Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Genital herpes is a common condition affecting around 45 million people in
the U.S. The herpes viruses responsible for genital herpes (herpes simplex virus
type 2, or HSV-2; and, less commonly, herpes simplex virus type 1 or HSV-1) are
transmitted through close personal contact such as sexual contact.
The symptoms of genital herpes vary among people. Most people infected with
HSV have no symptoms or have only mild symptoms, but some develop severe
symptoms. When symptoms do occur, the infected person usually develops one or
more painful blisters in the anal or genital areas that eventually ulcerate and
heal over a period of a few weeks.
When a person is first infected with the herpes virus, if symptoms occur,
these usually develop within the first two weeks after infection. These symptoms
of an initial infection can include:
Sexually transmitted diseases (STDs) are infections that can be
transferred from one person to another through any type of sexual contact. STDs
are sometimes referred to as sexually transmitted infections (STIs) since they
involve the transmission of a disease-causing organism from one person to
another during sexual activity. It is important to realize that sexual contact
includes more than just sexual intercourse (vaginal and anal). Sexual contact
includes kissing, oral-genital contact, and the use of sexual "toys," such as
vibrators. STDs probably have been around for thousands of years, but the most
dangerous of these conditions, the
acquired immunodeficiency syndrome (AIDS), has only been recognized since
1984.
Many STDs are treatable, but effective cures are lacking
for others, such as HIV, HPV, and hepatitis B and C. Even gonorrhea, once easily
cured, has become resistant to many of the older traditional antibiotics. Many
STDs can be present in, and spread by, people who do not have any symptoms of
the condition and have not yet been diagnosed with an STD. Therefore, public awareness and education about these infections and
the methods of preventing them is important.
There really is no such thing as "safe" sex. The only truly effective way to
prevent STDs is abstinence.
Sex in the context of a monogamous relationship wherein neither party is
infected with a STD also is considered "safe." Most people think that kissing is
a safe activity. Unfortunately, syphilis, herpes, and other infections can be
contracted through this relatively simple and apparently harmless act. All other
forms of sexual contact carry some risk.
Condoms are commonly thought
to protect against STDs. Condoms are useful in decreasing the spread of certain
infections, such as chlamydia and gonorrhea; however, they do not fully protect
against other infections such as genital herpes, genital warts, syphilis, and
AIDS. Prevention of the spread of STDs is dependent upon the counseling of
at-risk individuals and the early diagnosis and treatment of infections.
Gonorrhea
What is gonorrhea?
Gonorrhea is a bacterial infection caused by the organism Neisseria
gonorrheae that is transmitted by sexual contact. Gonorrhea is one of the
oldest known sexually transmitted diseases. It is estimated that over one
million women are currently infected with gonorrhea. Among women who are
infected, 25%-40% also will be infected with chlamydia, another type of bacteria
that causes another STD. (Chlamydia infection is discussed later in this
article.)
Contrary to popular belief, gonorrhea cannot be
transmitted from toilet seats or door handles. The bacterium that causes
gonorrhea requires very specific conditions for growth and reproduction. It cannot live outside the body for more than a few seconds or
minutes, nor can it live on the skin of the hands, arms, or legs. It survives
only on moist surfaces within the body and is found most commonly in the
vagina, and, more commonly, the
cervix. (The cervix is the end of the
uterus that protrudes into the vagina.) It can also live in the tube (urethra)
through which urine drains from the
bladder. Gonorrhea can even exist in the back of the throat (from
oral-genital contact) and in the
rectum.
Symptoms of gonorrhea
Over 50% of infected women have no symptoms, especially in the early
stages of the infection. Symptoms of gonorrhea include burning or frequent
urination, a yellowish vaginal
discharge, redness and swelling of the genitals, and a burning or
itching of
the vaginal area. If untreated, gonorrhea can lead to a severe pelvic infection
with inflammation of the Fallopian tubes and ovaries. Gonorrheal infection of
the Fallopian tubes can lead to a serious, painful infection of the
pelvis known as pelvic
inflammatory disease or PID.
PID occurs in 10%-40% of women with gonorrheal infection of the uterine cervix.
Symptoms of pelvic infection include fever, pelvic cramping,
abdominal pain, or pain
with intercourse. Pelvic infection can lead to difficulty in becoming pregnant
or even sterility.
Occasionally, if the infection is severe enough, a localized area of infection
and pus (an abscess) forms, and major surgery may be necessary and even lifesaving.
Gonorrhea infection in people with conditions causing serious abnormal immune
function, such as AIDS, can also be more serious.
Diagnosis of gonorrhea
Testing for gonorrhea is done by swabbing the infected site (rectum, throat, cervix) and identifying the bacteria in the laboratory either through culturing of the material from the swab (growing the bacteria) or identification of the genetic material from the bacteria. Sometimes the tests do not show bacteria because of sampling errors (the sampled area does not contain bacteria) or other technical difficulties, even when the woman has an infection. Newer tests to diagnose gonorrhea involve the
use of DNA probes or
amplification techniques (for example,
polymerase chain reaction, or
PCR) to identify the genetic material of the bacteria. These tests are more
expensive than cultures but typically yield more rapid results.
Treatment of gonorrhea
In the past, the treatment of uncomplicated gonorrhea was fairly simple. A
single injection of penicillin
cured almost every infected person. Unfortunately, there are new strains of
gonorrhea that have become resistant to various antibiotics, including
penicillins, and are therefore more difficult to treat. Fortunately, gonorrhea
can still be treated by other injectable or oral medications.
Uncomplicated gonococcal infections of the cervix, urethra, and rectum, are usually treated by a single injection of ceftriaxone intramuscularly or by 400mg of cefixime
(Suprax) in a single oral dose. For uncomplicated gonococcal infections of the pharynx, the recommended treatment is 125 mg of ceftriaxone in a single IM dose.
Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, and rectum are 2 g of spectinomycin in nonpregnant women (not available in the United States) in a single IM dose or single doses of cephalosporins (ceftizoxime, 500 mg IM; or cefoxitin, 2 g IM, administered with probenecid
(Benemid), 1 g orally; or cefotaxime, 500 mg IM).
Treatment should always include medication that will treat chlamydia [for
example, azithromycin (Zithromax,
Zmax) or doxycycline
(Vibramycin, Oracea, Adoxa, Atridox and others)] as well as gonorrhea, because gonorrhea and chlamydia frequently exist together in the same person. The sexual partners of women who have had either gonorrhea or chlamydia must receive treatment for both infections since their partners may be infected as well. Treating the partners also prevents reinfection of the woman. Women suffering from PID require more aggressive treatment that is effective against the bacteria that cause gonorrhea as well as against other organisms. These women often require intravenous administration of antibiotics.
It is important to note that doxycycline, one of the recommended drugs for treatment of PID, is not recommended for use in pregnant women.
Gonorrhea is one of the easier STDs to prevent because the bacterium that causes the infection can survive only under certain conditions. The use of condoms protects against gonorrhea infection. Since the organism can live in the throat, condoms should be used during oral-genital contact as well.
Scabies are itch mites that burrow under the skin and produce intense itching that's usually worse at night. Symptoms of scabies are small bumps and blisters on the wrists, knees, between the fingers, on the back of the elbows, in the groin and on the buttocks. Treatment involves applying a mite-killing cream, antihistamines for itch relief, washing bedclothes and linens.
Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge resulting from an overgrowth of normal bacteria in the vagina. Although it may cause some disturbing symptoms (discharge and odor), it is not dangerous and cannot be passed by sex. Diagnosis becomes important to exclude serious infections like gonorrhea and Chlamydia. Many treatment options are available such as oral antibiotics and vaginal gels.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Genital herpes, a viral infection by the herpes simplex virus (HSV), is transmitted during sexual contact with the mucous-covered linings of the mouth, vagina, or the genital skin. A typical outbreak begins with an itching or tingling sensation followed by redness of the skin and blister formation. The blisters and ulcers that form when the blisters break are painful to the touch, and last from 7 days to 2 weeks. Though there is no cure for herpes, there are ways to treat outbreaks.
HIV (human immunodeficiency virus) is the cause of AIDS (acquired immunodeficiency syndrome). HIV is a type of virus called a retrovirus, which infects humans when it comes in contact with a break in the skin or tissues such as those that line the vagina, anal area, mouth, or eyes.
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Treatment options include observation, medication, or surgery.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
Chlamydia, a type of bacteria that causes an infection, is spread through sexual contact. Most of the time, women with chlamydia have no symptoms. Antibiotics are an effective treatment for chlamydia.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
E. coli is the most common cause of bladder infections. Bladder infection symptoms and signs include frequent urination, burning urination, and foul smelling urine. Mild bladder infections may go away by increasing one's intake of fluid. More severe infections may be treated with a few days of antibiotics.
Pelvic inflammatory disease (PID) is the most common and serious complication of sexually transmitted diseases (STDs), aside from AIDS, among women. The signs and symptoms of pelvic inflammatory disease include: fever, vaginal discharge with a foul odor, abdominal pain, including pain during intercourse, and irregular vaginal bleeding. Pelvic inflammatory disease can scar the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences. Pelvic inflammatory disease treatment includes several types of antibiotics.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Group B strep are bacteria called Streptococcus agalactiae that may sometimes cause infections both in a pregnant woman and her newborn. Symptoms include fever, seizures, heart rate abnormalities, breathing problems, and fussiness. Intravenous antibiotics are used to treat group B strep infections.
Cervical dysplasia is a condition in which the cells of the inner lining of the cervix have precancerous changes. There are two types of cervical dysplasia; 1) squamous intraepithelial lesion, and 2) cervical intraepithelial neoplasia. Cervical dysplasia is caused by infection of the cervix with HPV (human papillomavirus). There are various diagnostic measures for cervical dysplasia. Treatment generally depends upon the progression of the dysplasia, mild, moderate, or severe.
Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the U.S. HPV is primarily transmitted by sexual contact. While some people develop warts in the genital region after infection, others experience no symptoms. Though genital warts can be removed, there is no cure for HPV infection. There is a vaccine to prevent infection from four common HPV types.
Sexually transmitted diseases, or STDs, are infections that are transmitted during any
type of sexual exposure, including intercourse (vaginal or anal), oral sex, and
the sharing of sexual devices, such as vibrators. Although treatment exists for many STDs, others currently are
usually incurable, such as those caused by HIV, HPV, hepatitis B and C, and HHV-8.
Gonorrhea is a bacterial infection transmitted during sexual contact. In women, symptoms include a yellow vaginal discharge, burning or frequent urination, and redness, swelling, burning and itching of the vaginal area. Gonorrhea can be treated with injectable (penicillin) or oral medications.
Anal cancer, cancer located at the end of the large intestine, has symptoms that include anal or rectal bleeding, anal pain or pressure, anal discharge or itching, a change in bowel movements, and/or a lump in the anal region. Treatment for anal cancer may involve radiation, chemotherapy, or surgery and depends upon the stage of the cancer, its location, whether cancer is eradicated after the first treatment, and whether the patient has HIV.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Pubic lice (crabs) are parasitic insects found in the genital area, and are primarily spread through sexual contact. Symptoms of crabs include itching and visible nits (lice eggs) and crawling lice. Treatment includes using lice-killing shampoo and washing bedding and clothing in hot water.
Trichomoniasis is a sexually transmitted disease (STD) caused by a parasite passed from person to person. Trichomoniasis can be picked up from contact with damp, moist objects like towels, wet clothing, or toilet seat. Symptoms include yellow, green, or gray vaginal discharge with a strong odor, painful intercourse or urination, genital irritation and itching, and lower abdominal pain. Medication is the only treatment for trichomoniasis.
The HPV virus (genital warts) in men can cause health problems. Genital warts are confined primarily to the moist skin of the genitals or around the anus. Genital warts are caused by the human papillomaviruses (HPVs), which are transmitted through sexual contact.
Aortic dissection is a small tear in the large blood vessel that leads from the heart and supplies blood to the body. There are two types of aortic dissection, type 1 and type 2. Signs and symptoms of aortic dissection include a tearing or ripping pain, nausea, sweating, weakness, shortness of breath, sweating, or fainting. Treatment depends on the type of aortic dissection, and the severity of the tear in the aorta.
The time when boys and girls begin the process of sexual maturation is called puberty. During this time, both sexes undergo a series of biological changes that include a rapid increase in height, bone growth, weight increase, the growth of pubic hair, breast development and the onset of menstruation in girls, and testicle, penis, and muscle enlargement in boys.
Syphilis, a sexually transmitted disease, is caused by a microscopic, wormlike bacterial organism called a spirochete. There are three stages of syphilis. The first involves the formation of the chancre. The second stage often includes hair loss, a sore throat, white patches in the nose, mouth, and vagina, fever, headaches, and a skin rash. The third stage can cause extensive damage to the internal organs and the brain, and can lead to death. Though early infection often resolves on its own, treatment usually varies based on the stage of the infection at the time of diagnosis.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
AIDS is the advanced stage of HIV infection. Symptoms and signs of AIDS include pneumonia due to Pneumocystis jiroveci, tuberculosis, toxoplasmosis, seizures, weakness, meningitis, yeast infection of the esophagus, and Kaposi's sarcoma. Anti-retroviral therapy (HAART) is used in the treatment of AIDS.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
The aorta is the large blood vessel that leads from the heart and carries
blood to the rest of the body. The aorta originates at the aortic valve at the
outlet of the left ventricle of the heart. It ascends in the chest to an arch
where blood vessels branch off to supply blood flow to the arms and head. It
then begins to descend through the chest and into the abdomen, where it splits
into two iliac arteries that provide blood flow to the legs. Along its descent,
more small arteries branch out to supply blood to the stomach, intestine, colon,
kidneys, and the spinal cord.
The aorta has a thick wall, with three layers of muscle that allow the blood
vessel to withstand the high pressure that is generated when the heart pumps
blood to the body. The three layers are the tunica intima, tunica media, and the
tunic adventitia. The intima is the inside layer that is in contact with the
blood, the media is in the middl...