Sexually Transmitted Diseases

Acknowledgement: “Encyclopedia of Men’s Health” Edited by Neil Wertheimer

Say No to Unhealthy Erotic Reminders
You wouldn’t bungee jump without an elastic cord. You wouldn’t skydive without a parachute. You wouldn’t skydive without a parachute. So why in blazes would you have sex with a stranger without a condom?
Consider this : Skydiving accounts for about 30 deaths a year. Bungee jumping, less than one. Yet thousands of people are dying each year because of diseases passed on during sex.
There are more than 20 sexually transmitted diseases, or STDs. With the frightening exception of AIDS, which has claimed more than 200,000 lives, few people die from STDs. Even so, they’re potentially serious and anything but rare.
Experts estimate that STDs affect roughly 1 out of 20 Americans each year. In one year, adult men contracted 17,977 cases of syphilis,257, 591 cases of gonorrhea and 48,208 cases of chlamydia (statistics for other STDs are not accumulated).
All this despite the fact that STDs nearly always can be avoided.
“STDs are with us and they’re not showing any signs of leaving,” says Deborah A. Ingram, nursing instructor in the College of Nursing at the University of Florida in Gainesville. “But there definitely are some methods you can use to prevent an STD.”

Keeping STDs at Bay
Nature appears to be on the side of males. Although the issue is still largely unresolved, traditional thought has it that a man’s body is less likely to be invaded by marauding bacteria than a woman’s. That’s because a woman’s vagina is dark, warm and moist-conditions under which bacteria thrive. Can’t say that about a penis. Plus, urination helps flush out whatever gets inside a man’s member.
On the flip side, men claim to have far more sexual partners over time than women, putting them at greater risk of exposure. While no one can say definitively whether men get STDs more or less than women, there is absolutely no question that if you have sex, you are susceptible. So here’s how to avoid the potential dangers.
Consider abstaining. Life offers few promises, but abstaining from sex pretty much guarantees you won’t get an STD. Unless you are in a healthy, monogamous relationship, you may want to contemplate sleeping alone until you meet that special someone you think you might have a future with.
Watch the numbers. Obviously, abstention isn’t for everyone. A 3, 432-person study conducted through the Nation Opinion Research Center found that more than 50 percent of men claim to have had five or more sex partners after age 18.
Time to face up to facts: The more sexually active you are, the greater your potential risk for contracting an STD. And you don’t have to be a Don Juan or have a new partner each week to be at risk, says Robert E. Johnson, M. D., a research scientist with the Centers for Disease Control and Prevention in Atlanta. “For most people it’s the fact that they’re changing partners once every year or two,” Dr. Johnson says.
Count on prescription relief. Since the advent of antibiotics in the 1940s, diseases that had plagued men for centuries suddenly could be cured or controlled. So if you do contract an STD, there’s probably no need to take religious vows-just medication.
“Ever with most advanced cases of gonorrhea or chlamydia, you can treat them and get good results,” Ingram says. ” Just don’t slip in during the dark of night, get your treatment and disappear,” she adds. “You’ll need follow-up treatments and blood work” to confirm the treatment has worked.
Take the test you needn’t study for. If you’re a mature, responsible, sexually active adult-whether you’re 18 or 80-then get tested for STDs. Not only will testing help prevent the potential long-term damage that can be caused by undetected STDs, it will also help ensure you don’t inadvertently infect someone else.
“If you’ve had more than one partner or your partner has had more than one partner, then periodic examinations would be a good idea,” Dr. Johnson advises. ” It’s especially important for men to get tested since men don’t always exhibit symptoms.”
Private physicians and health clinics routinely test for STDs. Some clinics offer subsidized or free testing for patients unable to shoulder the cost. To detect syphilis or HIV (the virus that causes AIDS), doctors will draw a blood sample. For gonorrhea and chlamydia they’ll take a culture from the inside of your penis with a cotton swab. For herpes and genital warts doctors usually give a visual exam, though a culture can be taken from open sores.
“Just remember that tests are not a panacea. The emphasis should be on prevention,” Dr. Johnson warns. And remember to ask your partners to get tested, too. It won’t do you much good to get a clean bill of health if you’re just going to get re-infected again.
Use condom sense. Aside from abstention or healthy monogamy, “a latex condom is the best way to protect yourself, ” says Katherine A. Forrest, M.D., a medical researcher and marketing consultant in Portola Valley, California.
Latex condoms create a barrier that prevents the passage of microorganisms that cause STDs, Dr. Forrest says. For added protection consider using condoms coated with the spermicide nonoxynol 9 (such as Trojan-Enz), which has been shown to help kill the AIDS virus in laboratory studies.
When choosing a condom, stick with the latex variety, are porous and may not stop STDs from being passed.
Always keep a condom handy, and remember these tips. Put a condom on before any sex act (including oral sex). Roll the condom to the base of your penis. Don’t use oil-based lubricants-hand lotions or petroleum jelly, for example-with condoms since they damage the latex. Remove condoms immediately after sex by holding the rim as you withdraw so the condom won’t fall off or spill its contents. Use a new condom for each sex act.
Make her bag it. These are the 1990s and real men favor equality, so it’s not out of the question to discuss with your partner whether she might share the condom-wearing responsibility.
The female condom works like a traditional condom, except in reverse. Rather than fitting tightly over the penis, it clings to the inner contours of a woman’s vagina. The open end provides protection to the outside of the vagina and the base of the penis. A soft, flexible ring at each end of the condom keeps it in place.
“No one is born knowing how to use a condom, so it takes a little practice. They’re just about as effective as other barrier devices,” says Holly Sherman, spokeswoman for The Female Health Company, which markets the Reality female condom. “As with all condoms, the key is careful and consistent use.”
Reality condoms are made of polyurethane, not latex, and appear to be effective in preventing STDs when used properly. Polyurethane is 40 percent stronger than the latex used in male condoms, and does not disintegrate when used with oil-based lubricants.
“The biggest secret is these condoms feel great for men,” Sherman adds. ” The condom warms up to body temperature, and it’s not tight-fitting, so it feels natural. And because an erection is not needed for use, the woman can insert the female condom before lovemaking begins.”

The Usual Suspects
In some ways it’s easier to guard against an STD than other infectious diseases-at least you know when you’re likely to catch it. But you also have to know what you’re looking for.
Below are descriptions of some of the more common STDs, like chlamydia and gonorrhea. (AIDS and genital herpes are discussed in their own chapters.)

Chlamydia is responsible for three to five million new infections a year, making it the most common STD in the United States.
Despite this, ” many people don’t recognize the name of this STD,” says Dr. Johnson. “It’s important to get tested for chlamydia since many men won’t have any symptoms.”
A bacterial infection, chlamydia is spread by sexual contact-it cannot be spread by sharing toilets, kissing, swimming in pools or relaxing in hot tubs. Studies have shown that 25 percent of men with chlamydia have no symptoms at all. If symptoms do show up, it is typically about two weeks after the sexual contact. Symptoms include penile discharge (usually whitish and runny), a burning sensation during urination and, occasionally, swelling of the testicles. Even if you don’t show symptoms, the disease spells trouble for men and their partners.
“You can develop epididymitis (an inflammation in the scrotum), which is extremely painful and that can cause scarring, which may leave you sterile,” Ingram says.
Treatment for chlamydia consists of oral antibiotics, usually doxycycline (Doryx) or tetracycline (Achromycin V).

Commonly known as clap, gonorrhea strikes about 700,000 times a year. The bacteria die easily outside the body, so it’s highly unlikely for gonorrhea to be spread by bathtubs, wet towels or by borrowing your best friend’s trunks. Occasionally, however, the disease has been spread by objects. Witness the unfortunate sailor who contracted gonorrhea after surreptitiously using his infected shipmate’s inflatable plastic doll.
Gonorrhea typically appears within 3 to 5 days, although it may surface in as little as 1 day or in as many as 30. Symptoms in men include penile discharge (usually greenish or yellow) and painful urination. Sometimes the penis head will swell. In as many as 80 percent of women the disease produces no noticeable symptoms.
Gonorrhea can be cured with shots of the antibiotic ceftriaxone (Rocephin) or antibiotic ofloxacin tablets (Floxin).

Syphilis has been around at least since the fifteenth century, so you’d think we’d have learned our lesson by now. Yet in 1990 new cases of syphilis reached their highest point in 40 years.
Caused by bacteria, syphilis could be called the STD of the rich and famous since it’s ravaged such notables as Al Capone and the British statesman Lord Randolph Churchill. But you don’t have to be famous-or infamous-to catch syphilis. The disease strikes approximately 100,000 Americans each year.
Syphilis is usually transmitted by direct contact with a sore or rash. It’s usually passed during sex, but you can also catch it from kissing if there’s a sore on the inside of the mouth, or from touching an open sore with your bare hands.
Symptoms progress in three stages. The first stage typically occurs between 10 and 90 days after infection. It’s marked by the outbreak of a small, single, painless sore, called a chancre (SHANK-er), that pops up where the bacteria entered your body.
The second stage, which may last several weeks, includes a rash that rarely itches and which generally appears as the chancre fades. The rash often appears on the palms of the hands and soles of the feet, although it can appear elsewhere as well. Other symptoms of stage-two syphilis include fever, swollen lymph glands, sore throat, patchy hair loss and weight loss.
The third stage, which may occur years later, brings the whole, sad act to a close. Symptoms at this stage include paralysis, blindness, heart problems, nerve damage, insanity and even death.
Although syphilis can be treated with penicillin (Pen-Vee K), the antibiotic only kills bacteria-it can’t reverse damage already done.

Trichomoniasis (trik-o-mo-nye-ah-sis) is the Stealth fighter of STDs. Caused by bacteria, it usually goes undetected in men. In fact, some studies suggest that “trich” might be the underlying cause for some chronic cases of male urethritis, an inflammation of the tube that expels urine and semen from the body.
So don’t feel lucky if your partner recently had trich and you assume you did not. In a study of 447 men at the University of Washington School of Medicine in Seattle, researchers found that 22 percent of men whose female partners were infected had the disease themselves.
Symptoms of trich that may appear include irritation on the inside or outside of the penis, as well as a slight discharge and burning sensation when urinating. Treatment usually consists of one oral dose of metronidazole (Flagyl).

Crabs are pubic lice-small, flat-bodied bloodsuckers that you can see with a magnifying glass. (They look like tiny scabs to the naked eye.) About one million people get crabs each year, mostly from skin-to-skin contact with someone who has them. You can catch crabs during sex. You can also get them from towels or other personal belongings, or even by sitting on an infested toilet seat.
Symptoms-itching in the pubic or groin areas, accompanied by the appearance of small, blue bite marks-often appear about five days after exposure. You can treat crabs with over-the-counter medications or shampoos (such as A-200) that you apply directly to your pubic area. “Treat it the way the package says, then make sure you dry clean or wash all your linens and underwear in a hot washer and hot dryer,” says Dr. Forrest. “Make sure everyone you live with does the same.” Items that can’t be washed can be put in a sealed plastic bag for two weeks. This starves the lice. Big items, like couches, can be cleaned with bug sprays containing disinfectants.

Chancroid is a bacterial disease that causes genital ulcers. Although painful, it is quite rare, with about 4,000 new cases occurring in this country each year.
You can get chancroid by touching an open sore. Unfortunately, avoiding the sores can be tricky since they may be hidden out sight inside the rectum or vagina. The symptoms, however, which typically appear in four to ten days, can be hard to miss. First, there’s a tender bump at the spot where the bacteria entered the body. After a couple of days the bump becomes a soft, tender, ragged sore that is often filled with pus. Chancroid is easily treated with pills of the antibiotic erythromycin (E-mycin) or with a shot of the antibiotic ceftriaxone.