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Sexually transmitted diseases (STDs)

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Related Terms
  • Acquired immune deficiency syndrome, AIDS, antibiotics, antiretrovirals, chlamydia, Chlamydia trachomatis, condyloma acuminate, genital warts, gonorrhea, herpes, herpes simplex type 2, HHV-2, HIV, HPV, human immunodeficiency virus, human papilloma virus, pelvic inflammatory disease, PID, sexually transmitted, STD, syphilis, trichomoniasis, venereal diseases, venereal warts.

Background
  • Sexually transmitted diseases (STDs) are infections that can be transmitted through oral, anal, and vaginal sex. These diseases may be transmitted from person to person through blood, semen, vaginal secretions, and breast milk. STDs are sometimes called sexually transmitted infections (STIs) because they involve passing a disease-causing microorganism (e.g. bacteria or viruses) to another person during sex.
  • STDs are among the most common infectious disease in the United States. Researchers estimate that 13 million Americans become infected with STDs each year.
  • There are more than 20 different STDs. Examples of common STDs include chlamydia, genital herpes, gonorrhea, HIV (human immunodeficiency virus), human papilloma virus (HPV), pelvic inflammatory disease (PID), syphilis, and trichomoniasis.
  • HIV is the most dangerous STD because it progresses to AIDS (acquired immune deficiency syndrome), which is an incurable and fatal disease. However, many other STDs, such as syphilis, may also be life threatening if left untreated.
  • Certain patients have an increased risk of developing STDs. This includes patients who have multiple sexual partners, engage in unprotected sex (oral, anal, or vaginal), or who have sexual partners who have or have previously had an STD. In addition, men who have sex with men (MSM) are more likely to develop many STDs because they are more likely to engage in risky or unsafe sexual behavior.
  • It is important that patients, especially those at high risk, are regularly tested for STDs. This is because patients do not always experience symptoms of diseases or infections. If a patient has an STD and is not tested, he/she may unknowingly pass the disease onto his/her sexual partner(s).
  • Treatment and prognosis depends on the specific type of STD. Not all STDs can be cured. Some STDs, such as HIV, HPV, and genital herpes, require lifelong medication and treatment to manage symptoms and prevent complications.
  • Patients should always take medications exactly as prescribed. This is especially important for patients who are taking antibiotics to treat bacterial infections, such as gonorrhea or syphilis. Even if symptoms go away, medications should not be stopped early because the bacteria may still be present in the body. If the medication is stopped too early, the remaining bacteria in the body may mutate and become resistant to treatment. Once the bacteria are resistant to a medication, the antibiotic is no longer effective.
  • There are many ways to reduce the risk of developing STDs. Individuals should practice safe sex, avoid risky behaviors (e.g. sharing needles or having multiple sex partners), and undergo routine screenings for STDs. Patients should also follow the recommended safety precautions to avoid exposure to blood or other bodily fluids. For instance, individuals should wear rubber gloves when applying first aid to someone who is bleeding.

Integrative therapies
  • Good scientific evidence:
  • Aloe: The transparent gel from the pulp of the meaty leaves of aloe (Aloe vera) has been used topically (on the skin) for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Limited evidence suggests that aloe in a cream preparation is an effective treatment for genital herpes in men. Additional research is warranted in this area.
  • Caution is advised when taking aloe supplements, as adverse effects including diarrhea and drug interactions are possible. Aloe supplements should not be used if pregnant or breast feeding, unless otherwise directed by a doctor. Do not use for more than three days without consulting a doctor.
  • Green tea: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use, dating back to China approximately 5,000 years ago. Green tea, black tea, and oolong tea are all derived from the same plant. Polyphenon E®, a proprietary extract of green tea, has been approved in the United States for external topical use as a prescription for genital warts caused by the human papilloma virus.
  • Avoid if allergic or hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver disease.
  • Lemon balm: Several clinical studies have reported that a topical preparation of lemon balm (Melissa officinalis) heals sores associated with oral herpes simplex virus infections (herpes simplex type 1). More studies are needed in this area.
  • Based on available research, lemon balm taken by mouth has been reported to be relatively well tolerated when taken for up to eight weeks. Evidence for topical administration of cream suggested minimal side effects for up to 10 days of application. Avoid if allergic or hypersensitive to lemon balm. Avoid with Grave's disease or thyroid hormone replacement therapy. Use cautiously in glaucoma because lemon balm may increase eye pressure. Use caution when operating heavy machinery. Lemon balm preparations may contain trace amounts of lead. Avoid if pregnant or breastfeeding.
  • Para-aminobenzoic acid: Evidence of para-aminobenzoic acid's (PABA) possible antiviral activity have led to its study as a therapeutic agent for herpetic keratitis. Actipol® is a 0.007% PABA solution for ophthalmic use that has been studied for this purpose and found to be effective in most patients. Further randomized trials may help to confirm its effectiveness for this indication.
  • Sunlight exposure, particularly ultraviolet B (UVB) radiation (290-320nm), has been shown to stimulate recurrence of the herpes simplex virus infection on the mouth. Sunscreens are known to prevent erythema and sunburn following exposure to UVB rays. For this reason, it is hypothesized that sunscreens may be capable of preventing UVB-induced reactivation of recurrent herpes labialis infection (prevention) in predisposed patients.
  • Avoid with known hypersensitivity to PABA or its derivatives. Avoid oral use in children and pregnant or nursing women. Use cautiously in patients with renal disease, bleeding disorders or those taking anticoagulants, diabetics or patients at risk for hypoglycemia. Discontinue use if rash, nausea, or anorexia occurs. Pharmaceutical doses of PABA and its derivatives should only be taken under appropriate medical supervision. PABA should not be given concurrently with sulfonamides.
  • Sage: Early laboratory and clinical evidence suggests that sage extracts may be useful in the treatment of herpes skin manifestations. Additional research is needed in this area.
  • Avoid if allergic or hypersensitive to sage, its constituents, or to members of the Lamiaceae family. Use cautiously with hypertension (high blood pressure). Use the essential oil or tinctures cautiously in patients with epilepsy. Avoid if pregnant or breastfeeding.
  • Zinc: Proper nutrition, including vitamins and minerals, has been reported to help in decreasing recurrent herpes simplex virus infections. Lesser quality studies have been conducted to assess the effects of zinc (topical or taken by mouth) in herpes type 1 or type 2. A small study found that oral zinc sulphate appeared to reduce both the number of episodes and the time to recovery of herpes labialis. Several of these studies used combination treatments or permitted the continued use of other medications, so the exact role of zinc in those studies is unclear. However, the positive results obtained in most trials suggest that zinc may represent a safe and effective alternative or adjunct treatment for herpes type 1 and 2, and should encourage further research into the topic using well-designed studies.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
  • Unclear or conflicting scientific evidence:
  • Acupuncture: Several clinical studies have reported that acupuncture therapy is effective in reducing the pain associated with post-herpetic neuralgia (PHN). More studies need to be performed before a firm conclusion can be drawn.
  • Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding (e.g. anticoagulants). Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers because therapy may interfere with the device.
  • Alizarin: Limited available evidence suggests that alizarin may be of benefit in the treatment of viral infections. Additional research is needed in this area.
  • Avoid if allergic or hypersensitive to alizarin or any plants in the Rubiaceae family. Alizarin may be toxic and should not be handled for long periods of time, rubbed in the eyes, or eaten. Avoid if pregnant or breastfeeding.
  • Aloe: Although aloe has been suggested as a possible treatment for HIV infection, further research is needed before a firm conclusion can be made.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, and tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds, or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools, or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease, or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
  • Antineoplastons: Antineoplastons are substances found in human blood and urine. Preliminary study reported increased energy and weight in patients with HIV who were treated with antineoplaston AS2-1, as well as a decreased number of opportunistic infections and increased CD4 cell counts. However, this evidence cannot be considered conclusive. Currently, there are drug therapy regimens available for HIV with clearly demonstrated effects (highly active anti-retroviral therapy), and patients with HIV are recommended to consult with their physicians about treatment options.
  • Avoid if allergic or hypersensitive to antineoplastons. Use cautiously with high medical or psychiatric risk. Use cautiously with an active infection due to a possible decrease in white blood cells. Use cautiously with high blood pressure, heart conditions, chronic obstructive pulmonary disease, liver disease/damage, or kidney disease/damage. Avoid if pregnant or breastfeeding.
  • Astragalus: Some studies suggest that astragalus may inhibit herpes viruses. Antiviral effects have also been reported in early studies for HIV. Additional research is needed in this area.
  • Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, or transplant or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
  • Beta sitosterol: Beta-sitosterol is found in plant-based foods, such as fruits, vegetables, soybeans, breads, peanuts, and peanut products. It is also found in bourbon and oils (such as olive oil, flaxseed, and tuna). Due to data that suggest immune modulating effects of beta-sitosterol and beta-sitosterol glucoside, these sterols have been studied in combination in the treatment of HIV. Larger populations of patients with HIV should be evaluated in randomized controlled trials to draw any conclusions.
  • Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (like Parkinson's disease or Alzheimer's disease), diverticular disease (bulging of the colon), short bowel syndrome, celiac disease, and sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding.
  • Bitter melon: Laboratory studies have shown that a protein in bitter melon called MAP30 may have antiviral activity against HIV. However, this has not been studied in humans. Further research is needed before a firm conclusion can be made.
  • Avoid if allergic to bitter melon or members of the Curcurbitaceae (gourd or melon) family. Avoid ingesting bitter melon seeds. Avoid with glucose-6-phosphate dehydrogenase deficiency. Use cautiously with diabetes, glucose intolerance, or with hypoglycemic agents due to the risk of hypoglycemia (low blood sugar). Avoid if pregnant or breastfeeding.
  • Blessed thistle: Laboratory studies report no activity of blessed thistle against herpes viruses, influenza, or poliovirus. Effects of blessed thistle (or chemicals in blessed thistle called lignans) against HIV are not clear. Human research of blessed thistle as a treatment for viral infections is lacking.
  • Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding.
  • Boxwood: Trials have been conducted for SPV30 (extract of boxwood, Arkopharma, France) to evaluate its potential effectiveness for HIV/AIDS. Rigorous clinical study is needed to confirm these early study results.
  • Avoid if allergic or hypersensitive to boxwood, its constituents, or any plants in the Buxaceae family. Use cautiously with HIV or AIDS. Avoid if pregnant or breastfeeding.
  • Carrageenan: Carrageenan-based gels may reduce HIV transmission during sexual intercourse and have been investigated for safety and acceptability in published studies involving healthy females. Overall, studies suggest that carrageenan is not associated with abnormal genital clinical findings or severe side effects, and is considered acceptable for use by females and their male partners. Additional research is needed to better determine the role of carrageenan for HIV infection prevention.
  • Use oral carrageenan cautiously in infants. Use cautiously in patients with, or at risk for, cancer. Use cautiously in patients treated with azoxymethane or nitrosomethylurea. Use cautiously in patients with gastrointestinal, immune, inflammatory, or bleeding disorders, or in patients with low blood pressure or diabetes. Use cautiously intravaginally. Use cautiously in patients using antilipemic agents. Use cautiously in combination with any oral medication, as the fiber in carrageenan may impair the absorption of oral medications.
  • Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. There is currently not enough reliable scientific evidence to conclude the effects of chiropractic techniques on CD4 cell count or quality of life in patients with HIV/AIDS.
  • Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders or migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.
  • Chlorophyll: Oral consumption of chlorophyll liquid was reported in clinical study to be effective in both herpes simplex and varicella-zoster infections. More clinical research is needed.
  • Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.
  • Coenzyme Q10: Coenzyme Q10 (CoQ10) is produced by the body and it is necessary for basic functioning of cells. CoQ10 levels decrease with age. There is limited evidence that natural levels of CoQ10 in the body may be reduced in people with HIV/AIDS. Reliable scientific research showing that CoQ10 supplements have any effect on this disease is currently lacking.
  • There are currently no documented cases of allergy associated with Coenzyme Q10 supplements, although rash and itching have rarely been reported. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use cautiously with history of blood clots, diabetes, high blood pressure, heart attack, or stroke. Use cautiously with anticoagulants (blood thinners), antiplatelet drugs, blood pressure drugs, blood sugar drugs, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.
  • Cranberry: Limited laboratory research has examined the antiviral activity of cranberry. Further research is warranted in this area.
  • Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.
  • DHEA: DHEA (dehydroepiandrosterone) is a hormone that is secreted by the adrenal glands. Although some studies suggest that DHEA supplementation may be beneficial in patents with HIV, results from different studies do not agree with each other. There is currently not enough scientific evidence to recommend DHEA for AIDS, and other therapies are more proven in this area.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants, or drugs, herbs, or supplements for diabetes, heart disease, seizures, or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Dimethylsulfoxide (DMSO): Topical use of dimethylsulfoxide (DMSO) has been reported effective in the treatment of herpes zoster (shingles). Limited available study reported that benefits may be more effective when DMSO is combined with the drug idoxuridine. Further research is necessary.
  • Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
  • Flaxseed and flaxseed oil: Flaxseed and flaxseed oil/linseed oil are rich sources of the essential fatty acid, alpha-linolenic acid (omega-6). While flaxseed has been used to treat HIV/AIDS, no strong evidence supports its use and no recommendation can be made without further research.
  • Flaxseed has been well tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil, or other plants of the Linaceae family. Avoid with prostrate cancer, breast cancer, uterine cancer, or endometriosis. Avoid ingestion of immature flaxseed pods. Avoid large amounts of flaxseed by mouth and mix plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with history of esophageal stricture, ileus, gastrointestinal stricture, or bowel obstruction. Avoid with history of acute or chronic diarrhea, irritable bowel syndrome (IBS), diverticulitis (inflammation of the diverticula, small sacs in the intestine's inner lining), or inflammatory bowel disease (IBD). Avoid topical flaxseed in open wounds or abraded skin surfaces. Use cautiously with history of a bleeding disorder or with drugs that increase the risk of bleeding (such as anticoagulants and non-steroidal anti-inflammatories). Use cautiously with high triglyceride levels, diabetes, mania, seizures, or asthma. Avoid if pregnant or breastfeeding.
  • Healing Touch: Healing touch (HT) is a combination of hands-on and off-body techniques that influence the flow of energy through a person's biofield. Data from small preliminary studies are insufficient to support any recommendations for or against use of HT in HIV/AIDS patients. Studies of better design are needed before any conclusions can be reached.
  • HT should not be regarded as a substitute for established medical treatments. Use cautiously if pregnant or breastfeeding.
  • Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. It has been used for thousands of years as a healing agent. Limited available clinical study found that topical honey may be effective in treating labial but not genital herpes. More research is needed in this area to draw a conclusion.
  • Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in the recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously if taking antibiotics. Avoid in patients with diabetes. Potentially harmful contaminants (e.g. C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously if pregnant or breastfeeding.
  • Hydrotherapy: There is currently insufficient evidence to determine the safety or effectiveness of hydrotherapy for treatment of pelvic inflammatory disease (PID). PID is a potentially serious medical condition that should be evaluated by a qualified, licensed healthcare provider.
  • Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, or saunas, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
  • Hypnosis: Hypnosis is associated with a deep state of relaxation. A small study showed potential benefit of a hypnotherapeutic treatment program for patients suffering from recurrent orofacial herpes infections. Further research is needed to confirm these results.
  • Use cautiously with mental illnesses (e.g. psychosis, schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
  • L-carnitine: L-carnitine may be beneficial in AIDS treatment by increasing proliferation of mononuclear cells and increasing CD4 counts. Additional study is needed to make a firm recommendation.
  • Avoid if allergic or hypersensitive to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
  • Licorice: Licorice (Glycyrrhiza glabra) has been found in laboratory studies to hinder the spread and infection of the herpes simplex virus. Early studies also suggest that glycyrrhizin, a constituent from licorice, may inhibit HIV replication in patients with AIDS. However, human reports are lacking. Additional study is needed to make a conclusion.
  • Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or if taking diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
  • Massage: Evidence is limited and mixed as to whether massage may be of benefit for immune functioning or health services utilization in people with HIV/AIDS.
  • Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
  • Meditation: Various forms of meditation have been practiced for thousands of years throughout the world, with many techniques originating in Eastern religious practices. A common goal is to attain a state of "thoughtless awareness" of sensations and mental activities occurring at the present moment. More studies are needed to establish how meditation may be useful as an adjunctive therapy in HIV/AIDS patients.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professionals before starting a program of meditation and they should explore how meditation may or may not fit in with their current treatment plans. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses.
  • Melatonin: Melatonin is a neurohormone produced in the brain. There is a lack of well-designed scientific evidence to recommend for or against the use of melatonin as a treatment for AIDS. Melatonin should not be used in place of more proven therapies, and patients with HIV/AIDS should be treated under the supervision of their healthcare professionals.
  • Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses for short-term use. There are rare reports of allergic skin reactions after taking melatonin by mouth. Use cautiously with bleeding disorders, seizure disorders, or if taking drugs that increase the risk of bleeding.
  • Mistletoe: Treatment of HIV patients with mistletoe has been conducted in Europe since the beginning of the AIDS epidemic. Treatment seems to be tolerable with minimal side effects reported. Mistletoe may assist in inhibiting disease progression. However, not all mistletoe preparations have shown equal effects. Further study is needed before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to mistletoe or to any of its constituents. Anaphylactic reactions (life threatening, shock) have been described after injections of mistletoe. Avoid with acute, highly febrile, inflammatory disease, thyroid disorders, seizure disorders, or heart disease. Use cautiously with diabetes, glaucoma, or with cholinergics.
  • Peppermint oil: The essential oil from peppermint (Mentha piperita) has been reported effective in decreasing recurrent herpes infection. Case study found that topical peppermint oil was effecting in reducing the pain of post-herpetic neuralgia. More clinical studies are needed.
  • Avoid if allergic or hypersensitive to peppermint or menthol. Peppermint is generally considered safe in non-allergic adults when taken in small doses. Use cautiously with G6PD deficiency or gallbladder disease. Menthol, which makes up part of peppermint oil, is generally considered safe in non-allergic adults. However, doses of menthol greater than 1 gram per kilogram of body weight may be deadly in humans. Peppermint oil may burn the skin if undiluted. Avoid if pregnant or breastfeeding.
  • Prayer/distant healing: Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. Limited study of prayer in patients with HIV/AIDS reports fewer new AIDS-related illnesses and hospitalizations. However, due to methodological problems, these results cannot be considered conclusive.
  • Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches and require an open dialog between patients and caregivers.
  • Propolis: Propolis is a natural flavonoid-rich resin created by bees, used in the construction of hives. Propolis is produced from the buds of conifer and poplar tress, in combination with beeswax and other bee secretions. A limited number of laboratorystudies have demonstrated effectiveness of propolis and its constituents against herpes simplex virus types 1 and 2. Preliminary results from human trials suggest some degree of efficacy of topical propolis for resolving the lesions associated with genital herpes virus infections. There is also limited research of propolis for the treatment of post-herpetic corneal complications. Some evidence suggests that propolis may speed up healing and improve sight. More clinical research is needed.
  • Avoid if allergic or hypersensitive to propolis, black poplar (Populas nigra), poplar bud, bee stings, bee products, honey, or Balsam of Peru. Severe allergic reactions have been reported. Use cautiously with asthma or gastrointestinal disorders. Avoid if pregnant or breastfeeding because of the high alcohol content in some products.
  • Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient will explore thoughts, feelings, and behaviors to help with problem solving. Psychotherapy, especially supportive psychotherapy, may reduce depression in HIV-positive patients. It may also help with treating substance abuse when used in combination with prescription medicine. Supportive-expressive group therapy may also have concomitant improvements in CD4 cell count and viral load. More research is needed in this area, especially to determine the best type of psychotherapy.
  • Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may get worse if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.
  • Reiki: Reiki instruction may help reduce pain or anxiety in HIV/AIDS patients, but results are unclear.
  • Reiki is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.
  • Reishi: Reishi mushroom (Ganoderma lucidum) has been reported to improve immune system function in humans. Reishi extract was shown to be effective in decreasing post-herpetic neuralgia in case study. However, there is insufficient data to make any conclusion at this time.
  • Avoid if allergic or hypersensitive to any constituents of Ganoderma lucidum or any member of its family. Use cautiously with diabetes, blood disorders (including hemophilia), low blood pressure or ulcers. Avoid if pregnant or breastfeeding.
  • Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. Mental health and quality-of-life improvements have been seen in preliminary studies of HIV/AIDS patients. These findings suggest the need for further, well-controlled research.
  • Avoid with psychiatric disorders like schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses like heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven techniques.
  • Rhubarb: Clinical study indicates that topically applied rhubarb-sage extract cream may reduce the symptoms of herpes. It was compared to acyclovir (Zovirax®) cream and was equally effective in relieving the symptoms. More high quality studies using rhubarb as a monotherapy are needed to discern rhubarb's effect on herpes symptoms.
  • Avoid if allergic/hypersensitive to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks because it may induce tolerance in the colon, melanosis coli, laxative dependence, pathological alterations to the colonic smooth muscles, and substantial loss of electrolytes. Avoid with atony, colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction or ileus, irritable bowel syndrome, menstruation, pre-eclampsia, renal disorders, ulcerative colitis and urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children under age 12 due to potential water depletion. Use cautiously with bleeding disorders, cardiac conditions, coagulation therapy, constipation, history of kidney stones, or thin or brittle bones. Use cautiously if taking anti-psychotic drugs or oral drugs, herbs or supplements (including calcium, iron, and zinc). Avoid if pregnant or breastfeeding.
  • Selenium: Selenium is a mineral found in soil, water, and some foods. Selenium supplementation has been studied in HIV/AIDS patients, and some reports associate low selenium levels with complications such as cardiomyopathy. It remains unclear if selenium supplementation is beneficial in patients with HIV, particularly during antiretroviral therapy.
  • Avoid if allergic or sensitive to products containing selenium. Avoid with history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Shiitake: In preliminary studies, lentinan from shiitake mushroom has been shown to modulate immune function and may be effective as an adjunct therapy in HIV and may reduce the recurrence rate of genital warts. Further well-designed studies are needed to confirm these early results. Side effects have been reported and more proven therapies are recommended at this time.
  • Avoid if allergic or hypersensitive to shiitake mushrooms. Avoid if pregnant or breastfeeding.
  • Sorrel: There is currently not enough evidence on the proposed antiviral effects of sorrel. More research is needed.
  • Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Many sorrel tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. These sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.
  • Spiritual healing: Distant healing and prayer have been used in patients with HIV/AIDS. There is conflicting evidence in this area and more study is needed.
  • Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.
  • Tea tree oil: Tea tree oil, from the Melaleuca alternifolia tree, has been proposed as a potential topical therapy for genital herpes simplex virus infections based on in vitro findings of antiviral activity. However, at this time there is insufficient human evidence to recommend either for or against this use of tea tree oil for recurrent herpes labialis infection.
  • Tea tree oil should not be taken internally, although vaginal and rectal use is recommended by some healthcare providers. Apply tea tree oil with a cotton ball. If sensitivity develops, such as rash or irritation, diluting the oil with water may help. If the rash or irritation continues, discontinue use. Avoid if allergic or hypersensitive to tea tree oil (Melaleuca alternifolia), any of its constituents, balsam of Peru, benzoin, colophony (rosin) tinctures, eucalyptol, or other members of the Myrtle (Myrtaceae) family. Avoid if taking antineoplastic agents. Avoid if pregnant or breastfeeding.
  • TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin or using acupuncture-like needles. TENS is believed to help stimulate the chi or energy of the body. TENS has been effectively used in treating pain associated with post-herpetic neuralgia in several clinical studies. However, more studies are needed.
  • Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
  • Therapeutic touch: There is currently not enough evidence that therapeutic touch may benefit immunity or emotional well-being in HIV/AIDS patients. More research is needed.
  • Avoid with fever or inflammation, and on areas of the body with cancer.
  • Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves. Preliminary evidence found no improvement in HIV progression to AIDS or immunostimulation, although some immunological activity was noted in a non-randomized controlled trial. Additional study is needed to better understand the effects of thymus extract for HIV/AIDS. Thymus extract is also of interest in the treatment of human papilloma virus due to its role in immunostimulation. Preliminary positive results were found in several cases.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy or hormone therapy. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if pregnant or breastfeeding. Thymic extract increases human sperm motility and progression.
  • Traditional Chinese medicine (TCM): Traditional Chinese medicine (TCM) is a broad term that refers to many different treatments and traditions of healing. They share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism) that dates back over 5,000 years. TCM herbs are a popular complementary therapy in HIV/AIDS. However, study results conflict. More studies are needed before the potential benefits of TCM herbs in HIV/AIDS can be established.
  • Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ma huang, which is the active ingredient in ephedra. Avoid ginseng if pregnant or breastfeeding.
  • Turmeric: Turmeric is a perennial plant native to India and Indonesia, and it is often used as a spice in cooking. Based on early research, turmeric may help treat various viral infections. Several laboratory studies suggest that curcumin, a component of turmeric, may have activity against HIV/AIDS. However, reliable human studies are lacking in this area. Well-designed trials are needed.
  • Avoid if allergic or hypersensitive to turmeric (curcumin), yellow food colorings, or plants belonging to the Curcuma or Zingiberaceae (ginger) families. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, or gallstones. Use cautiously with blood thinners (e.g. warfarin). Use cautiously if pregnant or breastfeeding.
  • Usnea: Usnea and usnic acid both are reported in laboratory studies to have antiviral activity. A combination of usnic acid and zinc sulfate may help treat human papilloma virus. Additional study of usnea alone, and not in combination with other agents, is needed to a make a conclusion.
  • Avoid if allergic or hypersensitive to usnea, its constituents, or related lichens. Use cautiously as a topical preparation with a known allergy to perfumes. Use cautiously if taking antiplatelet or anticoagulant medications (blood-altering) or medications or dietary supplements that are metabolized by the cytochrome P450 microsomal enzyme system. Avoid with compromised liver function or if taking hepatotoxic agents. Avoid if pregnant or breastfeeding.
  • Vitamin A: Vitamin A is a fat-soluble vitamin that is derived from two sources: retinoids and carotenoids. Retinoids are found in animal sources (such as the liver, kidney, eggs, and dairy products). Carotenoids are found in plants like dark or yellow vegetables and carrots. The role of vitamin A in the prevention, transmission, or treatment of HIV infection is controversial and not well established. A clear conclusion cannot be formed based on the available scientific research.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Zinc: Patients with HIV/AIDS, especially those with low zinc levels, may benefit from zinc supplementation. Some low quality studies cite reduction in infections, enhanced weight gain, and immune system function, including increased CD4 and CD8 cells, with use of zinc. However, other low quality studies conflict with these findings. Further research is needed before a conclusion can be made.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
  • Fair negative scientific evidence:
  • Echinacea: Initial human studies suggest that echinacea is not helpful in the treatment of genital herpes. More research is needed to confirm these results.
  • Avoid if allergic to echinacea, its constituents, or any members of the Asteraceae/Compositae family (ragweed, chrysanthemums, marigolds, daisies). Use cautiously in patients prone to atopic reactions and in those with hemochromatosis and diabetes. Some natural medicine experts discourage the use of echinacea by people with conditions affecting the immune system, such as HIV/AIDS, some types of cancer, multiple sclerosis, tuberculosis, and rheumatologic diseases (such as rheumatoid arthritis or lupus). Use parenteral preparations of echinacea(no longer approved for use in Germany) cautiously. Use tinctures cautiously with alcoholic patients or in patients taking disulfiram or metronidazole. Avoid using echinacea in patients presenting for anesthesia. Use cautiously if pregnant or breastfeeding.
  • Ozone therapy: Ozone molecules are composed of three oxygen atoms. Ozone exists high in the earth's atmosphere and absorbs radiation from the sun. Reports of using ozone for medicinal purposes date to the late 19th Century. Laboratory studies have shown the HIV virus to be sensitive to ozone, but high-quality human studies are lacking. A preliminary study measured the safety and effectiveness of ozone-treated blood in the treatment of HIV infection and immune disease. Ozone therapy was not shown to enhance immune activation or diminish the HIV virus.
  • Autohemotherapy (a therapy in which blood is withdrawn from the body) infused with ozone, and then replaced into the body), has been associated with transmission of viral hepatitis and with a possible case of dangerously lowered blood cell counts. Insufflation of the ear carries a risk of tympanic membrane ("ear drum") damage, and colon insufflation may increase the risk of bowel rupture. Consult a qualified health professional before undergoing any ozone-related treatment.
  • St John's wort: Anti-viral effects of St. John's wort have been observed in laboratory studies, but were not found in available human study. Multiple reports of significant adverse effects and interactions with drugs used for HIV/AIDS, including protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), suggest that patients being treated for HIV/AIDS should avoid this herb. Therefore, there is evidence to recommend against using St. John's wort in the treatment of patients with HIV/AIDS.
  • Avoid if allergic or hypersensitive to plants in the Hypericaceaefamily. Rare allergic skin reactions like itchy rash have been reported. Avoid with immunosuppressant drugs (such as cyclosporine, tacrolimus, or myophenic acid). Avoid with non-nucleoside reverse transcriptase inhibitors or protease inhibitors. Avoid with organ transplants, suicidal symptoms, or before surgery. Use cautiously with history of thyroid disorders. Use cautiously with drugs that are broken down by the liver, with monoamine oxidase inhibitors (MAOI) or selective serotonin reuptake inhibitors (SSRIS), digoxin, or birth control pills. Use cautiously with diabetes or with history of mania, hypomania, or seasonal affective disorder (SAD). Avoid if pregnant or breastfeeding.
  • Traditional or theoretical uses lacking sufficient evidence:
  • Barberry: Barberry has been used in Indian folk medicine for centuries, and the Chinese have used berberine, a constituent of barberry, since ancient times. Barberry has been suggested as a possible treatment for sexually transmitted diseases, including chlamydia. However, human studies are lacking.
  • Because of the lack of available evidence investigating barberry, no firm recommendations can be made regarding barberry's safety. Avoid if allergic or hypersensitive to barberry, any of its constituents (including berberine), or any member of the Berberidaceae family. Use cautiously with heart disease, gastrointestinal disorders, or kidney disease. Use cautiously in children due to a lack of sufficient available evidence. Barberry has exhibited uterine stimulant properties, and berberine has been shown to have anti-fertility activity. Avoid if pregnant or breastfeeding.
  • Boswellia: Historically, boswellia has been used to treat sexually transmitted diseases, including genital warts and syphilis. However, further research in humans is needed to determine if it is a safe and effective treatment.
  • Avoid if allergic to boswellia. Avoid with a history of stomach ulcers or gastroesophageal reflux disease (GERD). Avoid if pregnant or breastfeeding.
  • Kava: Kava is a member of the pepper family and is native to many Pacific Ocean islands. Traditionally, kava has been used to treat syphilis. However, human studies have not tested the safety and effectiveness of this treatment. Further research is warranted.
  • Avoid if allergic to kava or kavapyrones. Avoid with a history of liver disease, Parkinson's disease, heart disease, lung disease, eye disease, depression, bipolar disease, or blood cell disorders. Avoid while driving or operating heavy machinery because kava may cause drowsiness. Avoid if pregnant or breastfeeding.
  • Lysine: In preliminary study, lysine has been investigated for its effects on the herpes simplex virus. Study results are conflicting at this time. Additional high quality clinical research is needed to make a conclusion.
  • Neem: Neem is thought to have originated in Assam (a state in northeast India) and Myanmar. Neem has been used to treat infections, skin conditions, and reduce inflammation. Although neem has been traditionally used to treat sexually transmitted disease, studies have not been performed to determine if it is effective.
  • Avoid if allergic or hypersensitive to neem (Azadirachta indica) or members of the Meliaceae family. Use cautiously with liver disease. Avoid in children and infants. Avoid if pregnant or breastfeeding.
  • Reiki: Reiki is a Buddhist practice that is about 2,500 years old. Treatments involve the systematic placing of hands in varying positions either directly on a clothed patient or held above the skin. Sessions may last 30-90 minutes. Reiki has been suggested as a possible treatment for venereal diseases, but human evidence is currently lacking. Further research is warranted in this area.
  • Reiki is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.

Prevention
  • Routine testing: According to the U.S. Centers for Disease Control and Prevention (CDC) guidelines, patients who are either at risk for acquiring HIV or are between the ages of 13 and 64 should be tested for HIV annually. Patients should talk to their doctors to determine how often they should be tested for other STDs.
  • If a patient has symptoms of an STD or suspects he/she was exposed to an STD, the patient should be tested.
  • Patients who test positive for STDs should tell their partners. Their partners should be tested and treated to prevent re-infection.
  • Females should undergo annual Pap smears.
  • Safe sex: Avoid unprotected sexual contact, including vaginal, anal, and oral sex, with an infected person or with someone who has not been tested for STDs.
  • Wear gloves when in contact with blood or other body fluids that could possibly contain blood, such as urine, feces, or vomit.
  • Patients should limit the number of sexual partners they have. Having multiple sexual partners increases a patient's risk of developing STDs.
  • Know your partner and his/her STD status and health.
  • Avoid risky behavior: Do not share needles or syringes
  • Avoid excessive use of alcohol or other drugs, which can cloud judgment and lead to unsafe sexual practices.
  • Practices that increase the likelihood of blood contact, such as the sharing of razors, toothbrushes, and nail clippers, should be avoided.
  • Safety precautions: Cuts, scrapes, sores, or breaks on the exposed skin of both the caregiver and patient should be covered with bandages.
  • Wash any part of the body that comes into contact with blood or other body fluids. Surfaces that have been tainted with blood should be disinfected with antibacterial soap.
  • Females should not douche because it decreases the number of good bacteria in the vagina. As a result, douching may increase the risk of infection.
  • Needles and other sharp instruments should be used only when medically necessary and handled appropriately.
  • In 1985, the CDC issued a list of routine precautions for all personal-service workers, such as hairdressers, barbers, cosmetologists, and massage therapists, to take. Instruments that penetrate the skin, such as tattoo and acupuncture needles or ear piercing guns, should either be used once and disposed of or thoroughly sterilized. Instruments that are not meant to penetrate the skin, but may come in contact with blood (such as razors), should not be shared unless thoroughly sterilized.
  • Preventing transmission during pregnancy: Antiviral therapy during pregnancy can significantly lower the chance that the HIV will be passed to the infant before, during, or after birth. The treatment is most effective if it is started as early as possible during pregnancy. However, there are still health benefits if treatment is begun during labor or shortly after the baby is born. This treatment has been shown to be safe and effective for the mother and her baby.
  • Delivering the baby by cesarean section has been shown to reduce the risk of transmission of HIV to the newborn. However, this is not the standard preventative care for HIV-infected pregnant women. It should only be considered in certain clinical circumstances (such as for patients who have a very high viral overload or for patients who do not take their medications exactly as prescribed.
  • Mothers with STDs should not breastfeed their newborn(s) because infections, such as HIV, may be transmitted to their babies. In addition, many medications used to treat STDs may be excreted in the breast milk and cause harm to the baby.
  • Human papilloma virus vaccine (HPV): In June 2006, the U.S. Food and Drug Administration (FDA) approved the first HPV vaccine called Gardasil®. The drug, developed by Merck & Co. Inc., is a recombinant vaccine. This means that the vaccine does not contain the live virus, so there is no chance that patients who receive the vaccine can become infected with HPV.
  • The vaccine is expected to prevent most cases of cervical cancer due to HPV types included in the vaccine. However, patients will not be protected if they have been infected with the HPV type(s) prior to vaccination and the drug does not protect against less common types of HPV.
  • The vaccine is given as three injections over the course of six months. The National Advisory Committee on Immunization Practices recommends routine vaccination for females who are 11 and 12 years old, as well as females ages 13 to 26 if they have not already received the vaccine. According to researchers, the vaccine is most effective if it is given to females before they are sexually active.
  • Possible side effects may include pain or swelling at the injection site, mild fever, nausea, vomiting, dizziness, stuffy nose, sore throat, cough, or muscle pain.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Social Health Association. . Accessed April 28, 2009.
  2. Centers for Disease Control and Prevention (CDC). . Accessed April 28, 2009.
  3. Cline JS. Sexually transmitted diseases: will this problem ever go away? N C Med J. 2006 Sep-Oct;67(5):353-8. .
  4. Enders M, Regnath T, Tewald F, et al. Syphilis. Dtsch Med Wochenschr. 2007 Jan 19;132(3):77-8. .
  5. Flipp E, Raczynski P, El Midaoui A, et al. Chlamydia trachomatis infection in sexually active adolescents and young women. Med Wieku Rozwoj. 2005 Jan-Mar;9(1):57-64. .
  6. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed April 28, 2009.
  7. No authors listed. Human papillomavirus vaccine: new drug. Cervical cancer prevention: high hopes. Prescrire Int. 2007 Jun;16(89):91-4. .
  8. Rupp RE, Stanberry LR, Rosenthal SL. Vaccines for sexually transmitted infections. Pediatr Ann. 2005 Oct;34(10):818-20, 822-4. .
  9. Siddiqui MA, Perry CM. Human papillomavirus quadrivalent (types 6, 11, 16, 18) recombinant vaccine (Gardasil). Drugs. 2006;66(9):1263-71; discussion 1272-3. .
  10. Weaver BA. Epidemiology and natural history of genital human papillomavirus infection. J Am Osteopath Assoc. 2006 Mar;106(3 Suppl 1):S2-8. .
  11. World Health Organization (WHO). . Accessed April 28, 2009.
  12. Zhou P, Qian Y, Xu J, et al. Occurrence of Congenital Syphilis After Maternal Treatment With Azithromycin During Pregnancy. Sex Transm Dis. 2007 Jul;34(7):472-474. .

Chlamydia
  • Overview: Chlamydia is a curable sexually transmitted infection (STI) of the genital tract. If left untreated, chlamydia may damage the genital tract and lead to serious illnesses, including pelvic inflammatory disease (PID) in females and inflammation of the tubes that carry semen (epididymitis) in males.
  • According to the U.S. Centers for Disease Control and Prevention (CDC), nearly three million Americans become infected with chlamydia each year. Although chlamydia can affect people of all ages, in the United States it is most common among teenagers.
  • A bacterium called Chlamydia trachomatis causes chlamydia. Most cases of chlamydia are transmitted from person to person through oral, anal, or vaginal sex. Pregnant women may also pass the infection onto their babies during vaginal childbirth. This is because the newborn is exposed to the mother's blood and other bodily fluids during birth.
  • Symptoms: During the early stages of chlamydia, most patients experience few or no symptoms of an infection. In general, symptoms usually develop one to three weeks after the bacterium has entered the body.
  • If patients develop the infection after vaginal sex, common symptoms include painful urination, vaginal or penile discharge, lower abdominal pain, painful sexual intercourse in women, and testicular pain in men.
  • If patients develop the infection after anal sex, rectal inflammation usually occurs. This inflammation typically causes pain and mucus discharge.
  • If patients touch their eyes after touching bodily secretions (e.g. semen or vaginal discharge) that are infected with chlamydia, they may develop an eye infection called pinkeye (conjunctivitis). Left untreated, pinkeye may lead to permanent blindness.
  • Newborns who contract chlamydia during childbirth usually develop pneumonia and/or severe eye infections, which may lead to blindness.
  • Complications: Patients infected with chlamydia are more vulnerable to other STDs, including the human immunodeficiency virus (HIV), gonorrhea, and syphilis, if they are exposed to them. Therefore, patients who test positive for chlamydia are often tested for other STDs.
  • Females with untreated chlamydia may develop pelvic inflammatory disease (PID). This is an infection of the fallopian tubes, uterus, and cervix. If left untreated, PID may cause permanent damage to the reproductive tract, which may lead to infertility. It may also lead to long-term pelvic pain.
  • Males with untreated chlamydia may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. Symptoms may include fever, scrotal pain, and swelling.
  • The infection may also spread to the prostate gland in males, causing inflammation (prostatitis). Symptoms of prostatitis may include pain during or after sex, fever, painful urination, and lower back pain.
  • Diagnosis: Patients should talk to their healthcare providers to determine how often they should be tested for chlamydia. Patients who have symptoms of chlamydia or suspect that they may have been exposed to chlamydia should be tested. The CDC recommends that all pregnant women are screened for chlamydia during the first prenatal examination and possibly later on in the pregnancy.
  • The standard diagnostic test for chlamydia is a culture swab. For females, the healthcare provider may swab the discharge from the cervix. For males, the healthcare provider inserts a thin swab into the tip of the penis to retrieve a sample of fluid from the urethra. In some cases, the healthcare provider may swab the anus. The sample is then rubbed on a petri dish. If the patient has chlamydia, Chlamydia trachomatis will grow on the petri dish.
  • A urine analysis may also be performed. A sample of the patient's urine is analyzed in a laboratory for the presence of the disease-causing bacteria.
  • Treatment: Chlamydia is curable. Patients take prescription antibiotics, such as azithromycin (Zithromax®), doxycycline, or erythromycin (ERYC® or Ery-Tab®), by mouth. Treatment may last up to 10 days. Patients should take their medications exactly as prescribed. Even if symptoms go away, medications should not be stopped early because the bacteria may still be present in the body.
  • The patient's sexual partner(s) will also require treatment, even if they do not have symptoms of the infection. Otherwise, the patient may become re-infected with chlamydia.

Genital herpes
  • Overview: Genital herpes, also called herpes simplex type 2 (HHV-2), is an incurable viral infection that is characterized by painful sores on the genitals.
  • Genital herpes can only be contracted through direct sexual contact, including genital-to-genital, mouth-to-genital, or hand-to-genital contact with an infected partner. Individuals cannot contract the virus through kissing. Occasionally, oral-genital contact can spread oral herpes to the genitals (and vice versa). Individuals with active herpes lesions on or around their mouths or on their genitals should only engage in oral sex if they use a condom or place a small piece of latex, called a dental dam, over the vagina or anus.
  • The chance of a pregnant woman passing herpes to her baby is highest if the first infection occurs near the time of delivery. The virus can be transmitted to the fetus through the placenta during pregnancy or during vaginal childbirth. First-time infection during pregnancy leads to an increased risk of miscarriage, decreased fetal growth, and preterm labor. About 30-50% of infants who are born vaginally to a mother with first-time infection become infected with the herpes virus. Of babies born to women experiencing recurrent outbreaks at the time of birth, one to four percent become infected with the herpes-simplex virus.
  • After an initial or primary infection, herpes viruses establish a period called latency, during which the virus is present in the cell bodies of nerves that attach to the area of the original viral outbreak (e.g. genitals, mouth, and lips). At some point, this latency ends and the virus becomes active again. While active, the virus begins to multiply (called shedding) and becomes transmittable again. This shedding may or may not be accompanied by symptoms. During reactivation, the virus multiplies in the nerve cell and is transported outwardly via the nerve to the skin. The ability of herpes virus to become latent and reactive explains the long-term, recurring nature of a herpes infection.
  • Recurrence of the viral symptoms is usually milder than the original infection. Recurrence may be triggered by menstruation, sun exposure, illnesses that cause fevers, stress, immune system imbalances, and other unknown causes. However, not all patients experience a second outbreak.
  • Symptoms: Genital herpes typically causes painful, watery blisters to develop on the skin, mucous membranes (e.g. the mouth or lips), or genitals. The location of these blisters depends on where contact was made during transmission. Lesions heal with a crust-forming scab, the hallmark of herpes. Many individuals with recurrent disease develop pain in the area of the infection even before any blisters or ulcers can be seen. This pain is due to irritation and inflammation of the nerves leading to the infected area of skin. These are signs that an outbreak is about to start. An individual is particularly contagious during this period, even though the skin still appears normal.
  • Diagnosis: A viral culture uses specimens taken from the blister, fluid in the blister, or sometimes spinal fluid. The samples are sent to a laboratory where they are analyzed. It takes between one and 14 days to detect the virus in the preparation made from the specimen. This test is useful, but it is sometimes difficult to detect the virus in the sample.
  • An immunofluorescence assay is a diagnostic technique used to identify antibodies to the HHV-2. These antibodies are proteins that help the body fight against HHV-2. If the specific antibodies are present, a positive diagnosis is made. This test is less expensive, more accurate, and faster than a viral culture. However, it may take up to 30 days for antibodies to build up to detectable levels. Therefore, if herpes is highly suspected and results are negative soon after possible exposure to the virus, a repeat test may be recommended.
  • A polymerase chain reaction (PCR) test may also be performed to determine whether the virus itself is present in the patient's blood. A sample of the patient's blood is taken and sent to a laboratory. If the virus' genetic makeup (DNA) is present, a positive diagnosis is made. The virus can even be detected during the latent stages of the infection.
  • Treatment: Although there is no cure for genital herpes, medications are available to minimize the number of outbreaks, reduce the likelihood of viral shedding, and decrease the likelihood of transmission.
  • There are three antiviral medications that the U.S. Food and Drug Administration (FDA) has approved for the treatment of genital herpes. Approved antiviral drugs include acyclovir (Zovirax®), valacyclovir (Valtrex®), and famciclovir (Famvir®). Antiviral medication is commonly prescribed for patients having a first episode of genital herpes, but they can be used for recurrent episodes as well. There are two kinds of treatment regimens: episodic therapy and suppressive therapy.
  • With episodic therapy, the patient begins taking the medication at the first sign of an outbreak. The medication is then taken for several days to hasten the recovery or healing or to prevent a full outbreak from fully occurring. All three of the approved medications help shorten the amount of time that a person may experience symptoms of herpes. However, results may vary from person to person.
  • Suppressive therapy is used in individuals with recurrent genital herpes who want to prevent outbreaks. Patients who have six or more outbreaks per year may take antiviral medications on a regular basis, before symptoms appear. For these individuals, studies have reported that suppressive therapy may reduce the number of outbreaks by at least 75% while the medication is being taken. Suppressive therapy may completely prevent outbreaks in some patients. Suppressive therapy may need to be taken for the rest of the patient's life.
  • Side effects of antiviral medicines include stomach upset, loss of appetite, nausea, vomiting, diarrhea, headache, dizziness, and/or weakness.

Gonorrhea
  • Overview: Gonorrhea, sometimes called the clap, is a curable bacterial infection that affects the sex organs. If left untreated, gonorrhea may lead to infertility.
  • Gonorrhea is caused by a bacterium called Neisseria gonorrhoeae. Gonorrhea is transmitted through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired.
  • Pregnant females with untreated gonorrhea may pass the infection onto their babies during vaginal childbirth (not cesarean section).
  • The bacterium can only live outside of the body for a few seconds. Therefore, the infection cannot be transmitted through toilet seats or other objects such as towels or clothing.
  • Symptoms: Most patients develop symptoms of gonorrhea one to 10 days after the bacterium enters the body. Some patients may be infected for months before symptoms develop. More than 50% of females with gonorrhea do not experience any symptoms.
  • Common symptoms of gonorrhea include thick or bloody discharge from the penis or vagina, pain or burning sensation during urination, frequent urination, and pain during sexual intercourse.
  • Anorectal gonorrhea may develop in males or females after anal intercourse with an infected person. In some cases, the infection may spread from the genitals to the anus. Anorectal gonorrhea may cause some discomfort in and discharge from the anal area, but many patients do not experience any symptoms.
  • Oral sex can cause pharyngeal gonorrhea. Symptoms of pharyngeal gonorrhea commonly include pain when swallowing and redness of the throat and tonsils.
  • If a patient touches an eye after touching bodily fluids that contain the bacteria, it may cause pinkeye (conjunctivitis). Symptoms may include reddening and inflammation of the eye(s).
  • Newborns with gonorrhea may develop permanent blindness and infection of the joints and blood.
  • Complications: In females, untreated gonorrhea may lead to pelvic inflammatory disease (PID). This is an infection of the fallopian tubes, uterus, and cervix. If left untreated, PID may cause permanent damage to the reproductive tract, which may lead to infertility. It may also lead to long-term pelvic pain.
  • Males with untreated gonorrhea may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. Symptoms may include fever, scrotal pain, and swelling.
  • In rare cases, Neisseria gonorrhoeae may enter the bloodstream and infect other parts of the body, such as the skin, joints, or internal organs. Symptoms may include fever, swelling, joint pain and stiffness, rash, and skin sores.
  • Diagnosis: Patients should talk to their healthcare providers to determine how often they should be tested for gonorrhea. Patients who have symptoms of gonorrhea or suspect they may have been exposed to gonorrhea should be tested.
  • The standard diagnostic test for gonorrhea is a culture swab. For females, the healthcare provider may swab the discharge from the cervix. For males, the healthcare provider inserts a thin swab into the tip of the penis to retrieve a sample of fluid from the urethra. In some cases, the healthcare provider may swab the anus. The sample is then rubbed on a petri dish. If the patient has gonorrhea, Neisseria gonorrhoeae will grow on the petri dish.
  • A urine analysis may also be performed. A sample of the patient's urine is analyzed in a laboratory for the presence of the disease-causing bacteria.
  • Treatment: Gonorrhea is curable. Patients typically take antibiotics, such as ciprofloxacin (Cipro® or Cipro XR®), ofloxacin (Floxin®), and levofloxacin (Levaquin®).
  • Babies with gonorrhea also receive antibiotics. In addition, medication, such as silver nitrate, is usually applied to the baby's eyes immediately after birth. This has been shown to help prevent the infection from spreading into the eyes.
  • Even if symptoms go away, medications should not be stopped early because the bacteria may still be present in the body. If the medication is stopped too early, the remaining bacteria in the body may mutate and become resistant to treatment. Once the bacterium is resistant to a medication, the antibiotic is no longer effective.

Hiv/aids
  • Overview: The human immunodeficiency virus (HIV) is a virus that progresses to AIDS (acquired immune deficiency syndrome). HIV primarily attacks the immune defense system, making the patient extremely vulnerable to opportunistic infections. Opportunistic infections are illnesses that occur in individuals who have weakened immune systems.
  • HIV primarily infects and destroys immune cells called CD4 T-cells. Healthy individuals have a CD4 cell count between 600 and 1,200 cells per microliter of blood. HIV patients who are not receiving treatment have less than 600 CD4 cells per microliter of blood. AIDS patients, who have CD4 cell counts that are lower than 200, have the greatest risk of developing opportunistic infections that may be fatal.
  • HIV is transmitted from person to person via bodily fluids including blood, semen, vaginal secretions, and breast milk. Therefore, it can be transmitted through sexual contact with an infected person, by sharing needles/syringes with someone who is infected, through breastfeeding, during vaginal birth or, less commonly (and rare in countries where blood is screened for HIV antibodies), through transfusions with infected blood.
  • Symptoms: Many patients experience no symptoms when they first become infected with HIV. After one or two months, an estimated 80-90% of HIV patients develop flu-like symptoms including headache, fever, fatigue, and enlarged lymph nodes. These symptoms usually disappear after one week to one month and are often mistaken for another viral infection, such as the flu. Despite having minimal or no symptoms during this stage, individuals are very infectious because the virus is present in large quantities in bodily fluids.
  • After the initial infection with HIV, the next stage is called clinical latency. Although patients experience few or no symptoms during the clinical latency stage, the infection may still be passed to others. Once infected with HIV, the clinical latency stage may last 10 or more years in adults or up to two years in children who are born with HIV infection. The length of this asymptomatic period varies in individuals. Some people may start to experience more serious symptoms within a few months, while others may be symptom-free for several years. The virus can also hide inside infected cells and lay dormant. Patients can still transmit the virus to others when the virus is dormant.
  • As the immune system continues to weaken many symptoms appear, including inflamed lymph nodes (swollen glands) that may be enlarged for longer than three months. Other symptoms often experienced months to years before the onset of AIDS include fatigue, weight loss, frequent fevers and sweats, persistent or frequent yeast infections (oral or vaginal), persistent skin rashes, flaky skin, pelvic inflammatory disease (PID) in women that does not respond well to treatment, and short-term memory loss.
  • In addition, some individuals develop a painful nerve disease called shingles or frequent and severe herpes infections that cause sores to develop on the mouth, genitals, or anus. Infected children may be sick often, grow or gain weight slowly, or take longer to develop important mental and motor skills.
  • Although treatment can slow the progression of HIV, nearly all patients eventually develop AIDS. Once the patient's CD4 T-cell count is less than 200 cells per microliter of blood, their condition has progressed to AIDS, the final stage of the disease. Some patients are diagnosed with AIDS after they developan AIDS-defining illness, such as Pneumocystis jiroveci pneumonia (formerly called Pneumocystis carinii or PCP). The first symptoms of AIDS often include moderate and unexplained weight loss, recurring respiratory tract infections, and oral ulcerations.
  • Patients with AIDS have the greatest risk of developing opportunistic infections and tumors. Opportunistic infections and tumors may include tuberculosis, thrush, herpes viruses, shingles, Epstein-Barr virus, pneumonia, and a type of cancer called Kaposi's sarcoma (KS). In the last stages of AIDS, it is common for individuals to develop respiratory infections, including cytomegalovirus or mycobacterium avium complex (MAC) infections.
  • Diagnosis: HIV is diagnosed after HIV antibodies or HIV itself is detected in the patient's body. As soon as the virus enters the body, the immune system produces antibodies, which are proteins that detect and bind to HIV. The presence of these antibodies, which may take months to build up to detectable levels in the blood, oral fluid, and urine, can be used to determine whether HIV is in the body.
  • It may take some time for the immune system to produce enough antibodies for the antibody test to detect them. This time period, known as the "window period," varies among patients. Most people will develop detectable antibodies two to eight weeks after exposure, with the average being 25 days. However, some individuals might take longer to develop detectable antibodies. Ninety-seven percent of patients develop antibodies within the first three months following the time of their infection. In very rare cases, it can take up to six months to develop antibodies to HIV. Therefore, if a patient tests negative for HIV in the first three months after possible exposure, repeat testing should be considered longer than three months after the exposure.
  • In the United States, the test results must remain confidential. Individuals who are younger than 18 years old can consent to or refuse to be tested for HIV, without the involvement of their legal guardians. Test results may not be released to the patient's legal guardian(s) without his/her consent
  • Treatment: Currently, there is no cure for HIV/AIDS. Patients may receive a combination of anti-HIV drugs called antiretrovirals. These drugs interfere with the virus's ability to multiply, which subsequently boosts the immune system. HIV patients typically receive a combination of antiretroviral drugs, called highly active antiretroviral therapy (HAART), because a single patient may have several different strains (types) of the virus circulating in the blood. The combination of drugs also helps prevent mutations from occurring. The different strains of the virus may respond differently to specific types of drugs. HAART is a combination of at least three drugs from at least two different classes. There are four major classes of antiretrovirals: fusion inhibitors, protease inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Each drug class disrupts different stages of HIV's life cycle.
  • Although HAART may help patients live longer lives, these drugs do not reduce the risk of transmitting the disease to someone else.
  • Many new HIV drugs are under investigation. The U.S. Food and Drug Administration is expected to approve a CCR5 receptor antagonist, called maraviroc (Celsentri®), and an integrase inhibitor, called raltegravir (Isentress®), in late 2007.

Human papilloma virus (hpv)
  • Overview: The human papilloma virus (HPV) is a viral infection that sometimes causes genital warts (also called venereal warts). There are more than 100 different types of HPV, but only a few cause genital warts.
  • HPV is highly contagious. The infection may be transmitted through direct contact with the virus during oral, anal, or vaginal sex. It may also be transmitted after touching objects (e.g. towels, bed linens, or clothing) that have come into contact with an infected person.
  • There is currently no cure for HPV. Although treatment can help manage symptoms, females with HPV have a much greater risk of developing cervical cancer than females who are not infected with HPV. It has also been associated with other types of genital cancers, including cancer of the penis, anus, vulva, and vagina.
  • In June 2006, the U.S. Food and Drug Administration (FDA) approved the first HPV vaccine called Gardasil®. The vaccine is expected to prevent most cases of cervical cancer due to HPV types included in the vaccine. However, patients will not be protected if they have been infected with the HPV type(s) prior to vaccination, and the drug does not protect against less common types of HPV.
  • Symptoms: Most patients develop symptoms within three months of exposure to HPV. However, some patients may not develop symptoms for several years, and others may not experience any symptoms at all.
  • Common symptoms include small swellings in the genital area, multiple warts that form cauliflower-shaped clusters, itching or discomfort in the genital area, and bleeding during intercourse. Warts may spread to other areas of the body. Symptoms may worsen during pregnancy.
  • Complications: HPV has been shown to cause cervical cancer in females. In addition, certain types of HPV have also been associated with cancer of the anus, vagina, vulva, and penis. Regular pelvic exams and Pap tests are recommended to diagnose and treat infections quickly.
  • Genital warts may also lead to complications during pregnancy. In some patients, the warts may enlarge, making it difficult to urinate. Also, warts on the vaginal wall may reduce flexibility of the vaginal tissues during childbirth. In rare cases, a baby born to a mother with genital warts may develop warts in the throat. In such cases, surgery may be required to remove the warts and prevent airway obstruction.
  • Diagnosis: An acetic acid solution may be applied to the patient's genitals. This solution helps the healthcare provider detect warts because it turns warts a white color. Then, a specialized microscope, called a colposcope, is used to view the warts. If they are characteristic of HPV, a positive diagnosis is made.
  • It is especially important for women to undergo routine pelvic exams and Pap tests because HPV increases a female's risk of developing cervical cancer. Patients diagnosed with HPV may need to have a Pap test every three to six months. Patients should talk to their healthcare providers to determine how often they should be screened.
  • Treatment: There is currently no cure for HPV. However, many treatments are available to manage symptoms. Even if genital warts are no longer present, the virus is never eliminated from the body. This means warts may come back in the future.
  • Patients should not use over-the-counter wart removers for genital warts. These products are not designed for genital warts and they may cause serious side effects. Patients should consult their healthcare providers to determine the safest and most effective way to remove warts.
  • Many creams and ointments, such as imiquimod (Aldara®) and podofilox (Condylox®), may be applied directly to the skin to remove warts. Healthcare providers may also apply a chemical called trichloroacetic acid (TCA) to the skin to burn off warts. These medications may damage condoms, making them less effective.
  • Many surgical procedures, including cryotherapy, electrocautery, surgical incision, and laser removal, are available to remove warts. During cryotherapy, a healthcare provider applies liquid nitrogen to freeze off the wart. During electrocautery, an electrical current is used to burn off warts. Surgical incisions, which involve using a scalpel and other surgical instruments to remove the wart, may also be used. During laser treatments, the warts are removed with an intense beam of light. These procedures are usually only performed for severe warts that do not respond to other types of treatment.
  • Patients should not have sex while they are receiving treatment. Sexual partners of patients who have been diagnosed with HPV should be tested and treated for STDs.

Pelvic inflammatory disease (pid)
  • Overview: Pelvic inflammatory disease (PID) is an infection of the female reproductive organs that causes pain and swelling. If left untreated, PID may cause scarring and permanently damage the reproductive organs. Without treatment, some patients may become infertile or experience complications during pregnancy.
  • PID usually develops when a sexually transmitted bacteria enters the uterus and reproduces in the upper genital tract. The most common bacteria that causes PID also cause the sexually transmitted diseases (STDS) gonorrhea and chlamydia.
  • Symptoms: Common symptoms of pelvic inflammatory disease include pain in the lower abdomen and pelvis, irregular menstrual bleeding, foul-smelling vaginal discharge, lower back pain, fever, fatigue, diarrhea, vomiting, pain during intercourse, and difficulty or pain during urination.
  • Up to 50% of females with PID develop chronic pelvic pain that may last for months or years. PID may cause scarring in the fallopian tubes and other organs that may cause pain during exercise, ovulation, and sexual intercourse.
  • Diagnosis: Pelvic inflammatory disease (PID) is diagnosed after a pelvic examination, cervical cultures, and/or analysis of the vaginal discharge. The reproductive organs, including the uterus, will appear inflamed during a pelvic exam. Cervical cultures and/or analyses of vaginal discharge are performed to detect the presence of bacteria known to cause PID. If bacteria are present, a positive diagnosis is made.
  • Treatment: Antibiotics are the standard treatment for pelvic inflammatory disease. These medications, which are usually taken by mouth, kill the disease-causing microorganism. Severe infections that have spread to the kidneys may require hospitalization and intravenous antibiotics. Commonly prescribed antibiotics include amoxicillin (Amoxil® or Trimox®), nitrofurantoin (Furadantin® or Macrodantin), trimethoprim (Proloprim®), and trimethoprim/sulfamethoxazole (Bactrim® or Septra®). Symptoms usually start to improve after a few days of treatment.
  • Patients should take medications exactly as prescribed. Even if symptoms appear to go away, patients should take all of their medication because there may still be bacteria in the body. Stopping medication early may allow the infection to return. Also, stopping medication early may lead to antibiotic resistance. The few remaining bacteria in the body that survive most of the antibiotic therapy are the most difficult to kill. If the bacteria become resistant to treatment, the medications will no longer be effective if taken in the future.
  • Treating sexually transmitted diseases (STDs), such as gonorrhea, promptly reduces the risk of developing pelvic inflammatory disease (PID).
  • Sexual partners of patients who have been diagnosed with PID should be tested and treated for STDs.

Syphilis
  • Overview: Syphilis is a bacterial infection that initially causes skin sores and rashes to form on the genitals, skin, and mucus membranes. Although this infection is curable, it can be fatal if it is not treated quickly. If left untreated, syphilis may cause permanent damage to other organs, such as the brain and heart.
  • Syphilis is caused by a bacterium called Treponema pallidum. There are four different stages of syphilis: primary, secondary, latent, and tertiary. The disease is contagious during the primary and secondary stages, and sometimes, the latent period.
  • Most cases of syphilis are transmitted during oral, anal, or vaginal sex. A patient may also acquire the infection if his/her blood comes into contact with an infected patient's blood. It may also be transmitted through direct contact with an infected person's skin sore. An infected pregnant woman may also transmit the infection onto her fetus during pregnancy. This is because the mother's infected blood passes through the placenta and to the baby.
  • Treponema pallidum is not able to survive outside of the body. Therefore, the disease cannot be transmitted by sharing clothing, toilet seats, or other objects with an infected person.
  • Symptoms: Symptoms of syphilis vary with each stage. Initial symptoms during the primary stage typically develop 10 days to three months after exposure. Symptoms commonly include enlarged lymph nodes near the groin and a small painless chancre sore on the part of the body where the bacterium was transmitted. Chancre sores are most common on the tongue, lips, genitals, or rectum. Some patients may develop several sores. If patients do not receive treatment, the symptoms will go away on their own within three to six weeks. However, this does not mean that the infection is gone. In fact, it means that the infection is progressing to the secondary stage.
  • Symptoms of secondary syphilis develop two to 10 weeks after the first chancre sore appears. Symptoms may include a skin rash that causes small reddish-brown sores, fever, fatigue, general feeling of discomfort, soreness, and aching. If the patient does not receive treatment during this stage, symptoms may go away within a few weeks or repeatedly go away and come back for as long as one year. Even if symptoms are not present, the infection will continue to worsen without treatment.
  • Some patients experience a period called latent syphilis before tertiary symptoms develop. During the clinical latency stage, no symptoms are present. This stage may last one to two years.
  • The tertiary stage may develop immediately after the secondary stage or one to two years after the latent stage. This is the final and most severe stage of the infection. During the tertiary stage, syphilis may cause permanent organ damage and death. It often causes brain (neurological) problems, which may include stroke, infection and inflammation of the membranes that surround the brain and spinal cord (meningitis), numbness, poor muscle coordination, deafness, visual problems or blindness, changes in personality, and dementia. Syphilis may also affect the heart, causing bulging (aneurysm) and inflammation of blood vessels, including the aorta, which is the body's main artery. It may also cause valvular heart disease, such as aortic valve stenosis (when the valve becomes narrowed). All of these symptoms are potentially life threatening.
  • Babies born with syphilis may develop symptoms that are apparent at birth or several weeks after birth. Syphilis progresses much quicker and is more likely to cause complications in infants than adults. If the baby does not receive prompt treatment, serious and life-threatening complications may develop. Symptoms may include bone abnormalities, depressed nose bridge (saddle nose), vision and hearing problems (that may lead to deafness or blindness), swollen joints, screwdriver-shaped teeth (Hutchinson's teeth), and scarring where chancre sores developed.
  • Complications: In general, patients with syphilis have an increased risk of developing the human immunodeficiency virus (HIV). This is because a syphilis chancre sore provides an easy way for HIV to enter the body.
  • Diagnosis: In order to prevent life-threatening complications of syphilis, patients should be tested if they have symptoms of syphilis or suspect that they were exposed to syphilis. Doctors recommend annual STD screenings for patients who have increased risks of developing STDs. This includes patients who have multiple sexual partners, engage in unprotected sex, or who have sexual partners who have or have previously had an STD. Routine testing is especially important for detecting syphilis because symptoms may come and go.
  • If the patient has sores that are characteristic of syphilis, a healthcare provider may scrape a small sample of cells from affected skin. The cells are then analyzed under a microscope for the presence of Treponema pallidum. If the bacterium is present, a positive diagnosis is made. If patients do not have sores, a blood test may be used to diagnose syphilis. A sample of blood is taken from the patient and analyzed for antibodies to the bacterium that causes syphilis. These antibodies are proteins that are specialized to detect and help destroy the bacterium. If the antibodies are present, a positive diagnosis is made.
  • If it is suspected that the infection has spread to the brain, a healthcare provider may recommend a test called a lumbar puncture. During the procedure, a long thin needle is inserted into the lower back. A small sample of fluid from the spine (cerebrospinal fluid) is removed and analyzed under a microscope for the disease-causing bacteria.
  • Treatment: If treated early, patients with syphilis can expect a full recovery. Patients receive one to three injections of an antibiotic called penicillin. This medication kills the bacterium and cures syphilis. Even if a pregnant mother receives treatment for syphilis, the newborn should also receive antibiotics as a precautionary measure. Patients should avoid sexual contact with their partners during treatment in order to prevent transmitting the infection.
  • During the first day of antibiotic treatment, many patients experience the Jarisch-Herxheimer reaction. Researchers believe that this reaction occurs because so many bacteria are dying at once. Symptoms, which usually only last one day, may include fever, nausea, aching pain, and headache.
  • Sexual partners of patients who have been diagnosed with syphilis should be tested and treated for STDs.

Trichomoniasis
  • Overview: Trichomoniasis is a sexually transmitted infection that usually causes pain, inflammation, and irritation in the vagina, penis, and urethral tissues. Although trichomoniasis may affect males or females, symptoms are more common among females.
  • Trichomoniasis is caused by Trichomonas vaginalis, a microscopic parasite, called a protozoan.
  • Symptoms: Females typically develop foul-smelling vaginal discharge that may appear foamy and yellow or green in color. Vaginal itching and pain during urination may also occur.
  • Males typically experience penile discharge, pain during urination, and pain and swelling of the scrotum (caused by epidiymitis).
  • Diagnosis: For females, the healthcare provider may swab the discharge from the cervix. For males, the healthcare provider inserts a thin swab into the tip of the penis to retrieve a sample of fluid from the urethra. The sample is then analyzed under a microscope. If the parasite is present, a positive diagnosis is made.
  • Treatment: Patients take the antibiotic metronidazole (Flagyl®) by mouth to kill the parasite and cure the infection. This drug is not safe during pregnancy. Pregnant females who are infected typically apply an antibiotic cream, called clotrimazole (Gyne-Lotrimin, Mycelex-7®), to the genitals. Patients should abstain from sex while they are receiving treatment.
  • Sexual partners of patients who have been diagnosed with trichomoniasis should be tested and treated for STDs.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.