``STD'' is a term applied to more than two dozen diseases that are transmitted primarily through anal, oral, or vaginal sex. Their effects are not limited to the reproductive organs, and they do not always have to involve sexual activity, but most often they do. In most cases, the organisms that cause STDs enter the body through the mucous membranes: the warm, moist surfaces of the vagina, urethra, anus, and mouth. However, in some instances, exposure to sores or other types of skin-to-skin contact may be sufficient to transmit infection (see description of each disease). In addition, any cuts or lesions that allow germs to get into the bloodstream may increase the risk of transmission, particularly for blood-borne infections such as HIV and hepatitis B.

Most STDs that are caused by bacteria, protozoa, and other small organisms can usually be cured with antibiotics or topical creams and lotions. Among the most common STDs are two bacterial infections known since ancient times: syphilis and gonorrhea (the ``clap''). A third, chlamydia, is becoming alarmingly widespread today. All three may be cured with antibiotics, but they can cause serious complications if left untreated.

Viral infections, however, while treatable, are not curable. These include herpes; human papillomavirus (HPV), which causes genital warts; and human immunodeficiency virus (HIV), which produces AIDS. Treatment may help relieve the symptoms and/or slow the progression of the disease.

Hepatitis is the only STD for which a vaccine exists. Some other common STDs include trichomoniasis, which is caused by protozoa and is treated by a simple oral antibiotic, and scabies and crabs, which are tiny organisms that infest the skin or pubic hair and can be treated by the application of topical creams and lotions. Bacterial vaginosis may or may not be sexually transmitted, because changes in vaginal flora (the organisms that naturally live in a healthy vagina) may occur without sexual contact. There are over 24 STDs, more than we will be able to cover in this chapter. For additional descriptions of STDs, read chapters 15, HIV, AIDS, and Women, and 24, Selected Medical Practices, Problems, and Procedures, or the STD Handbook (Montreal Health Press). See the Resource section for a complete listing.

The most likely way to get an STD is to engage in unprotected vaginal, anal, or oral sex, although the diseases described in this chapter can also be transmitted through other intimate sexual and skin-to-skin contact and through donor insemination.

In general, any physical activity that allows blood or other infected body fluid or tissue to come in contact with the mucous membrane, or to enter the body through cuts or lesions, could transmit an STD. Oral sex, penetration with fingers, and sharing infected and unsterilized sex toys, as well as touching open sores and then other parts of the body, may all be potential ways to transmit diseases. If any of your sexual partners (or their partners) has an STD, you are likely to become infected unless you practice prevention consistently. Although it is rare for STDs to be transmitted on inanimate objects, contagion is possible when fresh body fluids are on the object (such as a shared sex toy). Toilet seats or towels are possible but unlikely routes of transmission.

Statistically, if you are young (between 15 and 24), are sexually active with more than one partner, and live in an urban setting, where the number of people with STDs is greater and other risk factors are multiplied, you are at highest risk. Unprotected sex with a new partner, or with anyone whose sexual history you do not know, may put you at risk. For many women, poverty may contribute to a higher risk of STD. Not having enough money can mean lack of access to prevention and treatment, engaging in commercial sex work, economic dependence on a partner who may be exposing you to infection, or just being preoccupied with day-to-day survival, so that STD prevention may not be your highest priority.

Some biological factors may also affect risk for certain groups of women. In young girls, the cervix is not yet fully developed and is more vulnerable to infection. Older women are more likely to get small abrasions in the vagina during sexual activity as a result of thinning of the membrane and, possibly, dryness. Women who already have an infection, particularly one with genital lesions, are more likely to get or transmit another STD, including HIV.

If you are a woman who has sex exclusively with other women, your chances of getting an STD are significantly lower. However, since many women who consider themselves lesbian may also, currently or in the past, have been involved with men, it is more difficult to determine the risk of transmission exclusively from woman to woman. More research is needed in this area.

1. STDs are very common. If you are sexually active in anything but a totally monogamous relationship with someone who is having sex only with you and does not have an STD, you have a high risk of getting an STD. If your partner is not monogamous, you may be exposed to STDs, including HIV, from your partner's partners.

2. The best way to deal with STD is to avoid getting it in the first place. Practice prevention wherever possible. See the box on p. 344 for more information.

3. If you think there is the slightest possibility that you or your partners have an STD, get medical attention as soon as you can. Remember, you might not have any symptoms. In the meantime, try to find out whether the person you had sex with has been exposed to an STD.

4. Don't have sex until you and all your current partners (and their partners) have been tested, treated, and cured (check with your health care provider).

5. If you do have an STD, inform all your recent partners personally. Even an anonymous letter will do. The partner notification services available at local Department of Health offices will inform people anonymously, without revealing your identity.

6. Before accepting treatment, make sure you understand what you are taking and for how long, the side effects, and any followup tests or treatment required. Don't be embarrassed about asking questions. It's your life, not theirs.

7. Remember, even if you are cured you can get the same STD again. Also, having one STD doesn't protect you from getting others. Viral STDs--such as herpes, HPV (genital warts), and HIV--cannot be cured. Specific treatment and management strategies are covered later in this chapter and in chapters 15, HIV, AIDS, and Women, and 24, Selected Medical Practices, Problems, and Procedures.

Using any of the prevention methods described below should reduce your chances of catching an STD. Consider using more than one method since no method, including condoms, is 100% effective.

1. Latex condoms (rubbers) used during vaginal, oral, and anal intercourse are the best-known preventive method. The man or you must put the condom on his penis before it touches your vulva, mouth, or anus. If you or your partner experiences irritation or other adverse reactions to latex condoms, try another brand, a polyurethane condom, or condoms without spermicide. Condoms without nonoxynol-9 are available for oral sex, in flavors that may make them more pleasant to use. Latex condoms have been more widely tested and found effective for disease prevention, but polyurethane condoms also provide protection. Never use an oil-based lubricant--such as Vaseline--with latex, as it will break down the rubber and destroy its protection. (See chapters 13, Birth Control, and 15, HIV, AIDS, and Women.)

2. Use the new female condom (Realityrm, Femidomrm, Femyrm). This could be useful if your male partner(s) can't or won't use condoms. Small amounts of any lubricant, including oil-based ones, may be used inside the pouch or on the penis. Using a spermicide containing nonoxynol-9 with the female condom may irritate the vaginal surface. (See chapter 13, Birth Control, for more information on the female condom.)

3. Use vaginal spermicides (contraceptive foams, films, creams and jellies).* You can purchase them in a drugstore without a prescription and use them with or without a diaphragm or condom. Using a barrier contraIceptive--condom or diaphragm--with spermicide may increase your protection. When using a condom, put an applicatorful of spermicide inside the vagina before sexual intercourse.

Using nonoxynol-9 can irritate the vaginal mucosa. Whether this increases the risk of HIV transmission is still uncertain. The question is controversial because much of the research indicating increased risk was based on very frequent use among sex workers.

4. A diaphragm (with spermicide) gives better protection against STDs that affect the cervix, 5. such as gonorrhea and chlamydial infection. Other cervical barrier contraceptives, such as caps and the sponge, have not proved to be as effective for STD prevention. Cervical barriers do not protect you from infection in other parts of the body, such as the vulva, vagina, or rectum, by organisms such as herpes, warts, or syphilis.

5. Washing the genitals before and right after sex may not help much. Douching, in most cases, does not prevent STD, as it washes away the normal vaginal secretions that help our bodies fight off infection and may even push infections higher up in your reproductive system. Men should wash their testicles and penis, particularly after anal sex and before going on to vaginal or oral sex.

6. Barrier methods can be used for mouth-to-vagina or mouth-to-anus contact. Dental dams (squares of latex used by dentists) can be used as a barrier for oral sex. Some people now place household plastic wrap over the area before contact, then discard it after one-time use. If nothing else is available, you can cut up a latex glove and use that as a barrier.

Remember: Barriers don't protect you from an infection on parts of the body that they do not cover.

7. Avoid sharing sex toys. Body secretions on sex toys may transmit STDs. Some people soak sex toys in hydrogen peroxide for 15 minutes. Also, be very careful in any sexual activities that involve blood, including bondage and discipline. Direct contact with the blood--including menstrual blood--of an infected person can transmit HIV or hepatitis.

8. Talk to your lover about STD before having sex. Ask if she or he has been exposed to an STD. This is especially important if you are pregnant! Look carefully at your body and your lover's, checking for a bad smell, an unusual discharge, sores, bumps, itching, or redness. If you think you or your partner may have an infection, don't touch the sores or have sex. Also, remember that a person may be infected with an STD, such as herpes or HIV, and look completely healthy.

It's one thing to talk about ``being responsible about STD'' and a much harder thing to do it at the moment. It's just plain hard to say to someone I am feeling very erotic with, ``Oh, yes, before we go any further, can we have a conversation about STD?'' It is hard to imagine murmuring into someone's ear at a time of passion, ``Would you mind slipping on this condom just in case one of us has an STD?'' Yet, it seems awkward to bring it up any sooner if it's not clear between us that we want to make love.

For some ideas on how to talk about sex more comfortably with a lover, see chapter 11, Sexuality.

9. We do not recommend morning-after antibiotics for STDs. Taken just before or within nine hours after exposure to an infected person, these antibiotic pills contain enough drug to prevent these diseases, but not enough to cure an established infection. Taking antibiotics frequently or in less than the optimal dosage may encourage the development of resistant strains of bacteria.

*Many creams, films, foams, and jellies have been shown in the laboratory to kill organisms that cause gonorrhea, syphilis, trichomoniasis, candidiasis, chlamydial infection, HIV infection, and herpes. In actual use, they have been shown to be effective only against chlamydial infection and gonorrhea. Test your sensitivity to these products on your body before using them during sex. Try latex separately from nonoxynol-9, and experiment with different brands of condom or spermicide. These products have not been tested for use in anal sex.

Copyright © 1984, 1992, 1998 by the Boston Women's Health Book Collective. All rights reserved. Published by Touchstone, a division of Simon & Schuster Inc.

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