serious problems. Cosmetic brushes and sponges pick up bacteria from the skin. And if you moisten brushes with saliva, the problem can be worse. Washing your hands before using make-up will help prevent this problem.
Sleeping while wearing eye make-up can cause problems too. If mascara flakes into your eyes while you sleep, you might wake up with itching, bloodshot eyes, infections, or eye scratches. So be sure to remove all make-up before going to bed.
Cosmetic products that come in aerosol containers also can be a hazard. For example, it is dangerous to use aerosol hairspray near heat, fire, or while smoking. Until hairspray is fully dry, it can catch on fire and cause serious burns. Fires related to hairsprays have caused injuries and death. Aerosol sprays or powders also can cause lung damage if they are deeply inhaled into the lungs.
To find out more about cosmetic safety, please visit FDA's cosmetics safety section athttp://www.fda.gov/Cosmetics/ProductandIngredientSafety/default.htm.
How can I protect myself against the dangers of cosmetics?
- Never drive and put on make-up. Not only does this make driving a danger, hitting a bump in the road and scratching your eyeball can cause serious eye injury.
- Never share make-up. Always use a new sponge when trying products at a store. Insist that salespersons clean container openings with alcohol before applying to your skin.
- Keep make-up containers closed tight when not in use.
- Keep make-up out of the sun and heat. Light and heat can kill the preservatives that help to fight bacteria. Don't keep cosmetics in a hot car for a long time.
- Don't use cosmetics if you have an eye infection, such as pinkeye. Throw away any make-up you were using when you first found the problem.
- Never add liquid to a product unless the label tells you to do so.
- Throw away any make-up if the color changes, or it starts to smell.
- Never use aerosol sprays near heat or while smoking, because they can catch on fire.
- Don't deeply inhale hairsprays or powders. This can cause lung damage.
- Avoid color additives that are not approved for use in the eye area, such as "permanent" eyelash tints and kohl (color additive that contains lead salts and is still used in eye cosmetics in other countries). Be sure to keep kohl away from children. It may cause lead poisoning.
What are “cosmeceuticals?”
Some products can be both cosmetics and drugs. This may happen when a product has two uses. For example, a shampoo is a cosmetic because it's used to clean the hair. But, an anti-dandruff treatment is a drug because it's used to treat dandruff. So an antidandruff shampoo is both a cosmetic and a drug. Other examples are:
- toothpastes that contain fluoride
- deodorants that are also antiperspirants
- moisturizers and make-up that provide sun protection
These products must meet the standards for both cosmetics (color additives) and drugs.
Some cosmetic makers use the term “cosmeceutical” to refer to products that have drug-like benefits. FDA does not recognize this term. A product can be a drug, a cosmetic, or a combination of both. But the term "cosmeceutical" has no meaning under the law.
While drugs are reviewed and approved by FDA, FDA does not approve cosmetics. If a product acts like a drug, FDA must approve it as a drug.
While drugs are reviewed and approved by FDA, FDA does not approve cosmetics. If a product acts like a drug, FDA must approve it as a drug.
How long do cosmetics last?
You may not be able to use eye make-up, such as mascara, eyeliner, and eye shadow for as long as other products. This is because of the risk of eye infection. Some experts recommend replacing mascara three months after purchase. If mascara becomes dry, throw it away. Don't add water or, even worse, saliva to moisten it. That will bring bacteria into the product.
You may also need to watch certain "all natural" products that contain substances taken from plants. These products may be more at risk for bacteria. Since these products contain no preservatives or have non-traditional ones, your risk of infection may be greater.
If you don't store these products as directed, they may expire before the expiration date. For example, cosmetics stored in high heat may go bad faster than the expiration date. On the other hand, products stored the way they should be can be safely used until they expire.
What are hypoallergenic cosmetics?
Hypoallergenic (hy-po-al-ler-gen-ic) cosmetics are products that makers claim cause fewer allergic reactions than other products. Women with sensitive skin, and even those with "normal" skin, may think these products will be gentler. But there are no federal standards for using the term hypoallergenic. The term can mean whatever a company wants it to mean. Cosmetic makers do not have to prove their claims to the FDA.
Some products that have “natural” ingredients can cause allergic reactions. If you have an allergy to certain plants or animals, you could have an allergic reaction to cosmetics with those things in them. For example, lanolin from sheep wool is found in many lotions. But it's a common cause of allergies too.
Can cosmetics cause acne?
Some skin and hair care products can cause acne. To help prevent and control acne flare-ups, take good care of your skin. For example, use a mild soap or cleanser to gently wash your face twice a day. Choose “non-comedogenic” make-up and hair care products. This means that they don't close up the pores.
Are tattoos and permanent make-up safe?
FDA is looking into the safety of tattoos and permanent make-up since they are now more popular. The inks, or dyes, used for tattoos are color additives. Right now, no color additives have been approved for tattoos, including those used in permanent make-up.
You should be aware of these risks of tattoos and permanent make-up:
- Tattoo needles and supplies can transmit diseases, such as hepatitis C and HIV. Be sure all needles and supplies are sterile before they are used on you.
- Tattoos and permanent make-up are not easy to take off. Removal may cause a permanent change in color.
- Think carefully before getting a tattoo. You could have an allergic reaction.
- You cannot make blood donations for a year after getting a tattoo or permanent make-up.
Are cosmetic products with alpha hydroxy acids safe?
Alpha hydroxy acids (AHAs) come from fruit and milk sugars. They are found in many creams and lotions. Many people buy products with AHAs, because they claim to reduce wrinkles, spots, sun-damaged skin, and other signs of aging. Some studies suggest they may work.
But are these products safe? FDA has received reports of reactions in people using AHA products. Their complaints include:
- severe redness
- swelling (especially in the area of the eyes)
- burning
- blistering
- bleeding
- rash
- itching
- skin discoloration
AHAs may also increase your skin's risk of sunburn.
To find out if a product contains an AHA, look on the list of ingredients. By law, all cosmetics have ingredients on their outer label. AHAs may be called other names, like glycolic acid and lactic acid.
What precautions should I follow when using AHA products?
If you want to use AHA products, follow these safety tips:
- Always protect your skin before going out during the day. Use a sunscreen with a SPF (sun protection factor) of at least 15. Wear a hat with a brim. Cover up with lightweight, loose-fitting, long-sleeved shirts, and pants.
- Buy products with good label information:
- a list of ingredients to see which AHA or other chemical acids are in the product
- the name and address of the maker
- a statement about the product's AHA and pH levels
The first two have to be on the label. The third is one is by choice. You can call or write the maker to find about a product's AHA and pH levels.
- Buy only products with an AHA level of 10 percent or less and a pH of 3.5 or more.
- Test a small area of skin to see if it is sensitive to any AHA product before using a lot of it.
- Stop using the product right away if you have a reaction, such as stinging, redness, or bleeding.
- Talk with your doctor or dermatologist (a doctor that treats skin problems) if you have a problem. You also can report your reaction to the FDA. Write to: Office of Cosmetics and Colors (HFS-106), 5100 Paint Branch Parkway, College Park, MD 20740-3835. Or you can call them at (202) 401-9725.
Are hair dyes safe?
The decision to change your hair color may be a hard one. Some studies have linked hair dyes with a higher risk of certain cancers, while other studies have not found this link. Most hair dyes also don't have to go through safety testing that other cosmetic color additives do before hitting store shelves. Women are often on their own trying to figure out whether hair dyes are safe.
When hair dyes first came out, the main ingredient in coal-tar hair dye caused allergic reactions in some people. Most hair dyes are now made from petroleum sources. But FDA still considers them to be coal-tar dyes. This is because they have some of the same compounds found in these older dyes.
Cosmetic makers have stopped using things known to cause cancer in animals. For example, 4-methoxy-m-phenylenediamine (4MMPD) or 4-methoxy-m-phenylenediamine sulfate (4MMPD sulfate) are no longer used. But chemicals made almost the same way have replaced some of the cancer-causing compounds. Some experts feel that these newer ingredients aren't very different from the things they're replacing.
Experts suggest that you may reduce your risk of cancer by using less hair dye over time. You may also reduce you risk by not dyeing your hair until it starts to gray.
What precautions should I take when I dye my hair?
You should follow these safety tips when dyeing your hair:
- Don't leave the dye on your head any longer than needed.
- Rinse your scalp thoroughly with water after use.
- Wear gloves when applying hair dye.
- Carefully follow the directions in the hair dye package.
- Never mix different hair dye products.
- Be sure to do a patch test for allergic reactions before applying the dye to your hair. Almost all hair dye products include instructions for doing a patch test. It's important to do this each time you dye your hair. Your hairdresser should also do the patch test before dyeing your hair. To test, put a dab of hair dye behind your ear, and don't wash it off for two days. If you don't have any signs of allergic reaction, such as itching, burning, or redness at the test spot, you can be somewhat sure that you won't have a reaction to the dye applied to your hair. If you do react to the patch test, do the same test with different brands or colors until you find one to which you're not allergic.
- Never dye your eyebrows or eyelashes. An allergic reaction to dye could cause swelling or increase risk of infection in the eye area. This can harm the eye and even cause blindness. Spilling dye into the eye by accident could also cause permanent damage. FDA bans the use of hair dyes for eyelash and eyebrow tinting or dyeing even in beauty salons.
Are lead acetates safe in hair dyes?
Lead acetate is used as a color additive in "progressive" hair dye products. These products are put on over a period of time to produce a gradual coloring effect. You can safely use these products if you follow the directions carefully. This warning statement must appear on the product labels of lead acetate hair dyes:
"Caution: Contains lead acetate. For external use only. Keep this product out of children's reach. Do not use on cut or abraded scalp. If skin irritation develops, discontinue use. Do not use to color mustaches, eyelashes, eyebrows, or hair on parts of the body other than the scalp. Do not get in eyes. Follow instructions carefully and wash hands thoroughly after use."
Is it safe to dye my hair when I'm pregnant?
We don't know much about the safety of hair dyes during pregnancy. It's likely that when you apply hair dye, only a small amount is absorbed into your system. So very little chemicals, if any, would be able to get to your baby. In the few animal and human studies that have been done, no changes were seen in the developing baby. Talk with your doctor if you have questions or concerns.
Sleep Disorders
What is insomnia?
Insomnia is a common sleep disorder. If you have insomnia, you may:
- Lie awake for a long time and have trouble falling asleep
- Wake up a lot and have trouble returning to sleep
- Wake up too early in the morning
- Feel like you haven’t slept at all
Lack of or poor quality sleep causes other symptoms that can affect daytime function. You may feel very sleepy and have low energy throughout the day. You may have trouble thinking clearly or staying focused. Or, you might feel depressed or irritable.
Insomnia is defined as short and poor quality sleep that affects your functioning during the day. Although the amount of sleep a person needs varies, most people need between 7 and 8 hours of sleep a night to feel refreshed.
Insomnia can be mild to severe and varies in how often it occurs and how long it lasts. Acute insomnia is a short-term sleep problem that is generally related to a stressful or traumatic life event and lasts from a few days to a few weeks. Acute insomnia might happen from time to time. With chronic insomnia, sleep problems occur at least 3 nights a week for more than a month.
Insomnia tends to increase as women and men age.
What are the different types of insomnia and what causes them?
There are 2 types of insomnia:
- Primary insomnia is not a symptom or side-effect of another medical condition. It is its own disorder. It may be life-long or triggered by travel, shift work, stressful life events, or other factors that disrupt your sleep routine. Primary insomnia may end once the issue is resolved, or can last for years. Some people tend to be prone to primary insomnia.
- Secondary insomnia has an underlying cause, so it’s a symptom or side-effect of something else. It is the most common type. Secondary insomnia may have a medical cause, such as:
- Depression or anxiety
- Chronic pain such as from fibromyalgia, migraine, or arthritis
- Gastrointestinal problems such as heartburn
- Sleep disorders, such as sleep apnea or restless leg syndrome
- Stroke
- Alzheimer’s disease
- Menopause
Secondary insomnia also can result from:- Some medicines, such as those that treat asthma, heart problems, allergies, and colds
- Caffeine, tobacco, and alcohol
- Poor sleep environment (such as too much light or noise, or a bed partner who snores)
Secondary insomnia often goes away once the underlying cause is treated, but may become a primary insomnia.
Some people with primary or secondary insomnia form habits to deal with the lack of sleep, such as worrying about sleep or going to bed too early. These habits can make insomnia worse or last longer.
Do more women than men have insomnia?
Women are more likely to have insomnia than men. One reason is that hormonal changes during the menstrual cycle and menopause can affect sleep. During perimenopause, women may have trouble falling asleep and staying asleep. Hot flashes and night sweats often can disturb sleep.
During pregnancy, hormonal, physical, and emotional changes can disturb sleep. Pregnant women, especially in the third trimester, may wake up frequently due to discomfort, leg cramps, or needing to use the bathroom.
Some medical conditions that can cause secondary insomnia also are more common in women than men. These include depression, anxiety, fibromyalgia, and some sleep disorders, such as restless leg syndrome.
How is insomnia diagnosed?
Talk to your doctor if you are having problems falling or staying asleep, especially if lack of sleep is affecting your daily activities. Keep a sleep diary for 2 weeks before you see your doctor. Note the time of day you fall asleep and wake up, changes in your daily sleep routine, your bedtime routine, and how you feel during the day.
Your doctor may do a physical exam and take medical and sleep histories. He or she may also want to talk to your bed partner about how much and how well you are sleeping. In some cases, you may be referred to a specialist or a sleep center for special tests.
How is insomnia treated?
If insomnia is caused by a short-term change in the sleep/wake schedule, as with jet lag, your sleep schedule may return to normal on its own. Making lifestyle changes to help you sleep better can also help. If your insomnia makes it hard for you to function during the day, talk to your doctor.
Treatment for chronic insomnia begins by:
- Finding and treating any medical or mental health problems
- Stopping or reducing behaviors that may lead to the insomnia or make it worse, like drinking moderate to large amounts of alcohol at night
Other treatments are:
- Cognitive behavioral therapy (CBT)
- Medication
Research shows that CBT is an effective and lasting treatment of insomnia. CBT helps you change thoughts and actions that get in the way of sleep. This type of therapy is also used to treat conditions such as depression, anxiety, and eating disorders.
CBT consists of one or more approaches. These are:
- Cognitive control and psychotherapy — Controlling or stopping negative thoughts and worries that keep you awake.
- Sleep hygiene — Taking steps to make quality sleep more likely, such as going to bed and waking up at the same time each day, not smoking, avoiding drinking too much coffee or alcohol late in the day, and getting regular exercise.
- Sleep restriction — Matching the time spent in bed with the amount of sleep you need. This is achieved by limiting the amount of time spent in your bed not sleeping. You go to bed later and get up earlier then you would normally, and then slowly increase the time in bed until you are able to sleep all night.
- Stimulus control — Conditioning a positive response with getting into bed. For example, using the bed only for sleep and sex.
- Relaxation training — Reducing stress and body tension. This can include meditation, hypnosis, or muscle relaxation.
- Biofeedback — Measuring body actions, such as muscle tension and brain wave frequency, to help you control them.
- Remain passively awake — Trying not to fall asleep, thereby stopping any worries you might have about falling asleep easily.
Medication
In some cases, insomnia is treated with medicine:
In some cases, insomnia is treated with medicine:
- Prescription sleep medicines — Prescription sleep medicines can help some people get much-needed rest. Most sleep medicines are used for short-term treatment, though some people with severe chronic insomnia may benefit from longer treatment. It is important to understand the risks before using a sleep medicine. In some cases, sleep medicines may:
- Become habit-forming
- Mask medical problems that may be causing the insomnia, and delay treatment
- Interact with other medicines you use and cause serious health problems
- Cause grogginess or rebound insomnia, where the sleeping problems get worse
Uncommon side-effects of sleep medicines include:- Severe allergic reactions or facial swelling
- High blood pressure, dizziness, weakness, nausea, confusion, or short-term memory loss
- Complex sleep-related behaviors, such as binge eating or driving while asleep
- Over-the-counter (OTC) sleep aids — OTC sleep aids may help on an occasional sleepless night, but they are not meant for regular or long-term use. Most OTC sleep aids contain antihistamines (ant-ih-HISS-tuh-meenz). Antihistamines are not safe for some people to use. OTC sleep aids also can have some unpleasant side-effects, such as dry mouth, dizziness, and prolonged grogginess.
Some dietary supplements claim to help people sleep. Some are “natural” products like melatonin (mel-uh-TOH-nuhn). Others are food supplements such as valerian (an herb) teas or extracts. The U.S. Food and Drug Administration does not regulate dietary supplements as it does medicine. It is unclear if these products are safe or if they actually work.Talk to your doctor about sleep problems before using an OTC sleep aid. You may have a medical issue that needs to be treated. Also, the insomnia may be better treated in other ways.If you decide to use a sleep medicine, experts advise you to:- Read the Medication Guide first.
- Use the medicine at the time of day directed by your doctor.
- Do not drive or engage in activities that require you to be alert.
- Always take the dose prescribed by your doctor.
- Tell your doctor about other medicines you use.
- Call your doctor right away if you have any problems while using the medicine.
- Avoid drinking alcohol and using drugs.
- Talk to your doctor if you want to stop using the sleep medicine. Some medicines must be stopped gradually.
What can I do to sleep better?
- Try to go to sleep at the same time each night and get up at the same time each morning. Do not take naps after 3 p.m.
- Avoid caffeine, nicotine, and alcohol late in the day or at night.
- Get regular physical activity. But exercise or physical activity done too close to bed time can make it hard to fall asleep. Make sure you eat dinner at least 2 to 3 hours before bedtime.
- Keep your bedroom dark, quiet, and cool. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a "white noise" machine to cover up the sounds.
- Follow a routine to help relax and wind down before sleep, such as reading a book, listening to music, or taking a bath.
- If you can't fall asleep within 20 minutes or don't feel drowsy, get out of bed and sit in your bedroom or another room. Read or do a quiet activity until you feel sleepy. Then try going back to bed.
- If you lay awake worrying about things, try making a to-do list before you go to bed so that you don’t use time in bed for worry.
- Use your bed only for sleep and sex.
- See your doctor or a sleep specialist if you think that you have insomnia or another sleep problem.
Skin Cancer
What is skin cancer?
Cancer is a disease in which cells become abnormal and form more cells in an uncontrolled way. With skin cancer, the cancer begins in cells that make up the skin. The skin is the body's largest organ. It protects us against heat, light, injury, and infection. It regulates body temperature and stores water, fat, and vitamin D. With skin cancer, new cells form when the skin does not need them, and old cells do not die when they should. These extra cells form a mass of tissue called a tumor. Not all tumors are cancer. Tumors that are cancer can invade and damage nearby tissues and organs, and sometimes can spread to other parts of the body.
Skin cancers are named for the type of cells where the cancer starts. The three types are:
- Basal cell carcinoma (BAY-suhl sel kars-uhn-OH-muh) — usually occurs on parts of the skin that have been in the sun a lot, such as the face. It is slow-growing and rarely spreads to other parts of the body.
- Squamous cell carcinoma (SKWAY-muhss sel kars-uhn-OH-muh) — also occurs on parts of the skin that have been in the sun. But also can be found on parts of the skin not exposed to the sun. This type sometimes spreads to other organs inside the body.
- Melanoma (mel-uh-NOH-muh) — the most serious type, this skin cancer is likely to spread to other parts of the body if not caught and treated early. It is much less common than the other types.
Why should I be concerned about skin cancer?
Skin cancer is the most common type of cancer in the United States. About one million Americans get it each year. The number of new cases of skin cancer appears to be rising each year. The number of deaths due to skin cancer, though, is fairly small. The good news is that skin cancer is now almost 100 percent curable if found early and treated promptly.
Ultraviolet (UV) radiation from the sun is the main cause of skin cancer. Other sources of UV radiation, such as sunlamps and tanning booths, also can cause skin cancer. Although anyone can get skin cancer, the risk is greatest for people who have:
- skin that tans poorly or burns easily
- a large number of moles, especially abnormal moles
Varicose Veins and Spider Veins
What are varicose veins and spider veins?
Varicose (VAR-i-kos) veins are enlarged veins that can be blue, red, or flesh-colored. They often look like cords and appear twisted and bulging. They can be swollen and raised above the surface of the skin. Varicose veins are often found on the thighs, backs of the calves, or the inside of the leg. During pregnancy, varicose veins can form around the vagina and buttocks.
Spider veins are like varicose veins but smaller. They also are closer to the surface of the skin than varicose veins. Often, they are red or blue. They can look like tree branches or spiderwebs with their short, jagged lines. They can be found on the legs and face and can cover either a very small or very large area of skin.
What causes varicose veins and spider veins?
Varicose veins can be caused by weak or damaged valves in the veins. The heart pumps blood filled with oxygen and nutrients to the whole body through the arteries. Veins then carry the blood from the body back to the heart. As your leg muscles squeeze, they push blood back to the heart from your lower body against the flow of gravity. Veins have valves that act as one-way flaps to prevent blood from flowing backwards as it moves up your legs. If the valves become weak, blood can leak back into the veins and collect there. (This problem is called venous insufficiency.) When backed-up blood makes the veins bigger, they can become varicose.
Spider veins can be caused by the backup of blood. They can also be caused by hormone changes, exposure to the sun, and injuries.
How common are abnormal leg veins?
About 50 to 55 percent of women and 40 to 45 percent of men in the United States suffer from some type of vein problem. Varicose veins affect half of people 50 years and older.
What factors increase my risk of varicose veins and spider veins?
Many factors increase a person's chances of developing varicose or spider veins. These include:
- Increasing age. As you get older, the valves in your veins may weaken and not work as well.
- Medical history. Being born with weak vein valves increases your risk. Having family members with vein problems also increases your risk. About half of all people who have varicose veins have a family member who has them too.
- Hormonal changes. These occur during puberty, pregnancy, and menopause. Taking birth control pills and other medicines containing estrogen and progesterone also may contribute to the forming of varicose or spider veins.
- Pregnancy. During pregnancy, there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. The growing uterus also puts pressure on the veins. Varicose veins usually improve within 3 months after delivery. More varicose veins and spider veins usually appear with each additional pregnancy.
- Obesity. Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.
- Lack of movement. Sitting or standing for a long time may force your veins to work harder to pump blood to your heart. This may be a bigger problem if you sit with your legs bent or crossed.
- Sun exposure. This can cause spider veins on the cheeks or nose of a fair-skinned person.
Why do varicose veins and spider veins usually appear in the legs?
Most varicose and spider veins appear in the legs due to the pressure of body weight, force of gravity, and task of carrying blood from the bottom of the body up to the heart.
Compared with other veins in the body, leg veins have the toughest job of carrying blood back to the heart. They endure the most pressure. This pressure can be stronger than the one-way valves in the veins.
What are the signs of varicose veins?
Varicose veins can often be seen on the skin. Some other common symptoms of varicose veins in the legs include:
- Aching pain that may get worse after sitting or standing for a long time
- Throbbing or cramping
- Heaviness
- Swelling
- Rash that’s itchy or irritated
- Darkening of the skin (in severe cases)
- Restless legs
Are varicose veins and spider veins dangerous?
Spider veins rarely are a serious health problem, but they can cause uncomfortable feelings in the legs. If there are symptoms from spider veins, most often they will be itching or burning. Less often, spider veins can be a sign of blood backup deeper inside that you can’t see on the skin. If so, you could have the same symptoms you would have with varicose veins.
Varicose veins may not cause any problems, or they may cause aching pain, throbbing, and discomfort. In some cases, varicose veins can lead to more serious health problems. These include:
- Sores or skin ulcers due to chronic (long-term) backing up of blood. These sores or ulcers are painful and hard to heal. Sometimes they cannot heal until the backward blood flow in the vein is repaired.
- Bleeding. The skin over the veins becomes thin and easily injured. When an injury occurs, there can be significant blood loss.
- Superficial thrombophlebitis (throm-bo-fli-BYT-uhs), which is a blood clot that forms in a vein just below the skin. Symptoms include skin redness; a firm, tender, warm vein; and sometimes pain and swelling.
- Deep vein thrombosis, which is a blood clot in a deeper vein. It can cause a “pulling” feeling in the calf, pain, warmth, redness, and swelling. However, sometimes it causes no significant symptoms. If the blood clot travels to the lungs, it can be fatal.
Should I see a doctor about varicose veins?
You should see a doctor about varicose veins if:
- The vein has become swollen, red, or very tender or warm to the touch
- There are sores or a rash on the leg or near the ankle
- The skin on the ankle and calf becomes thick and changes color
- One of the varicose veins begins to bleed
- Your leg symptoms are interfering with daily activities
- The appearance of the veins is causing you distress
If you’re having pain, even if it’s just a dull ache, don’t hesitate to get help. Also, even if you don’t need to see a doctor about your varicose veins, you should take steps to keep them from getting worse (see How can I prevent varicose veins and spider veins? ).
How are varicose veins diagnosed?
Your doctor may diagnose your varicose veins based on a physical exam. Your doctor will look at your legs while you’re standing or sitting with your legs dangling. He or she may ask you about your symptoms, including any pain you’re having. Sometimes, you may have other tests to find out the extent of the problem and to rule out other disorders.
You might have an ultrasound, which is used to see the veins’ structure, check the blood flow in your veins, and look for blood clots. This test uses sound waves to create pictures of structures in your body.
Although less likely, you might have a venogram. This test can be used to get a more detailed look at blood flow through your veins.
If you seek help for your varicose veins, there are several types of doctors you can see, including:
- A phlebologist, which is a vein specialist
- A vascular medicine doctor, who focuses on the blood system
- A vascular surgeon, who can perform surgery and do other procedures
- An interventional radiologist, who specializes in using imaging tools to see inside the body and do treatments with little or no cutting
- A dermatologist, who specializes in skin conditions
Each of these specialists do some or all of the procedures for treating varicose veins. You might start out by asking your regular doctor which specialist he or she recommends. You also might check with your insurance plan to see if it would pay for a particular provider or procedure.
How are varicose and spider veins treated?
Varicose veins are treated with lifestyle changes and medical treatments. These can:
- Relieve symptoms
- Prevent complications
- Improve appearance
Your doctor may recommend lifestyle changes if your varicose veins don’t cause many symptoms. If symptoms are more severe, your doctor may recommend medical treatments. Some treatment options include:
Compression Stockings
Compression stockings put helpful pressure on your veins. There are 3 kinds of compression stockings:
- Support pantyhose, which offer the least amount of pressure. These also often are not “gradient” or “graduated.” That means they provide pressure all over instead of where it is needed most.
- Over-the-counter gradient compression hose, which give a little more pressure. They are sold in medical supply and drugstores.
- Prescription-strength gradient compression hose, which offer the greatest amount of pressure. They are sold in medical supply and drugstores. You need to be fitted for them by someone who has been trained to do this.
Sclerotherapy
Sclerotherapy (SKLER-o-ther-a-pee) is the most common treatment for both spider veins and varicose veins. The doctor uses a needle to inject a liquid chemical into the vein. The chemical causes the vein walls to swell, stick together, and seal shut. This stops the flow of blood, and the vein turns into scar tissue. In a few weeks, the vein should fade. This treatment does not require anesthesia and can be done in your doctor's office. You can return to normal activity right after treatment.
Sclerotherapy (SKLER-o-ther-a-pee) is the most common treatment for both spider veins and varicose veins. The doctor uses a needle to inject a liquid chemical into the vein. The chemical causes the vein walls to swell, stick together, and seal shut. This stops the flow of blood, and the vein turns into scar tissue. In a few weeks, the vein should fade. This treatment does not require anesthesia and can be done in your doctor's office. You can return to normal activity right after treatment.
The same vein may need to be treated more than once. Treatments are usually done every 4 to 6 weeks. You may be asked to wear gradient compression stockings after sclerotherapy to help with healing and decrease swelling. This treatment is very effective when done correctly.
Possible side effects include:
- Stinging, red and raised patches of skin, or bruises where the injection was made. These usually go away shortly after treatment.
- Spots, brown lines, or groups of fine red blood vessels around the treated vein. These also usually go away shortly after treatment.
- Lumps of blood that get trapped in vein and cause inflammation. This is not dangerous. You can relieve swelling by applying heat and taking aspirin. Your doctor can drain the trapped blood with a small pinprick at a follow-up visit.
There is a type of sclerotherapy called ultrasound-guided sclerotherapy (or echo-sclerotherapy). This type of sclerotherapy uses ultrasound imaging to guide the needle. It can be useful in treating veins that cannot be seen on the skin’s surface. It may be used after surgery or endovenous techniques if the varicose veins return. This procedure can be done in a doctor’s office. Possible side effects include skin sores, swelling, injection into an artery by mistake, or deep vein thrombosis (a potentially dangerous blood clot).
Surface Laser Treatments
In some cases, laser treatments can effectively treat spider veins and smaller varicose veins. This technique sends very strong bursts of light through the skin onto the vein. This makes the vein slowly fade and disappear. Not all skin types and colors can be safely treated with lasers.
No needles or incisions are used, but the heat from the laser can be quite painful. Cooling helps reduce the pain. Laser treatments last for 15 to 20 minutes. Generally, 2 to 5 treatments are needed to remove spider veins in the legs. Laser therapy usually isn’t effective for varicose veins larger than 3 mm (about a tenth of an inch). You can return to normal activity right after treatment.
Possible side effects of lasers include:
- Redness or swelling of the skin right after the treatment that disappears within a few days
- Discolored skin that will disappear within 1 to 2 months
- Burns and scars from poorly performed laser surgery, though this is rare
Endovenous Techniques (Radiofrequency and Laser)
These methods for treating the deeper veins of the legs, called the saphenous (SAF-uh-nuhs) veins, have replaced surgery for most patients with severe varicose veins. These techniques can be done in a doctor’s office.
The doctor puts a very small tube, called a catheter, into the vein. A small probe is placed through the tube. A device at the tip of the probe heats up the inside of the vein and closes it off. The device can use radiofrequency or laser energy to seal the vein. The procedure can be done using just local anesthesia. You might have slight bruising after treatment.
Healthy veins around the closed vein take over the normal flow of blood. The symptoms from the varicose vein improve. Usually, veins on the surface of the skin that are connected to the treated varicose vein will also shrink after treatment. If they don’t, these connected veins can be treated with sclerotherapy or other techniques.
Surgery
Surgery is used mostly to treat very large varicose veins. Types of surgery for varicose veins include:
- Surgical ligation and stripping. With this treatment, problem veins are tied shut and completely removed from the leg through small cuts in the skin. Removing the veins does not affect the circulation of blood in the leg. Veins deeper in the leg take care of the larger volumes of blood. This surgery requires general anesthesia and must be done in an operating room. It takes between 1 and 4 weeks to recover from the surgery. This surgery is generally safe. Pain in the leg is the most common side effect. Other possible problems include:
- A risk of heart and breathing problems from anesthesia
- Bleeding and congestion of blood. But, the collected blood usually settles on its own and does not require any further treatment.
- Wound infection, inflammation, swelling, and redness
- Permanent scars
- Damage of nerve tissue around the treated vein. It’s hard to avoid harming small nerve branches when veins are removed. This damage can cause numbness, burning, or a change in feeling around the scar.
- A deep vein blood clot. These clots can travel to the lungs and heart. The medicine heparin may be used to reduce the chance of these dangerous blood clots. But, heparin also can increase the normal amount of bleeding and bruising after surgery.
- PIN stripping. In this treatment, an instrument called a PIN stripper is inserted into a vein. The tip of the PIN stripper is sewn to the end of the vein, and when it is removed, the vein is pulled out. This procedure can be done in an operating room or an outpatient center. General or local anesthesia can be used.
- Ambulatory phlebectomy. With ambulatory phlebectomy (AM-byoo-luh-TOHR-ee fluh-BEHK-toh-mee), tiny cuts are made in the skin, and hooks are used to pull the vein out of the leg. Only the parts of your leg that are being pricked will be numbed with anesthesia. The vein is usually removed in 1 treatment. Very large varicose veins can be removed with this treatment while leaving only very small scars. Patients can return to normal activity the day after treatment. Possible side effects of the treatment include slight bruising and temporary numbness.
How can I prevent varicose veins and spider veins?
Not all varicose and spider veins can be prevented. But, there are some steps you can take to reduce your chances of getting new varicose and spider veins. These same things can help ease discomfort from the ones you already have:
- Wear sunscreen to protect your skin from the sun and to limit spider veins on the face.
- Exercise regularly to improve your leg strength, circulation, and vein strength. Focus on exercises that work your legs, such as walking or running.
- Control your weight to avoid placing too much pressure on your legs.
- Don’t cross your legs for long times when sitting. It’s possible to injure your legs that way, and even a minor injury can increase the risk of varicose veins.
- Elevate your legs when resting as much as possible.
- Don’t stand or sit for long periods of time. If you must stand for a long time, shift your weight from one leg to the other every few minutes. If you must sit for long periods of time, stand up and move around or take a short walk every 30 minutes.
- Wear elastic support stockings and avoid tight clothing that constricts your waist, groin, or legs.
- Avoid wearing high heels for long periods of time. Lower-heeled shoes can help tone your calf muscles to help blood move through your veins.
- Eat a low-salt diet rich in high-fiber foods. Eating fiber reduces the chances of constipation, which can contribute to varicose veins. High-fiber foods include fresh fruits and vegetables and whole grains, like bran. Eating less salt can help with the swelling that comes with varicose veins.
Can varicose and spider veins return even after treatment?
Current treatments for varicose veins and spider veins have very high success rates compared to traditional surgical treatments. Over a period of years, however, more abnormal veins can develop because there is no cure for weak vein valves. Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.
The single most important thing you can do to slow down the development of new varicose veins is to wear gradient compression support stockings as much as possible during the day.
Sexually Transmitted Infections
Chlamydia
What is chlamydia and how common is it?
Chlamydia (kluh-MID-ee-uh) is a sexually transmitted infection (STI). STIs are also called STDs, or sexually transmitted diseases. Chlamydia is an STI caused by bacteria called chlamydia trachomatis. Chlamydia is the most commonly reported STI in the United States. Women, especially young women, are hit hardest by chlamydia.
Women often get chlamydia more than once, meaning they are “reinfected.” This can happen if their sex partners were not treated. Reinfections place women at higher risk for serious reproductive health problems, such as infertility.How do you get chlamydia?
You get chlamydia from vaginal, anal, or oral sex with an infected person. Chlamydia often has nosymptoms. So people who are infected may pass chlamydia to their sex partners without knowing it. The more sex partners you (or your partner) have, the higher your risk of getting this STI.
An infected mother can pass chlamydia to her baby during childbirth. Babies born to infected mothers can get pneumonia (nuh-MOHN-yuh) or infections in their eyes.What are the symptoms of chlamydia?
Chlamydia is known as a "silent" disease. This is because 75 percent of infected women and at least half of infected men have no symptoms.
If symptoms do occur, they most often appear within 1 to 3 weeks of exposure. The infection first attacks the cervix and urethra. Even if the infection spreads to the uterus and fallopian tubes, some women still have no symptoms. If you do have symptoms, you may have:
- Abnormal vaginal discharge
- Burning when passing urine
- Lower abdominal pain
- Low back pain
- Nausea
- Fever
- Pain during sex
- Bleeding between periods
Men with chlamydia may have:
- Discharge from the penis
- Burning when passing urine
- Burning and itching around the opening of the penis
- Pain and swelling in the testicles
The chlamydia bacteria also can infect your throat if you have oral sex with an infected partner.
Chlamydia is often not diagnosed or treated until problems show up. If you think you may have chlamydia, both you and your sex partner(s) should see a doctor right away –– even if you have no symptoms.
Chlamydia can be confused with gonorrhea (gahn-uh-REE-uh), another STI. These STIs have some of the same symptoms and problems if not treated. But they have different treatments.How is chlamydia diagnosed?
A doctor can diagnose chlamydia through:
- A swab test, where a fluid sample from an infected site (cervix or penis) is tested for the bacteria
- A urine test, where a urine sample is tested for the bacteria
Who should get tested for chlamydia?
You should be tested for chlamydia once a year if you are:
- 25 or younger and have sex
- Older than 25 and:
- Have a new sex partner
- Have more than one sex partner
- Have sex with someone who has other sex partners
- Do not use condoms during sex within a relationship that is not mutually monogamous, meaning you or your partner has sex with other people
- Pregnant
What is the treatment for chlamydia?
Antibiotics are used to treat chlamydia. If treated, chlamydia can be cured.
All sex partners should be treated to keep from getting chlamydia again. Do not have sex until you and your sex partner(s) have ended treatment.
Tell your doctor if you are pregnant! Your doctor can give you an antibiotic that is commonly used during pregnancy.
What should I do if I have chlamydia?
Chlamydia is easy to treat. But you should be tested and treated right away to protect your reproductive health. If you have chlamydia:
- See a doctor right away. Women with chlamydia are 5 times more likely to get HIV, the virus that causes AIDS, from an infected partner.
- Follow your doctor’s orders and finish all your antibiotics. Even if symptoms go away, you need to finish all the medicine.
- Don’t engage in any sexual activity while being treated for chlamydia.
- Tell your sex partner(s) so they can be treated.
- See your doctor again if your symptoms don’t go away within 1 to 2 weeks after finishing the medicine.
- See your doctor again within 3 to 4 months for another chlamydia test. This is most important if your sex partner was not treated or if you have a new sex partner.
Doctors, local health departments, and STI and family planning clinics have information about STIs. And they can all test you for chlamydia. Don’t assume your doctor will test you for chlamydia when you have your Pap test. Take care of yourself by asking for a chlamydia test.
The Centers for Disease Control and Prevention (CDC) has free information and offers a list of clinics and doctors who provide treatment for STIs. Call CDC-INFO at 1-800-CDC-INFO (232-4636), TTY: 1-888-232-6348. You can call for information without leaving your name.What health problems can result from untreated chlamydia?
Untreated chlamydia can damage a woman’s reproductive organs and cause other health problems. Like the disease itself, the damage chlamydia causes is often "silent."
For women, untreated chlamydia may lead to:- Pelvic inflammatory disease (PID). PID occurs when chlamydia bacteria infect the cells of the cervix, then spread to the uterus, fallopian tubes, and ovaries. PID occurs in up to 40 percent of women with untreated chlamydia. PID can lead to:
- Infertility, meaning you can’t get pregnant. The infection scars the fallopian tubes and keeps eggs from being fertilized.
- Ectopic or tubal pregnancy. This happens when a fertilized egg implants outside the uterus. It is a medical emergency.
- Chronic pelvic pain, which is ongoing pain, most often from scar tissue.
- Cystitis (siss-TEYE-tuhss), inflammation of the bladder.
- HIV/AIDS. Women who have chlamydia are 5 times more likely to get HIV, the virus that causes AIDS, from a partner who is infected with it.
For men, untreated chlamydia may lead to:
- Infection and scarring of the urethra, the tube that carries urine from the body
- Prostatitis (prah-stuh-TEYE-tuhss), swelling of the prostate gland
- Infection in the tube that carries sperm from the testes, causing pain and fever
- Infertility
For women and men, untreated chlamydia may lead to:
- Chlamydia bacteria in the throat, if you have oral sex with an infected partner
- Proctitis (prok-TEYE-tuhss), which is an infection of the lining of the rectum, if you have anal sex with an infected partner
- Reiter’s syndrome, which causes arthritis, eye redness, and urinary tract problems
For pregnant women, chlamydia infections may lead to premature delivery. And babies born to infected mothers can get:
- Infections in their eyes, called conjunctivitis (kuhn-junk-tih-VEYE-tuhss) or pinkeye. Symptoms include discharge from the eyes and swollen eyelids. The symptoms most often show up within the first 10 days of life. If left untreated, it can lead to blindness.
- Pneumonia. Symptoms include congestion and a cough that keeps getting worse. Both symptoms most often show up within 3 to 6 weeks of birth.
How can chlamydia be prevented?
You can take steps to lower your risk of getting chlamydia and other STIs. The following steps work best when used together. No single strategy can protect you from every type of STI.
- Don’t have sex. The surest way to avoid getting chlamydia or any STI is to practice abstinence. This means not having vaginal, anal, or oral sex.
- Be faithful. Having sex with only one unaffected partner who only has sex with you will keep you safe from chlamydia and other STIs. Both parthers must be faithful all the time to avoid STI exposure. This means you have sex only with each other and no one else. The fewer sex partners you have, the lower your risk of being exposed to chlamydia and other STIs.
- Use condoms correctly and every time you have sex. Use condoms for all types of sexual contact, even if pen etration does not take place. Condoms work by keeping blood, a man’s semen, and a woman’s vaginal fluid — all of which can carry chlamydia — from pass ing from one person to another. Use protection from the very beginning to the very end of each sex act, and with every sex partner. And be prepared: Don’t rely on your partner to have protection.
- Know that most methods of birth control — and other methods — will not protect you from chlamydia and other STIs. Birth control methods including the pill, shots, im plants, intrauterine devices (IUDs), diaphragms, and spermicides will not protect you from STIs. If you use one of these birth control methods, make sure to also use a condom with every sex act. You might have heard of other ways to keep from getting STIs — such as washing genitals before sex, passing urine after sex, douching after sex, or washing the genital area with vinegar after sex. These methods do not prevent the spread of STIs.
- Talk with your sex partner(s) about STIs and using condoms before having sex. Make it clear that you will not have any type of sex at any time without a condom. It’s up to you to make sure you are protected. Remember, it’s your body! For more information, call the CDC at (800) 232-4636.
- Get tested for STIs. If either you or your partner has had other sexual part ners in the past, get tested for STIs before becoming sexually active. This includes women who have sex with women. Most women who have sex with women have had sex with men, too. So a woman can get an STI, including chlamydia, from a male partner, and then pass it to a female partner. Don’t wait for your doctor to ask you about getting tested — ask your doctor! Many tests for STIs can be done at the same time as your regular pelvic exam.
- Learn the symptoms of chlamydia. But remember, chlamydia often has no symptoms. Seek medical help right away if you think you may have chlamydia or another STI.
- Have regular checkups and pelvic exams — even if you think you’re healthy. During the checkup, your doctor will ask you a lot of questions about your lifestyle, including your sex life. This might seem too personal to share. But answering honestly is the only way your doctor is sure to give you the care you need.
Bacterial Vaginosis
What is bacterial vaginosis (BV)?
The vagina normally has a balance of mostly “good” bacteria and fewer “harmful” bacteria. Bacterial vaginosis, known as BV, develops when the balance changes. With BV, there is an increase in harmful bacteria and a decrease in good bacteria. BV is the most common vaginal infection in women of childbearing age.
What causes BV?
Not much is known about how women get BV. Any woman can get BV. But there are certain things that can upset the normal balance of bacteria in the vagina, raising your risk of BV:
- Having a new sex partner or multiple sex partners
- Douching
- Using an intrauterine device (IUD) for birth control
- Not using a condom
BV is more common among women who are sexually active, but it is not clear how sex changes the balance of bacteria. You cannot get BV from:
- toilet seats
- bedding
- swimming pools
- touching objects around you
What are the signs of BV?
Women with BV may have an abnormal vaginal discharge with an unpleasant odor. Some women report a strong fish-like odor, especially after sex. The discharge can be white (milky) or gray. It may also be foamy or watery. Other symptoms may include burning when urinating, itching around the outside of the vagina, and irritation. These symptoms may also be caused by another type of infection, so it is important to see a doctor. Some women with BV have no symptoms at all.
How can I find out if I have BV?
There is a test to find out if you have BV. Your doctor takes a sample of fluid from your vagina and has it tested. Your doctor may also see signs of BV during an examination of the vagina. To help your doctor find the signs of BV or other infections:
- Schedule the exam when you do not have your period.
- Don’t douche for at least 24 hours before seeing your doctor. Experts suggest that women do not douche at all.
- Don’t use vaginal deodorant sprays. They might cover odors that are important for diagnosis. It may also lead to irritation.
- Don’t have sex or put objects, such as a tampon, in your vagina for at least 24 hours before going to the doctor.
How is BV treated?
BV is treated with antibiotic medicines prescribed by your doctor. Your doctor may give you either metronidazole (met-roh-NIH-duh-zohl) or clindamycin (klin-duh-MY-sin). Generally, male sex partners of women with BV don’t need to be treated. However, BV can be spread to female partners. If your current partner is female, talk to her about treatment. You can get BV again even after being treated.
Is it safe to treat pregnant women who have BV?
All pregnant women with symptoms of BV should be tested and treated if they have it. This is especially important for pregnant women who have had a premature delivery or low birth weight baby in the past. There are treatments available at any stage of your pregnancy. Be sure to talk to your doctor about what is right for you.
Can BV cause health problems?
In most cases, BV doesn't cause any problems. But some problems can arise if BV is untreated.
- Pregnancy problems. BV can cause premature delivery and low birth weight babies (less than five pounds).
- PID. Pelvic inflammatory disease or PID is an infection that can affect a woman's uterus, ovaries, and fallopian tubes. Having BV increases the risk of getting PID after a surgical procedure, such as ahysterectomy or an abortion.
- Higher risk of getting HIV and other sexually transmitted infections (STIs). Having BV can raise your risk of HIV, chlamydia, and gonorrhea. Women with HIV who get BV are also more likely to pass HIV to a sexual partner.
How can I lower my risk of BV?
Experts are still figuring out the best way to prevent BV. But there are steps you can take to lower your risk.
- Help keep your vaginal bacteria balanced. Wash your vagina and anus every day with mild soap. When you go to the bathroom, wipe from your vagina to your anus. Keep the area cool by wearing cotton or cotton-lined underpants. Avoid tight pants and skip the pantyhose in summer.
- Don't douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may raise your risk of BV. It may also make it easier to get BV again after treatment.
- Have regular pelvic exams. Talk with your doctor about how often you need exams, as well as STI tests.
- Finish your medicine. If you have BV, finish all the medicine your doctor gives you to treat it. Even if the symptoms go away, you still need to finish all of the medicine.
Practicing safe sex is also very important. Below are ways to help protect yourself.
- Don’t have sex. The best way to prevent any STI is to not have vaginal, oral, or anal sex.
- Be faithful. Having sex with just one partner can also lower your risk. Be faithful to each other. That means that you only have sex with each other and no one else.
- Use condoms. Protect yourself with a condom EVERY time you have vaginal, anal, or oral sex. Condoms should be used for any type of sex with every partner. For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. For oral sex, use a condom or a dental dam. A dental dam is a rubbery material that can be placed over the anus or the vagina before sexual contact.
- Talk with your sex partner(s) about STIs and using condoms. It’s up to you to make sure you are protected. Remember, it’s YOUR body! For more information, call the Centers for Disease Control and Prevention at (800) 232-4636.
- Talk frankly with your doctor or nurse and your sex partner(s) about any STIs you or your partner(s) have or had. Talk about any discharge in the genital area. Try not to be embarrassed.
Genital Herpes
What is genital herpes?
Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2. HSV-1 can cause genital herpes. But it more commonly causes infections of the mouth and lips, called “fever blisters.”
Most people have no or few symptoms from herpes infection. When symptoms do occur, they usually appear as 1 or more blisters on or around the genitals or rectum. The blisters break, leaving tender sores that may take up to 4 weeks to heal. Another outbreak can appear weeks or months later. But it almost always is less severe and shorter than the first outbreak.
Although the infection can stay in the body forever, the outbreaks tend to become less severe and occur less often over time. You can pass genital herpes to someone else even when you have no symptoms.
How common is genital herpes?
Genital herpes is common. At least 45 million Americans age 12 and older have genital herpes. Genital HSV-2 infection is more common in women than men. About 1 in 4 women have HSV-2 infection compared to almost 1 in 8 men. This is due to the fact that women can get genital herpes and some other STIs more easily than men.
How is genital herpes spread?
You can get genital herpes through genital-genital contact or genital-oral contact with someone who has herpes infection. The virus is most easily spread through contact with open sores. But you also can get the virus from skin that does not appear to have a sore. You can become infected with the herpes virus without having intercourse.
What are the symptoms of genital herpes?
The symptoms of genital herpes vary from person to person. Most people with genital herpes are not aware they are infected. But, if symptoms do occur with the first outbreak, they can be severe. Genital herpes infection also can be severe and long-lasting in people whose immune systems don’t work properly, such as people with HIV.
The first outbreak usually happens within 2 weeks of having sexual contact with an infected person, and symptoms can last from 2 to 3 weeks. Early symptoms of the first outbreak can include:
- Itching or burning feeling in the genital or anal area
- Flu-like symptoms, including fever
- Swollen glands
- Pain in the legs, buttocks, or genital area
- Vaginal discharge
- A feeling of pressure in the area below the stomach
Within a few days, sores show up where the virus has entered the body, such as on the mouth, penis, or vagina. Sores can also show up on a woman’s cervix or in the urinary passage in men. The sores are small red bumps that may turn into blisters or painful open sores. Over a period of days, the sores become crusted and then heal without scarring. Sometimes with the first outbreak, a second crop of sores appear and flu-like symptoms occur again.
Some people have no symptoms. Or they might mistaken mild sores for insect bites or something else. Yet even without symptoms, a person can still pass the herpes virus to others. So, if you have signs of herpes, see your doctor to find out if you are infected.
If you have herpes, do not have any sexual activity with an uninfected partner when you have sores or other symptoms of herpes. Even if you don’t have symptoms, you can still pass the virus to others. |
Can genital herpes come back?
Yes. Herpes symptoms can come and go, but the virus stays inside your body even after all signs of the infection have gone away. In most people, the virus becomes “active” from time to time, creating an outbreak. Some people have herpes virus outbreaks only once or twice. People who have a first outbreak can expect to have 4 or 5 outbreaks within a year. Over time, the outbreaks tend to occur less often and be less severe. Experts don't know what causes the virus to become active. Some women say the virus comes back when they are sick, under stress, out in the sun, or during their period.
How do I know for sure if I have genital herpes?
Doctors can diagnose genital herpes by looking at visible sores if the outbreak is typical and by taking a sample from the sore for testing in a lab. Some cases of herpes are harder to diagnose, especially between outbreaks. Blood tests that look for antibodies to HSV-1 or HSV-2 can help to detect herpes infection in people without symptoms or between outbreaks.
What is the treatment for genital herpes?
Genital herpes cannot be cured; the virus will always be in your body. But the antiviral drugs acyclovir,valacyclovir, and famciclovir can shorten outbreaks and make them less severe, or stop them from happening. Valacyclovir (brand name Valtrex) also can lower your risk of passing the infection to someone else.
Depending on your needs, your doctor can give you drugs to take right after getting outbreak symptoms or drugs to take on a regular basis to try to stop outbreaks from happening. Talk to your doctor about treatment options.
During outbreaks, these steps can speed healing and help keep the infection from spreading to other sites of the body or to other people:
- Keep the infected area clean and dry.
- Try not to touch the sores.
- Wash hands after contact.
- Avoid sexual contact from the time you first notice symptoms until the sores have healed.
Is there a cure for genital herpes?
No. Once you have the virus, it stays in your body and there is a chance that you will have outbreaks. Medicine can shorten and stop outbreaks from happening.
Research is underway to develop new ways to protect women from the herpes virus and prevent its spread. One large study is testing a herpes vaccine for women. Researchers are also working to make gels or creams that would kill the virus before it could infect someone.
Can genital herpes cause problems during pregnancy?
Yes. If the mother is having her first outbreak near the time of delivery, she is much more likely to pass the virus to her baby. If the outbreak is not the first one, the baby's risk of getting the virus is very low. Babies born with herpes may be premature or may die, or they may have brain damage, severe rashes, or eye problems. Doctors may do a cesarean delivery if the mother has herpes sores near the birth canal to lower the risk of passing the virus. Fortunately, most women with genital herpes have healthy babies. Also, medicines can help babies born with herpes if they are treated right away.
It is not yet known if all genital herpes drugs are safe for pregnant women to take. Some doctors may recommend acyclovir be taken either as a pill or through an IV (a needle into a vein) during pregnancy. Let your doctor know if you have genital herpes, even if you are not having an outbreak. He or she will help you manage it safely during pregnancy.
Can I breastfeed if I have genital herpes?
If you have genital herpes, you can keep breastfeeding as long as the sores are covered. Herpes is spread through contact with sores and can be dangerous to a newborn. If you have sores on your nipple or areola, the darker skin around the nipple, you should stop breastfeeding on that breast. Pump or hand express your milk from that breast until the sore clears. Pumping will help keep up your milk supply and prevent your breast from getting overly full. You can store your milk to give to your baby in a bottle at another feeding. If the parts of your breast pump that contact the milk also touch the sore(s) while pumping, you should throw the milk away.
Can genital herpes cause other problems?
Genital herpes infection usually does not cause serious health problems in healthy adults. People whoseimmune systems don’t work properly, such as people with HIV, can have severe outbreaks that are long-lasting. Sometimes, people with normal immune systems can get herpes infection in the eye. But this is less common with HSV-2 infection.
Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes sores can make it easier for HIV to get into your body. Also, herpes can make people who are HIV-positive more infectious.
Living with herpes can be hard to cope with even if you have no symptoms. At first, you might feel embarrassed or ashamed. You might worry whether having herpes will affect your relationship with your sexual partner or keep you from having meaningful relationships in the future. Keep in mind that millions of people have herpes. And not unlike many other health issues, treatment can help you manage the infection. After a little time, most people with herpes are able to adjust to the diagnosis and move on. Let your doctor know if you’re having a hard time adjusting. Talking to someone about your feelings may help.
What can I do to keep from getting genital herpes?
There are things you can do to lower your risk of getting genital herpes:
- Don’t have sex. The surest way to prevent any STI, including genital herpes, is to practice abstinence, or not having vaginal, oral, or anal sex. Keep in mind, you can get genital herpes from close contact other than sexual intercourse.
- Be faithful. Having a sexual relationship with one partner who has been tested for herpes and is not infected is another way to lower your risk of getting infected. Be faithful to each other, meaning that you only have sex with each other and no one else.
- Use condoms. Use condoms correctly and every time you have any type of sex. For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. For oral sex, use a dental dam. Keep in mind that condoms may not cover all infected areas, so you can still get herpes even if you use a condom.
- Know that some methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs. If you use one of these methods, be sure to also use a latex condom or dental dam correctly and every time you have sex.
- Talk with your sex partner(s) about STIs and using condoms. It’s up to you to make sure you are protected. Remember, it’s your body! For more information, call the Centers for Disease Control and Prevention at (800) 232-4636. If your partner is infected, take steps to lower your risk of getting herpes from your partner.
- Talk frankly with your doctor and your sex partner(s) about any STIs you or your partner has or has had. If you feel embarrassed, try to put this aside. Your doctor is there to help you with any and all health problems. Also, being open with your partners can help you protect your health and the health of others.
- Know the symptoms. Learn the common symptoms of genital herpes and other STIs. Do not have oral-genital contact if you or your partner has any signs of oral herpes, such as a fever blister. Seek medical help right away if you think you may have genital herpes or another STI. Don’t have sexual contact until you have seen your doctor.
What should I do if I have genital herpes?
- See your doctor for testing and treatment right away.
- Follow your doctor’s orders and finish all the medicine that you are given. Even if the symptoms go away, you still need to finish all of the medicine.
- Avoid having any sexual activity while you are being treated for genital herpes and while you have any symptoms of an outbreak.
- Be sure to tell your sexual partners, so they can be tested.
- Remember that genital herpes is a life-long disease. Even though you may have long periods with no symptoms, you can still pass the virus to another person. Talk with your doctor about what you can do to have fewer future outbreaks, and how to prevent passing the virus to another person.
What should I do if my partner has genital herpes?
- Get tested to find out if you also are infected with the herpes virus.
- Avoid having any sexual activity while your partner is being treated for a genital herpes outbreak or if your partner has symptoms of an outbreak, such as open sores.
- Use condoms correctly and every time you have sex to lower your risk of becoming infected. Keep in mind that you can become infected with the herpes virus since condoms do not always cover all infected areas. Also, the virus can spread even if no symptoms are present.
- Talk to your partner about using daily suppressive therapy to reduce the number of outbreaks and lower the risk of infecting you with the virus.
Gonorrhea
What is gonorrhea?
Gonorrhea (gon-uh-REE-uh) is a common sexually transmitted infection (STI). It’s caused by a type of bacteria that can grow in warm, moist areas of the reproductive tract, like the cervix, uterus, and fallopian tubes in women. It can grow in the urethra in men and women. It can also grow in the mouth, throat, eyes, and anus.
How do you get gonorrhea?
You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A man does not need to ejaculate to pass the infection or to become infected. Touching infected sex organs, like the vagina or penis, and then touching your eyes can cause an eye infection. Gonorrhea is not spread by shaking hands or sitting on toilet seats.
Gonorrhea also can be passed from a pregnant woman to her baby during delivery. In babies, gonorrhea infection can cause blindness, joint infection, or a life-threatening blood infection.
Who is at risk for gonorrhea?
Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans. In 2007, young women had over two times the gonorrhea rate of young men.
What are the symptoms of gonorrhea?
Many women who have gonorrhea do not have symptoms. When a woman does have symptoms, they often appear within 10 days of getting the STI. But symptoms can be so mild or general that they are overlooked or mistaken for something else.
A woman may have some of these symptoms:
- Pain or burning when passing urine
- Vaginal discharge that is yellow or sometimes bloody
- Bleeding between menstrual periods
- Heavy bleeding with periods
- Pain during sex
If you have any of these symptoms, stop having sex and see a doctor right away. Women with gonorrhea are at risk of developing serious health problems, whether or not there are symptoms.
For women and men, symptoms of an anal infection can include discharge, soreness, bleeding, or itching of the anus, and painful bowel movements. Infections in the throat may cause a sore throat but usually cause no symptoms. With an eye infection, symptoms may include redness, itching, or discharge from the eye.
For men, symptoms can include:
- Discharge from or pain inside the penis
- Pain or burning while passing urine
- Painful or swollen testicles
If your partner has any of these symptoms, stop having sex and ask your doctor about testing for both of you.
Are there tests for gonorrhea?
Yes. There are 3 types of tests for gonorrhea:
- Swab sample. A swab sample from the part of the body likely to be infected (cervix, urethra, penis, rectum, or throat) can be sent to a lab for testing.
- Urine test. Gonorrhea in the cervix or urethra can be diagnosed with a urine sample sent to a lab.
- Gram stain. This is done right in a clinic or doctor's office. A sample from the urethra or a cervix is placed on a slide and stained with dye. It allows the doctor to see the bacteria under a microscope. This test works better for men than for women.
Talk to your doctor about getting tested if you have any symptoms of gonorrhea, if you think you or your partner could have it, or if you know your partner has it. If you are tested for gonorrhea, you also should be tested for other STIs, including chlamydia, syphilis, and HIV.
How is gonorrhea treated?
Antibiotics are used to cure gonorrhea. But more and more people are becoming infected with types of gonorrhea that do not respond well to drugs. This problem is making it harder to treat gonorrhea. Many people who have gonorrhea also have chlamydia. So, doctors often give medicine to treat both STIs at the same time. For treatment to work, you must finish all the medicine that your doctor gives you, even if the symptoms go away. If symptoms don’t go away after treatment, see your doctor. Although treatment can cure the infection, it cannot fix any permanent damage done by the infection. Also, you can get gonorrhea again if you have sex with an infected person.
What happens if gonorrhea isn't treated?
Gonorrhea that is not treated can cause these serious problems in women:
- Pelvic inflammatory disease (PID). PID is an infection of a woman's reproductive organs above the cervix, such as the fallopian tubes and ovaries. Untreated gonorrhea is a common cause of PID. PID can lead to infertility, pregnancy problems, and pelvic pain. Some women have no symptoms of PID, and the damage caused by PID cannot be fixed. This is why finding out about and treating gonorrhea is so important.
- Widespread infection to other parts of the body, like the blood, joints, or heart.
- Increased risk of getting HIV or spreading HIV.
Can gonorrhea cause problems during pregnancy?
Yes. A pregnant woman with untreated gonorrhea has a higher risk of miscarriage, preterm birth, or having her water break too early. Also, her baby could get the infection while passing through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby. Treating the newborn’s eyes with medicine right after birth can prevent eye infection. Treatment of gonorrhea as soon as it is found in pregnant women will lower the risk of these problems. All sex partners of pregnant women with gonorrhea must also be treated. If you are pregnant, ask your doctor about testing for STIs, including gonorrhea. Testing is simple, and treatment usually cures the infection and prevents problems for the baby.
How can I keep from getting gonorrhea?
There are steps you can take to lower your risk of getting gonorrhea:
- Don’t have sex. The surest way to keep from getting gonorrhea is to practice abstinence. This means not having vaginal, oral, or anal sex.
- Be faithful. Having a sexual relationship with one partner who has been tested for gonorrhea and is not infected is another way to lower your risk of getting infected. Be faithful to each other. This means you only have sex with each other and no one else.
- Use condoms. Use condoms the right way and every time you have vaginal, anal, or oral sex. Because a man does not need to ejaculate to give or get gonorrhea, make sure to put on the condom before the penis touches the vagina, mouth, or anus. Use a new condom if you want to have sex again or in a different way. For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. For oral sex use a male latex condom. A dental dam might offer some protection during oral sex (mouth to vagina/anus).
- Know that some methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs, including gonorrhea. If you use one of these methods, be sure to also use a condom correctly every time you have sex.
- Talk with your sex partner(s) about STIs and using condoms. It’s up to you to make sure you are protected. Remember, it’s your body! For more information, call the Centers for Disease Control and Prevention at (800) 232-4636.
- Talk frankly with your doctor and your sex partner(s) about any STIs you or your partner has or has had. Talk about symptoms, such as sores or discharge. Try not to be embarrassed. Being honest could prevent serious health problems.
- Have a yearly pelvic exam. Ask your doctor if you should be tested for gonorrhea or other STIs, and how often you should be retested. Testing for many STIs is simple and often can be done during your checkup. The sooner gonorrhea is found, the more likely it can be cured before permanent damage is done.
- If you are pregnant, get tested for gonorrhea. Get tested as soon as you think you may be pregnant.
I just found out I have gonorrhea. What should I do?
- Finish all the medicine that your doctor gives you. Even if the symptoms go away, you still need to finish treatment. If symptoms continue after treatment, see your doctor.
- Talk with your sex partner(s). Your sex partner(s) should get tested and treated for gonorrhea, even if they don’t have any symptoms.
- Avoid sexual contact until you and your partner(s) have been treated and cured. People who have had gonorrhea and were treated can get infected again if they have sexual contact with a person who has gonorrhea.
- Once you have been treated and cured, take steps to lower your risk from getting gonorrhea again.
Viral Hepatitis
What is hepatitis?
Hepatitis means liver inflammation. Viral hepatitis means that a person has liver inflammation due to a virus. Viral infection of the liver makes the liver swell up and stop working well. The liver is an important organ. It helps your body with these functions:
- Digests food
- Stores energy
- Removes poisons
There are five types of viral hepatitis. The most common types in the United States are viral hepatitis A, B, and C.
What are the signs of viral hepatitis?
Some people with viral hepatitis have no signs of the infection. For other people, these signs might occur:
- Low grade fever
- Headache
- Muscle aches
- Tiredness
- Loss of appetite
- Nausea
- Vomiting
- Diarrhea
- Dark-colored urine and pale bowel movements
- Pain in the stomach
- Skin and whites of the eyes turning yellow, also called jaundice
What are the types of viral hepatitis?
Hepatitis A
- How you get it: Eating food or drinking water contaminated with feces, or the bowel movement (BM), from a person infected with the hepatitis A virus (HAV). It can also be caused by anal-oral contact. Some examples include:
- Eating food contaminated by a person with hepatitis A who prepares food. It can happen if the person did not wash his hands after using the bathroom and then touched the food.
- From infected household members or sexual partners
- Diaper changing tables, if not cleaned properly
- Eating raw selfish that came from sewage-contaminated water
- What it does to your body: While it can cause swelling of the liver, it doesn't normally cause permanent liver damage.
- Treatment: It usually gets better on its own. Almost everyone who gets hepatitis A gets better.
- Prevention:
- Get the hepatitis A vaccine. The vaccine is given in two doses, 6 to 18 months apart. The vaccine is recommended for the following groups:
- Travelers to areas with high rates of hepatitis A
- Men who have sex with men
- Injecting and non-injecting drug users
- Persons with clotting factor disorders, like hemophilia
- People with chronic liver disease
- Children who live in areas that had historically high rates of hepatitis A from 1987-1997
- Get an immune globulin (IG) shot for short-term protection. If you’re traveling to a place where hepatitis A is common and leaving in less than 4 weeks, an IG shot can temporarily keep you from getting the virus. An IG shot can also be given within 2 weeks after exposure to hepatitis A.
- Be careful about drinking the tap water when traveling internationally.
- Wash your hands with soap and water after using the toilet, changing a diaper, and before preparing and eating food.
- People who get hepatitis A once will not get it again.
Hepatitis B
- How you get it: Contact with a person infected with the hepatitis B virus (HBV). This can occur through having sex with an infected person, from an infected mother to her baby during childbirth, or through sharing needles with an infected person.
- What it does to your body: The liver swells, and liver damage can occur. Most people will get rid of the virus after a few months. Some people are not able to get rid of the virus, which makes the infection chronic, or life-long. This may lead to a scarring of the liver, called cirrhosis, liver failure, and can also lead to liver cancer.
- Treatment: Acute hepatitis B usually gets better on its own. Most people develop immunity to the virus and after recovery, can’t give it to others. Someone with chronic (long-term) hepatitis B still carries the virus and can pass it to others. Chronic hepatitis B can be treated with the drugs interferon, lamivudine, or adefovir. These drugs do not work for everyone.
- Prevention:
- Get the hepatitis B vaccine. The vaccine is usually given through 3 injections over 6 months. The vaccine is recommended for the following groups:
- All girls and boys from 0 to 18 years old
- A person whose sex partner has chronic hepatitis B
- Men who have sex with men
- Someone who has been recently diagnosed with a sexually transmitted disease
- People with multiple sex partners
- Someone who shoots drugs
- Someone who lives with a person with chronic hepatitis B
- People whose jobs expose them to human blood
- If you are having sex, but not with one steady partner, use latex condoms correctly and every time you have sex. Using condoms may lower your risk of getting hepatitis B.
- Don't share anything that could have an infected person's blood on it, like toothbrushes, razors, nail clippers, or washcloths.
- Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else's blood on them or if the artist or piercer does not follow good health practices.
- If you are a health care or public safety worker, get vaccinated against hepatitis B, and always follow routine barrier precautions and safely handle needles and other sharp objects.
- People with hepatitis B should not donate blood, organs, or tissue.
- Do not shoot drugs. If you shoot drugs, stop and get into a treatment program. If you can't stop, never share drugs, needles, syringes, water, or "works," and get vaccinated against hepatitis A and B.
- If exposed to hepatitis B, get a hepatitis B immune globulin injection within 14 days following exposure, and begin the hepatitis B vaccine series.
- If you are pregnant, get a blood test for hepatitis B. Infants born to infected mothers should be given hepatitis B immune globulin and vaccine within 12 hours after birth.
- If you have chronic hepatitis B, make sure your babies get all of their hepatitis B shots with the last shot at 6 months of age.
Hepatitis C
- How you get it: Most often through sharing injection drugs with a person infected with the hepatitis C virus (HCV). Many people don’t have symptoms and don’t know they have it.
- What it does to your body: Causes swelling of the liver and liver damage. Most people who are infected with HCV develop a chronic infection. This might lead to scarring of the liver, called cirrhosis, liver failure, and can also lead to liver cancer.
- Treatment: In some cases, it gets better on its own. The current treatment of choice is combination therapy using pegylated interferon and ribavirin.
- Prevention:
- Do not shoot drugs. If you shoot drugs, stop and get into a treatment program. If you can't stop, never share drugs, needles, syringes, water, or "works," and get vaccinated against hepatitis A and B.
- Don't share personal items like toothbrushes, razors, or nail clippers.
- Get vaccinated against hepatitis A if your liver is damaged and hepatitis B if you are in a group at increased risk of getting hepatitis B.
- Limit sexual partners and use latex condoms every time you have sex.
- Cover your cuts and open sores.
Hepatitis D
- How you get it: Contact with a person infected with the hepatitis D virus (HDV). You also must have current HBV infection to get HDV infection. HDV infection can occur by sharing needles to inject drugs, by having sex with an infected person, and from infected mother to child during childbirth.
- What it does to your body: Causes swelling of the liver and can lead to liver disease and cirrhosis.
- Treatment: It might get better on its own. Antiviral drugs might be helpful in treating chronic HDV infection.
- Prevention:
- Get hepatitis B vaccine.
- Do not shoot drugs. If you shoot drugs, stop and get into a treatment program. If you can't stop, never share drugs, needles, syringes, water, or "works," and get vaccinated against hepatitis A and B.
- Don't share personal items like toothbrushes, razors, and nail clippers with someone who has the virus.
- Use latex condoms every time you have sex.
Hepatitis E
- How you get it: A person can get infected with hepatitis E virus (HEV) by eating food or drinking water contaminated with feces from an infected person. Hepatitis E is usually a disease that occurs in persons who travel to areas that have high rates of HEV infection. This type of hepatitis is not common in the United States.
- What it does to your body: It causes swelling of the liver, but no long-term damage. Pregnant women and their babies are at increased risk of dying if infected with HEV.
- Treatment: It usually goes away on its own.
- Prevention: Be careful about drinking the tap water and eating uncooked foods when traveling internationally.
What’s the difference between acute viral hepatitis and chronic viral hepatitis?
Acute viral hepatitis is a short-term, viral infection. Chronic viral hepatitis is a longer-lasting, and generally life-long, viral infection lasting at least six months. To find out if you have acute or chronic viral hepatitis, your doctor will do a medical evaluation that includes blood tests.
How is viral hepatitis diagnosed?
Through blood tests and a medical evaluation. There are different blood tests, depending on the type of viral hepatitis that the doctor thinks you have.
Is it safe to visit someone with hepatitis?
It is safe to visit someone with viral hepatitis. You cannot get hepatitis through casual contact. It is ok to shake hands with, hug, or kiss someone who is infected with any of the viral hepatitis types.
How does a pregnant woman pass hepatitis B virus to her baby?
During the birth, blood from the mother gets inside the baby’s body. A very small number of babies get infected while the infected mother is pregnant. There is no treatment to prevent this from happening.
Can I breastfeed my baby if I have hepatitis B?
Yes, you can. Make sure your baby gets a shot called H-BIG and a shot of hepatitis B vaccine within 12 hours of birth. Take good care of your nipple areas to prevent cracking and bleeding. If your nipples are cracking or bleeding, avoid nursing your baby on that breast until the sores heal. Until they heal, you can pump your milk to keep up your milk supply. But you should discard this pumped milk.
If I have hepatitis B, what does my baby need so that she doesn't get the virus?
Make sure your baby gets all three hepatitis B shots plus H-BIG. If you are a mother with hepatitis B, follow this schedule for your baby:
- At birth: hepatitis B vaccine and H-BIG
- 1 to 2 months old: hepatitis B vaccine
- 6 months old: hepatitis B vaccine (not before 24 weeks, but no later than six months)
These shots will fight off the virus, and they are safe for your baby. If your baby gets those shots, there is a much lower chance your baby will get hepatitis B. A few months after your baby gets all of these shots, the doctor should do blood tests to see if your baby has the virus or if your baby is protected from HBV infection. If your baby does not get these shots, the baby has a very high chance of getting hepatitis B and developing serious liver disease.
How long do the hepatitis A and B vaccines protect you?
Only 1 series of the hepatitis A vaccine (2 shots) and hepatitis B vaccine (3 shots) is needed during a person's lifetime. Currently, there are no recommendations to give booster doses of either hepatitis A or hepatitis B vaccine.
Human Papillomavirus (HPV) and Genital Warts
What is human papillomavirus (HPV)?
Human papillomavirus (pap-uh-LOH-muh-veye-ruhss), or HPV, is the name for a group of viruses that includes more than 100 types. More than 40 types of HPV can be passed through sexual contact.
The types of HPV that infect the genital area are called genital HPV. Over half of sexually active people will have HPV at some point in their lives. But most people never know it. This is because HPV most often has no symptoms and goes away on its own.
How many people have HPV?
Genital HPV is the most common sexually transmitted infection (STI) in the United States. About 20 million Americans ages 15 to 49 currently have HPV. And at least half of all sexually active men and women get genital HPV at some time in their lives.
What is the difference between the high-risk and low-risk types of HPV?
Some types of HPV can cause cervical cancer. These types of HPV are called high-risk. Having high-risk HPV is not the same as having cervical cancer. But high-risk HPV can lead to cancer. Most often, high-risk HPV causes no health problems and goes away on its own. High-risk HPV cases that don’t go away are the biggest risk factor for cervical cancer. If you have high-risk HPV, your doctor can look for changes on your cervix during Pap tests. Changes can be treated to try to prevent cervical cancer. Be sure to have regular Pap tests so changes can be found early.
Low-risk HPV can cause genital warts. Warts can form weeks, months, or years after sexual contact with an infected person. In women genital warts can grow:- Inside and around the outside of the vagina
- On the vulva ("lips" or opening to the vagina), cervix, or groin
- In or around the anus
In men, genital warts can grow:
- On the penis
- On the scrotum, thigh, or groin
- In or around the anus
Rarely, genital warts grow in the mouth or throat of a person who had oral sex with an infected person.
The size of genital warts varies. Some are so small you can't see them. They can be flat and flesh-colored or look bumpy like cauliflower. They often form in clusters or groups. They may itch, burn, or cause discomfort.
Low-risk HPV doesn’t always cause warts. In fact, most people with low-risk HPV never know they are infected. This is because they don't get warts or any other symptoms.How do women get HPV?
Genital HPV is passed by skin-to-skin and genital contact. It is most often passed during vaginal and anal sex. Although much less common, it is possible to pass HPV during oral sex or hand to genital contact.
Should I get the HPV vaccine?
It depends on your age and whether or not you already have had sex.
Two vaccines (Cervarix and Gardasil) can protect girls and young women against the types of HPV that cause most cervical cancers. The vaccines work best when given before a person's first sexual contact, when she could be exposed to HPV. Both vaccines are recommended for 11 and 12 year-old girls. But the vaccines also can be used in girls as young as 9 and in women through age 26 who did not get any or all of the shots when they were younger. These vaccines are given in a series of 3 shots. It is best to use the same vaccine brand for all 3 doses. Ask your doctor which brand vaccine is best for you. The vaccine does not replace the need to wear condoms to lower your risk of getting other types of HPV and other sexually transmitted infections. Women who have had the HPV vaccine still need to have regular Pap tests.
Studies are also being done on HPV vaccines for males.
How do I know if I have an HPV infection?
Most women who have HPV infections never know it. This is one reason why you need regular Pap tests. A Pap test is when a cell sample is taken from your cervix and looked at with a microscope.
A Pap test can find changes on the cervix caused by HPV. To do a Pap test, your doctor will use a small brush to take cells from your cervix. It’s simple, fast, and the best way to find out if your cervix is healthy.
If you are age 30 or older, your doctor may also do an HPV test with your Pap test. This is a DNA test that detects most of the high-risk types of HPV. It helps with cervical cancer screening. If you’re younger than 30 years old and have had an abnormal Pap test result, your doctor may give you an HPV test. This test will show if HPV caused the abnormal cells on your cervix.
One other way to tell if you have an HPV infection is if you have genital warts. (See What is the difference between the high-risk and low-risk types of HPV? for more details.)Do I still need a Pap test if I got the HPV vaccine?
Yes. There are three reasons why:
- The vaccine does not protect against all HPV types that cause cancer.
- Women who don’t get all the vaccine doses (or at the right time) might not be fully protected.
- Women may not fully benefit from the vaccine if they got it after getting one or more of the four HPV types.
How often should I get a Pap test?
Follow these guidelines:
- Have a Pap test every 2 years starting at age 21. Women 30 and older who have had three normal Pap tests in a row can now have one every 3 years.
- If you are older than 65, you may be able to stop having Pap tests. Discuss your needs with your doctor.
- If you had your cervix taken out as part of a hysterectomy, you do not need further Pap tests if the surgery was not due to cancer.
- Talk with your doctor or nurse about when to begin testing, how often you should be tested, and when you can stop.
What happens if I have an abnormal Pap test?
An abnormal result does not mean you have HPV or cervical cancer. Other reasons for an abnormal Pap test result include:
- Yeast infections
- Irritation
- Hormone changes
If your Pap test is abnormal, your doctor may do the test again. You may also have an HPV test or these tests:
- Colposcopy. A device is used to look closely at your cervix. It lets the doctor look at any abnormal areas.
- Schiller test. The test involves coating the cervix with an iodine solution. Healthy cells turn brown and abnormal cells turn white or yellow.
- Biopsy. A small amount of cervical tissue is taken out and looked at under a microscope. This way the doctor can tell if the abnormal cells are cancer.
Could I have HPV even if my Pap test was normal?
Yes. You can have HPV but still have a normal Pap test. Changes on your cervix may not show up right away; or they may never appear. For women older than 30 who get an HPV test and a Pap test, a negative result on both the Pap and HPV tests means no cervical changes or HPV were found on the cervix. This means you have a very low chance of getting cervical cancer in the next few years.
Can HPV be treated?
No. There is no treatment or cure for HPV. But there are treatments for the changes HPV can cause on the cervix. Genital warts can also be treated.
What treatments are used to get rid of abnormal cells on the cervix?
If you have abnormal cells on the cervix, follow up with your doctor. If the problem is mild, your doctor may wait to see if the cells heal on their own. Or your doctor may suggest taking out the abnormal tissue. Treatment options include:
- Cryosurgery, when abnormal tissue is frozen off.
- Loop electrosurgical excision procedure (LEEP), where tissue is removed using a hot wire loop.
- Laser treatment, which uses a beam of light to destroy abnormal tissue.
- Cone biopsy, where a cone-shaped sample of abnormal tissue is removed from the cervix and looked at under the microscope for signs of cancer. This biopsy also can serve as a treatment if all the abnormal tissue is removed.
After these treatments, you may have:
- Vaginal bleeding
- Cramping
- Brownish-black discharge
- Watery discharge
After treatment, follow up with your doctor to see if any abnormal cells come back.
How are genital warts treated?
Genital warts can be treated or not treated.
Some people may want warts taken off if they cause itching, burning, and discomfort. Others may want to clear up warts you can see with the eye.
If you decide to have warts removed, do not use over-the-counter medicines meant for other kinds of warts. There are special treatments for genital warts. Your doctor may treat the warts by putting on a chemical in the office. Or your doctor may prescribe a cream you can apply at home. Surgery is also an option. Your doctor may:
- Use an electric current to burn off the warts
- Use a light/laser to destroy warts
- Freeze off the warts
- Cut the warts out
Even when warts are treated, the HPV virus may remain. This is why warts can come back after treatment. It isn’t clear if treating genital warts lowers a person's chance of giving HPV to a sex partner. It is not fully known why low-risk HPV causes genital warts in some cases and not in others.
If left untreated, genital warts may:- Go away
- Remain unchanged
- Increase in size or number
What about HPV in men?
HPV is as common in men as in women. HPV rarely causes severe health problems in men. But it can lead to anal cancer in men who have sex with men. There is no test for HPV in men.
How do I protect myself from HPV?
Using condoms may reduce the risk of getting genital warts and cervical cancer. But condoms don’t always protect you from HPV. The best ways to protect yourself from HPV are to:
- Not have sex
- Be faithful, meaning you and your partner only have sex with each other and no one else
If I had HPV that went away on its own, can I get it again?
Yes. There are many types of HPV, so you can get HPV again.
How do I protect my partner from HPV after my warts have gone away?
Even if you think the warts have gone away, there may be some you can’t see. And even after the warts are treated, the HPV virus may remain. Using condoms may reduce your risk of passing on genital warts.
How does HPV affect a pregnancy?
Most women who had genital warts, but no longer have them, do not have problems during pregnancy or birth. For women who have genital warts during pregnancy, the warts may grow or become larger and bleed. In rare cases, a pregnant woman can pass HPV to her baby during vaginal delivery. Rarely, a baby who is exposed to HPV gets warts in the throat or voice box.
If the warts block the birth canal, a woman may need to have a cesarean section (C section) delivery. But HPV infection or genital warts are not sole reasons for a C section.How can I be sure that I don’t get cervical cancer?
While there are no sure ways to prevent cervical cancer, you can lower your risk by:
- Getting regular Pap tests. The best time to get a Pap test is 10 to 20 days after the first day of your last period. Don’t have the test done during your period. Also, for 2 days before your Pap test don’t have sex or use douches, vaginal medicines (unless your doctor tells you to), or spermicides. Talk to your doctor about how often to get Pap tests.
- Not smoking. Smoking can raise your risk of cervical cancer.
- Being faithful. This means you and your partner only have sex with each other and no one else.
- Using a condom EVERY time you have vaginal, anal, or oral sex. Condoms don’t always protect you from HPV. But they may reduce your risk of getting genital warts and cervical cancer.
Syphilis
What is syphilis?
Syphilis (SIF-uh-luhss) is a sexually transmitted infection (STI) caused by bacteria (germ). It progresses in stages. Syphilis is easy to cure in its early stages. But without treatment, it can hurt your body’s organs, leading to severe illness and even death.
How is syphilis spread?
Syphilis is spread through direct contact with a syphilis sore or rash during vaginal, anal, or oral sex. The bacteria can enter the body through the penis, anus, vagina, mouth, or through broken skin. An infected pregnant woman can also pass the disease to her unborn child. Syphilis is not spread by contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.
What are the symptoms of syphilis?
Each stage of syphilis has different symptoms. A person infected with syphilis can pass it to others during the first two stages.
Primary Stage
A single sore, called a chancre (SHANG-kuhr), appears in the first, or primary stage. Sometimes, more than one sore appears. The time between infection with syphilis and the start of the chancre can range between 10 to 90 days (21 days average).The chancre is usually firm, round, small, and painless. It appears at the spot where the infection entered the body, such as the vulva, vagina, cervix, tongue, lips, or other parts of the body. In this stage, syphilis can be passed to others through contact with the chancre during vaginal, anal, or oral sex. The chancre lasts 3 to 6 weeks and heals with or without treatment. If the infection is not treated, it moves to the secondary stage.
A single sore, called a chancre (SHANG-kuhr), appears in the first, or primary stage. Sometimes, more than one sore appears. The time between infection with syphilis and the start of the chancre can range between 10 to 90 days (21 days average).The chancre is usually firm, round, small, and painless. It appears at the spot where the infection entered the body, such as the vulva, vagina, cervix, tongue, lips, or other parts of the body. In this stage, syphilis can be passed to others through contact with the chancre during vaginal, anal, or oral sex. The chancre lasts 3 to 6 weeks and heals with or without treatment. If the infection is not treated, it moves to the secondary stage.
Secondary Stage
The secondary stage can start as the chancre is healing or a few weeks after it has healed. It typically starts with a rash on 1 or more areas of the body. Some or all of these symptoms can appear:
The secondary stage can start as the chancre is healing or a few weeks after it has healed. It typically starts with a rash on 1 or more areas of the body. Some or all of these symptoms can appear:
- Skin rash with rough, red, or reddish-brown spots both on the palms of the hands and bottoms of the feet. The rash usually does not itch. Rashes on other parts of the body may not look the same.
- Sores on the throat, mouth, or cervix
- Fever
- Swollen glands
- Sore throat
- Patchy hair loss
- Headaches and muscle aches
- Weight loss
- Tiredness
In this stage, the infection can be passed to others through contact with open sores or rash during vaginal, anal, or oral sex. Rash and other symptoms will go away with or without treatment. But without treatment, the infection will move to the latent and possibly late stages of disease.
Latent Stage
The latent, or hidden, stage starts when symptoms from the first and second stages go away. The latent stage can last for many, many years. During this stage, the infection lives in the body even though there are no signs or symptoms. The infection cannot be passed to others during the latent stage. Sometimes, symptoms from the secondary phase come back. If this happens, the infection can be passed to others until the symptoms go away again. Without treatment, the infection will advance to the late stage in some people.
The latent, or hidden, stage starts when symptoms from the first and second stages go away. The latent stage can last for many, many years. During this stage, the infection lives in the body even though there are no signs or symptoms. The infection cannot be passed to others during the latent stage. Sometimes, symptoms from the secondary phase come back. If this happens, the infection can be passed to others until the symptoms go away again. Without treatment, the infection will advance to the late stage in some people.
Late Stage
About 15 percent of people with untreated syphilis will advance to the late stage. This can happen within a few years or as many as 20 years or more after first becoming infected. In the late stage, the disease can hurt your organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage can lead to nerve problems, paralysis, blindness, dementia, and other health problems. Some people may die from the disease. You will only reach the late stage if you do not receive treatment earlier. If you have syphilis, get treated as soon as possible to avoid these problems.
About 15 percent of people with untreated syphilis will advance to the late stage. This can happen within a few years or as many as 20 years or more after first becoming infected. In the late stage, the disease can hurt your organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage can lead to nerve problems, paralysis, blindness, dementia, and other health problems. Some people may die from the disease. You will only reach the late stage if you do not receive treatment earlier. If you have syphilis, get treated as soon as possible to avoid these problems.
How do I found out if I have syphilis?
A doctor can tell if you have syphilis. The most common ways include:
- Taking a sample of your blood and sending it to a lab for testing.
- Looking at the fluid from a syphilis sore under a special type of microscope. This can only be done during primary and secondary stages, when a sore is present.
How is syphilis treated?
Penicillin (an antibiotic) is the preferred drug to treat syphilis at all stages. The dose and length of treatment depends on the stage of syphilis and symptoms of the disease. For people who are allergic to penicillin, other drugs might work during the first and second stages. But they cannot be used by pregnant women. In late syphilis, treatment will prevent further harm, but damage already done to body organs cannot be reversed. Treatment does not protect you from getting syphilis again. You can get syphilis again after being cured if you are exposed to it.
What happens if syphilis isn’t treated?
Without treatment, syphilis can lead to severe illness and even death. Having syphilis also increases your risk of getting or giving HIV, the disease that causes AIDS. The open sores caused by syphilis make it easier for HIV to spread through sexual contact. If you have syphilis, you are thought to be 2 to 5 times more likely to get HIV if exposed. Untreated syphilis also can cause problems during pregnancy.
Can syphilis cause problems during pregnancy?
Yes. Pregnant women can pass syphilis to their babies during pregnancy and childbirth. It can cause miscarriage, stillbirth, or death soon after birth. An infected baby may be born without signs of disease. However, if not treated right away, the baby may have serious problems within a few weeks. Babies born with syphilis may develop skin sores, rashes, fever, jaundice, anemia, or a swollen liver and spleen. Untreated babies may become developmentally delayed, have seizures, or die.
All pregnant women should be tested for syphilis. Pregnant women with syphilis are treated right away with penicillin. For women who are allergic to penicillin, no other drugs are available for treatment. So, doctors try to help women with this allergy become less sensitive to the penicillin so it can be used. Penicillin will prevent passing syphilis to the baby. But women who are treated during the second half of pregnancy still are at risk of premature labor and problems with the unborn baby.
How can I keep from getting syphilis?
There are steps you can take to lower your risk of getting syphilis:
- Don’t have sex. The surest way to keep from getting syphilis is to practice abstinence. This means not having vaginal, oral, or anal sex.
- Be faithful. Having a sexual relationship with one partner who has been tested for syphilis and is not infected is another way to lower your risk of getting infected. Be faithful to each other. This means you only have sex with each other and no one else.
- Use condoms. Syphilis sores can occur in places that are covered by a condom, as well as areas that are not covered. So, using a condom the right way and every time you have vaginal, anal, or oral sex might lower your risk. For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. For oral sex use a male latex condom. A dental dam might offer some protection during oral sex (mouth to vagina/anus).
- Know that some methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs, including syphilis. If you use one of these methods, be sure to also use a latex condom every time you have sex.
- Talk with your sex partner(s) about STIs and using condoms. It’s up to you to make sure you are protected. Remember, it’s your body! For more information, call the Centers for Disease Control and Prevention at (800) 232-4636.
- Talk frankly with your doctor and your sex partner(s) about any STIs you or your partner has or has had. Talk about symptoms, such as sores or discharge. Try not to be embarrassed. Your doctor is there to help you with any and all health problems. Also, being open with your partners can help you protect your health and the health of others.
- Have a yearly pelvic exam. Ask your doctor if you should be tested for syphilis or other STIs, and how often you should be retested. Testing for many STIs is simple and often can be done during your checkup. The sooner syphilis is found, the more likely it can be cured quickly and easily.
- Avoid using drugs or drinking too much alcohol. These activities may lead to risky sexual behavior such as not wearing a condom.
Who should get tested for syphilis?
Ask your doctor about getting tested for syphilis if:
- You have symptoms and signs of syphilis.
- You think you might have been exposed to someone with syphilis.
- You are pregnant. All pregnant women should be tested for syphilis at their first prenatal checkup. Some pregnant women should be tested again, later in the pregnancy. Ask your doctor about retesting.
- Your or your partner’s sexual behavior puts you at risk for STIs (such as having sex with multiple partners, having unprotected sex, or having sex with men who have sex with men). Ask your doctor how often you should be retested.
- You have another STI.
I just found out I have syphilis. What should I do?
- Follow all your doctor’s treatment orders. Even if the symptoms go away, you still need to finish treatment. If symptoms continue after treatment, see your doctor.
- Avoid any sexual activity while you are being treated for syphilis. Don’t have sexual contact until the syphilis sores are completely healed.
- Tell your sex partner(s). Your sex partner(s) should get tested for syphilis and treated if needed.
- After you have completed treatment for syphilis, get retested after 6 months and 12 months. Some doctors recommend more frequent follow-up tests.
- Get tested for HIV. If your test result is negative, ask your doctor if you need to be retested and when.
- Once you have been treated and cured, take steps to lower your risk from getting syphilis again.
Trichomoniasis
How do women get trichomoniasis?
The parasite is spread through sexual contact. Women can get it by having penis-to-vagina intercourse with an infected man or vulva-to-vulva contact with an infected woman. Men usually get it only from infected women.
What are the symptoms of trichomoniasis?
Some women have no symptoms. Symptoms usually appear 5 to 28 days after exposure and can include:
- Yellow-green (sometimes frothy) vaginal discharge with a foul odor
- Discomfort during sex and when passing urine
- Irritation and itching in the genital area
- Lower abdominal pain in rare cases
Is there a test for trichomoniasis?
To tell if you have trichomoniasis, your doctor will do a pelvic exam and lab test. During the pelvic exam, your doctor may be able to see small red sores inside the vagina or on the cervix. Your doctor will also take a fluid sample from the vagina to look for the parasite under a microscope or to send to a lab. Other tests, like a vaginal culture or DNA test can also be used for testing.
If you have trichomoniasis, ask your doctor if you should be tested for other STIs too.How is trichomoniasis treated?
Trichomoniasis usually can be cured with these antibiotics:
- Metronidazole (me-truh-NYD-uh-zohl), or
- Tinidazole (teye-NID-uh-zohl)
These drugs usually are given by mouth in a single dose. If you are allergic to the medicines normally used, your doctor might suggest topical medicines, which are medicines applied to the skin. But the topical medicines don’t work as well and may not cure you. They might, however, ease the symptoms.
People being treated for trichomoniasis should not have sex until they and their sex partners complete treatment and have no symptoms.What happens if I don’t get treated?
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If you don’t get treated, the infection stays in your body. Even without symptoms, it can be passed to others. Having trichomoniasis also can increase a woman’s risk of getting HIV if she is exposed to the virus.
Should I tell my partner if I have trichomoniasis?
Yes — your partner could have the infection too. You and your partner should be treated at the same time to keep from infecting each other again. Be sure to tell all of your recent sex partners also, so they can get tested and treated.
Does trichomoniasis cause problems during pregnancy?
Pregnant women with trichomoniasis may have babies who are born early or at a low birth weight. Babies born early or too small can have health problems.
Metronidazole can be used during pregnancy. But some doctors feel that it’s best to not use metronidazole during the first 3 months, when the baby’s organs are forming. Talk to your doctor about the benefits and risks of treatment during pregnancy. Keep in mind that without treatment, you can give the infection to others.
How can I keep from getting trichomoniasis?
You can take steps to lower your risk of getting trichomoniasis and other STIs. The following steps work best when used together:
- Don’t have sex. The surest way to lower risk of trichomoniasis or any STI is to practice abstinence, which means not having vaginal, oral, or anal sex. Keep in mind that trichomoniasis can be spread through vulva-to-vulva contact.
- Be faithful. Having sex with one uninfected partner who only has sex with you will keep you safe from trichomoniasis and other STIs. Both you and your partner must be faithful all the time to avoid exposure. This means that you only have sex with each other and no one else. The fewer sex partners you have, the lower your risk of being exposed to an STI.
- Use condoms correctly and every time you have sex. Use condoms for all types of sexual contact, even if penetration does not occur. Use a condom from the very beginning to the very end of each sex act, and with every partner. For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. For oral sex, use a dental dam.
- Know that some birth control methods — and other methods — don’t protect against STIs.Birth control methods including the pill, shots, implants, IUD, diaphragm, and spermicides, don’t protect against STIs. If you use one of these methods, make sure to also use a condom with every sex act. Washing genitals, passing urine, and douching after sex will not keep you from getting an STI.
- Talk with your sex partner(s) about using condoms before having sex. Set the ground rules so you can avoid misunderstandings in a moment of passion. Be clear that you will not have any type of sex, any time, without using a condom. Remember, it’s your body!
- Get tested for STIs. If either you or your partner has had other sexual partners in the past, get tested for STIs before becoming sexually active.
- Have regular checkups and pelvic exams even if you’re healthy. During the checkup, your doctor will ask you a lot of questions about your lifestyle, including your sex life. Answering honestly is the only way your doctor is sure to give you the care you need.
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