Remember that you must finish your full course of treatment to completely rid yourself of the organism (for curable diseases). Even if you feel cured halfway through treatment, you're not. Also remember to get your partner tested and treated, regardless of the test results, especially for gonorrhea, chlamydia, and syphilis, otherwise you will reinfect yourself each time you come into sexual contact.

Risky Sexual Activities and Ways to Enjoy Them Without Infection

• Penis-vagina intercourse: use a latex condom, lubricated to avoid tearing and with a vaginal spermicide with nonoxynol-9 (which kills HIV in lab tests). Some condoms already contain a spermicide. The spermicidal foam or gel should coat the entire vagina. If you use a lubricant, choose one that's water based, since oil-based lubricants (such as Vaseline) will damage the condom within minutes.
• Oral sex on a man: even pre-cum can contain viruses and bacteria so use an unlubricated and dry condom as soon as he is erect and use a new one each time.
• Oral sex on a woman: use plastic wrap (beware, since suffocation is possible) or a dry condom (unroll it, tear off ring, cut or tear down the length of it and spread it out to cover both the labia and the anus. Put lubricant on the side next to the genitals). You can also use dental dams, but they are hard to find. Use special care during menstruation and vaginal infection.
• Penis-anus intercourse: this is a high-risk activity since rectum tissue tears easily. Use a latex condom with a water-based lube. Some people advise the use of two condoms at once but many health care providers feel that the friction between the condoms cancels out any extra protection and makes it more likely that the condom(s) will tear.
• Fisting and finger play: risky because tissue can be easily torn. STDs can travel from cuts on fingers and vice versa. Use latex surgical or veterinary gloves (or finger cots for finger play) and change with each use.
• Rimming (mouth-anus play): this can spread diseases carried in feces and saliva. Use plastic wrap, a cut condom, or dental dam (refer to Oral sex on a woman).
• Water sports (urination on partners): protect your eyes (i.e. with goggles) and avoid any broken skin or cuts.
• Dildos/sex toys/vibrators: if shared, they can transmit STDs so use a condom (a new one each time) on dildos and don't share sex toys and vibrators. Clean dildos and sex toys with hydrogen peroxide or bleach after each use.
• Less risky activities include kissing (except deep kissing with mouth cuts or gum disease), hugging, rubbing, hand jobs, mutual masturbation (avoid ejaculation on skin if there are small cuts or sores), fantasizing, and massage.

• Serial monogamy (when you are monogamous, break up, then are with someone else monogamously) is not a guarantee against infection. You are still sleeping with your partner's partners and your partner with yours. To be really sure you're HIV negative, take an HIV test at least 2-6 months after your last possible exposure to HIV (which often means after your last sexual activity).
• To be transmitted, STDs need to be present in you or your partner. They do not spontaneously appear in your body.
• You do not have to exhibit all the symptoms of a disease to be infected with it. In fact, many of the infections described here can be asymptomatic. If you suspect you maybe infected with an STD, call Health Services to set up an appointment for testing and/or counseling. Refer to the Introduction for phone numbers.

AIDS

• Virus must be present in sufficient quantity (blood, semen, vaginal, and cervical secretions, pre-cum). Saliva, tears, and urine have no or tiny amounts of HIV.
• HIV penetrates through the skin and into the body through tiny tears or sores in mucous membranes in the mouth, vagina or rectum.
• Possible risk factors for infection: STDs (which create a more direct route for HIV to enter the bloodstream), vaginal irritation due to yeast infection, trichomonas, or bacterial vaginosis (which can cause tiny tears or increased numbers of white blood cells, which in turn increases chances of transmission).

• HIV can live for up to ten years in the body without causing noticeable symptoms.
• Early phase
  • Weight loss
  • Fatigue
  • Swollen glands
  • Skin conditions
• Late phase
  • Bronchial infections
  • Sores in the mouth (thrush)
  • Fevers
  • Night sweats
  • Appetite loss
  • Trouble swallowing
  • Headaches
  • Diarrhea
• Possible gynecological signs of HIV infection:
  • Recurrent yeast infections
  • Chronic pelvic inflammatory disease (PID)
  • Severe, extensive genital herpes

Chlamydia and Ureaplasma

• Vaginal or anal sex with infected person
• Contact between hand with infected secretions and the eye
• Mother to baby during delivery
• Possible, though unlikely, to pass chlamydia to throat from oral sex on an infected man

• Incubation after infection is at least 7 days.
• Many women have no symptoms
• May be similar to gonorrhea but usually milder
• Increased vaginal discharge (usually 7-14 days after exposure)
• Painful urination
• Unusual vaginal bleeding or bleeding after sex
• Lower abdominal pain

• Many men have no symptoms, but they can still transmit the infection.
• Burning during urination
• Urethral discharge appearing 1-3 weeks after exposure

• In women: urethral infection, cervicitis (inflammation of the cervix), pelvic inflammatory disease (PID), infertility, dangerous complications during pregnancy and birth
• In men: nongonococcal urethritis (NGU)-inflammation of urethra, proctitis (inflammation of rectum)

• A course of antibiotics will usually be prescribed.
• Avoid alcohol until cured because it may irritate urethra.

Gonorrhea

• Most women are asymptomatic and many symptoms are mild or can be confused with other conditions.
• Appear 2 days to 3 weeks after infection
• Cervical: thick discharge, redness, small bumps, pus, or signs of erosion on cervix (which you can check by examining yourself with a speculum)
• Urethra: if infected, may have painful urination or burning
• Uterus and fallopian tubes: pain on one or both sides of the lower abdomen, vomiting, fever, and/or irregular periods
• Throat: soreness or swollen glands
• 1-3 % of infected women developed disseminated gonococcal infection (DGI). Symptoms include a rash, chills, fever, pain in joints, tendons of wrists, or fingers. May also have sores on hands, fingers, feet, or toes.

• May be asymptomatic
• Usually a thick, milky discharge from penis and pain or burning during urination
• If you or your partner has a discharge from the penis, take a test for diseases (can often be tested and diagnosed the same day)

Herpes

• Skin to skin contact during vaginal, anal, or oral sex with someone with an active infection
• Mouth to genitals (or eyes) via fingers (less likely)
• Most contagious from time skin reddens until the sores crust over
• Many transmissions occur when people are asymptomatic

• Appear about 2-20 days after infection
• Type I: cold sores or fever blisters on the lips, face, and mouth
• Type II: genital sores
• There can be crossover between types from oral-genital contact
• Usually begins with a tingling or itching of the skin in the genital area (prodromal period)
• May occur several hours to several days before the sores erupt or may not occur at all
• May also have burning sensations, pains in your legs, buttocks, or genitals and/or a feeling of pressure in the area
• Sores then appear, starting as red bumps and becoming watery blisters within a day or two.
• Within a few days, they rupture, leaving shallow ulcers that may ooze, weep, or bleed.
• Usually after 3 or 4 days a scab forms and the sores heal themselves without treatment.
• While sores are active, you may find it painful to urinate and may have a dull ache or a sharp burning pain in the entire genital area, sometimes spreading to the legs. May also have vulvitis (inflammation of the vulva) and a profuse watery vaginal discharge
• First outbreak: may also experience fever, headache, and/or swelling of lymph nodes in the groin. The initial outbreak is most painful and takes the longest to heal (2-3 weeks).

• Pain in the testicles during prodromal period
• Sores may follow, sometimes without being noticed
• May also be a watery discharge from the urethra

• 75% of people have outbreaks after the first episode, usually within 3-12 months and usually in the same area of the body.
• Usually milder and doesn't involve the cervix
• Associated with
  • Stress, illness, trauma to the skin, menstruation or pregnancy
  • Lowered resistance, poor diet, drugs that weaken the immune system (such as caffeine, speed, and possibly birth control pills and diet pills)
  • Deficiency in B vitamins
• Type II (genital area) is much more likely to recur than Type I.
• Frequency usually decreases with time.

• No medical cure
• Zovirax may shorten outbreaks and can be taken daily to prevent recurrences.
• Discuss with a health practitioner how to minimize discomfort, avoid infecting your partner, and prevent recurrences.

Human Papillomavirus (HPV) aka Genital Warts or Condyloma

• Symptoms don't appear until 3 weeks-several months after exposure, but HPV is most contagious during the pre-symptomatic stage.
• When visible, the warts look like regular warts (small, painless and hard spots that often develop a cauliflower-like appearance as they grow).
• May appear on the bottom of the vaginal opening, labia, vulva, inside the vagina, on the cervix, or around the anus
• Cervical lesions, although more prevalent than visible warts, can't be seen by the naked eye and don't cause any symptoms. Men's Symptoms: warts appear on the head of the penis (often under the foreskin), on the shaft, or sometimes on the scrotum

• Various methods to remove the warts, but they won't cure HPV so warts may return.
• As with herpes, a strong immune system is often key in warding off recurrences.

Syphilis

• Sexual or skin contact with someone who is in an infectious stage and when symptoms are present
• Pregnant women to their unborn babies

• Primary
  • Shows up 9 days-several months after infection
  • First sign is usually a painless sore called a chancre, which may look like a pimple, a blister, or an open sore and usually appears on the genitals but may also appear on the fingertips, lips, breast, anus, or mouth (at or near the place where the bacteria entered the body)
  • Few women who get chancres notice them.
  • Will heal (with or without treatment) within about 1-5 weeks, but bacteria will continue to spread
• Very infectious
• Secondary
  • Begins 1 week-6 months after infection and lasts weeks to months, although symptoms can come and go for several years
  • Bacteria has spread throughout the body.
  • May include rash (entire body or just in palms of hands or soles of feet, sores in the mouth, swollen, painful joints or aching bones, sore throat, mild fever, or headache (all flu-type symptoms)
  • May also lose some hair or discover a raised area similar to a wart around genitals and anus
  • Can be spread through mucus patches or condylomata lata (the raised areas)
• Latent
  • May last 10-20 years
  • No outward signs
  • Bacteria may be invading inner organs.
  • Not infectious after the first few years in this stage
• Late
  • Depending on which organs the bacteria have attacked, may develop serious heart disease, crippling blindness, and/or mental incapacity

• Can be diagnosed and treated at any time but early symptoms may be confused with other STDs
• Antibiotics are given but it is still important to have follow up tests 6 months and 1 year later.

Resources:

American Social Health Association (ASHA)
PO Box 13827
Research Triangle Park, NC 27709
Operates hotlines and publishes numerous materials on topics including chlamydia, PID, herpes, and HPV.

National Sexually Transmitted Disease (STD) Hotline
(800) 227-8922
Open Monday-Friday, 8 AM-11 PM, EST.

AIDS Information:

National HIV and AIDS Information Service
(800) 342-2437
Open 24 hours.

National HIV and AIDS SIDA Line
(800) 344-7432
For Spanish speakers. Open 8 AM-2 AM, EST.

National HIV and AIDS TTY Line
(800) 243-7889
For people with hearing impairments. Open Monday-Friday, 10 AM-10 PM, EST.

Herpes Information:

National Herpes Hotline
(919) 361-8488
Open Monday-Friday, 9 AM-7 PM, EST.

Herpes Helpline
(415) 388-7710
Open 8 AM-4:30 PM, PST.

Sources: Chapters 14 and 15, The New Our Bodies, Ourselves (1992 ed.), and Go Ask Alice.