Today we’re tackling the big one: HIV/AIDS. This is the STI that is effectively in a class of its own, both in terms of impact and the way people react to it. The good news is that while it is still a brutal disease, great strides have been made in treating AIDS over the past decades, and what was once a death sentence is now closer to being a chronic (though still deadly) infection.

One of my jobs as a freelance writer involved researching and writing about the latest HIV/AIDS research. While I will be surprised if we see even a functional cure (a treatment that acts like a cure, even though the infection is still present) in the next ten years, based on the current research I do believe we will see on in the next quarter century. Given the current life expectancy of people with HIV, that means that many people in developed nations who are currently infected will benefit from such a cure. Unfortunately, the hardest hit parts of the world are also the areas where treatment and access to medical help is hardest to get.

Transmission: HIV is transmitted through the bodily fluids. This means the bodily fluid (semen, vaginal discharge, blood, mucus, etc) of someone who is infected, needs to enter the body of someone who is not infected. Now, let me put something in perspective. The common cold is spread through bodily fluids – that’s why you are supposed to wash your hands after you blow your nose. But where a common cold goes through a household like a storm, HIV doesn’t. Because despite the bogey-man reputation HIV has, it is actually hard to transmit HIV. One study estimated that it takes around 100 episodes of sexual contact for one person to get infected. Of course, this isn’t universal. Some strains are more infectious than others, and some people are more susceptible to infection. But it does mean that if you know someone who has HIV/AIDS, you can shake their hands, sleep in the same bed, even share a toothbrush, without worrying about getting infected. Of course, there are other reasons you really shouldn’t be sharing a toothbrush.

Prevention: Female and male condoms are some of the best and most widely available avenues of prevention. Getting tested regularly (and your partners getting tested regularly) is also very important. The FDA recently approved over-the-counter tests for HIV, so you can order a test online and take it in total anonymity if you are worried. (I believe similar tests are available in some other countries, hopefully the availability will spread over the next few years). Other barrier methods like diaphragms may provide some protection, though less than condoms. Research is ongoing into vaginal gels which can prevent transmission. Some of these have been successful in testing, but are not yet available on the market. PrEP (Pre-Exposure Prophylaxis) is becoming more available–this is taking anti-retroviral medicine before infection to prevent getting infected. If you or a partner are at high risk for HIV infection, speak with your doctor about whether or not PrEP may be right for you.

Symptoms: Immediately after infection, a person develops  flu-like symptoms for a week or two. Afterwards, there are no symptoms under HIV progresses to AIDS. The main early symptoms of AIDS are the development of certain illnesses which only appear in people with suppressed immune symptoms. If you are sexually active (and I don’t care if you are monogamous, do you REALLY know what your partner is doing?) try to get tested for HIV at least once a year, because catching the infection before symptoms develop is crucial to effective treatment. If you have multiple partners or new sexual partners, get tested more often.

Treatment: The main treatment for HIV/AIDS is HAART or Highly Active Anti-Retroviral Therapy, which consists of a combination of medications that interfere with the way HIV reproduces in the body. Other treatments are aimed at treating and preventing opportunist infections (OIs) which develop when the body’s immune system becomes too weak to fight them off.

(Update) I want to add a bit here, because lately I’ve been running into a lot of mis-information about HIV/AIDS, and some of it really pisses me off. I spent a year deunking AIDS cure scams and identifying legitimate alternative medical treatments that would actually help people with HIV/AIDS. Here the bottom line: To date only one person has been cured of HIV/AIDS, and that cure was a medical miracle that cannot be reliably repeated. The only reliable, life-extending treatment is HAART. Magic Johnson had to hold a press conference earlier this year to say what everyone should have known: he still has HIV. Thanks to HAART and a lot of luck, he remains largely healthy and can expect to live for a long time yet. But the best that medical science can do is to put HIV/AIDS into what I call a ‘remission’ status, and that remission lasts only as long as you keep taking HAART. If someone tries to tell you there is a secret pill that can cure HIV/AIDS, or that Magic Johnson is still alive so obviously there is a cure or anything like that, that are dangerously misinformed. Please get the facts, and spread the truth.

Diagnosis: Doctors really prefer to diagnose HIV through testing. If testing is not available, or if a person has not gotten tested, doctors can diagnose based on the presence of what are known as “AIDSindicator diseases” – diseases that are extremely rare and only occur when the immune system is severely depressed. By the time these diseases develop, the infection has already progressed from HIV to AIDS, and it is too late for treatments to be fully effective. I repeat: get tested early and often!

Complications: Mainly the obvious: suppressed immune system, opportunistic infections and eventually death. Wasting is a lesser known effect of AIDS, where the body loses muscle mass over time, regardless of eating habits. The nausea and diarrhea that frequently accompany both AIDS and HAART just worsens the effects of wasting.

Folks, please don’t treat HIV as a bogey-man. Don’t treat people with HIV like pariahs, and don’t let fear tactics trick you into thinking that you can get infected in ways that you can’t. But do be careful, do educate yourself, and do protect your partners. Further information on HIV/AIDS can be found at, and on the World Health Organization and websites.

Back to the Long List of STD/STIs.

STD/STI: Herpes Simplex (1 and 2)

It sometimes seems like no STD/STI causes as much upset as herpes. People I speak with never worry about getting chlamydia, HPV or granuloma, but the minute STD/STIs come up, they start on herpes.

Folks, get over it. While not entirely benign, herpes is the closest thing you can get to an STD/STI version of acne. Annoying, epidemic, and the next best thing to untreatable, but rarely a real problem.

That said, there are some complications associated with herpes, and as always, you should avoid contact with open sores.

Transmission: Herpes is transmitted through skin-to-skin contact with an infected area. Herpes 1 usually infects the mouth and herpes 2 usually infects the genital region, but they can both infect either area, and more rarely other parts of the body. Infection is most likely to be transmitted during an outbreak, but can be transmitted at other times.

Prevention: Condoms can reduce the chance of contracting herpes, but since the infection can settle outside the area covered by condoms, they are not perfect protection. Female condoms provide better protection than male condoms, because they cover a wider area. Don’t have sex during an outbreak, or any other time one of you or one or your partners has open sores.

Symptoms: Most people have no symptoms of herpes. People who do experience symptoms will develop sores that break open and heal over a period of weeks. These outbreaks happen with decreasing frequency over time.

Treatment: Antiviral medication can reduce the frequency of outbreaks and the risk of transmission. There is no cure.

Diagnosis: A test during outbreaks can confirm the presence of herpes, however tests done when there is no outbreak may return a false-negative – which means a person may test negative for infection even though they are infected. The CDC estimates that 1 in 6 people in the US have herpes 2, and most of them are unaware of it.

Complications: Herpes sores can be spread to other parts of the body by touching an open sore and then an uninfected region. This can be particularly problematic in areas such as the eyes which are highly sensitive. Always wash hands well after touching open sores. People who are infected with herpes are at higher risk of contracting HIV and other STD/STIs that can be transmitted through blood. This is because the open sores create an avenue for the virus to infect the body. People who have herpes and are not in the middle of an outbreak are not at higher risk. Again, don’t have sex or physical contact when you have open sores. Herpes 2 may create risks for a pregnant mother, if you have been diagnosed or have an outbreak, speak with your ob-gyn. It is important to avoid outbreaks during pregnancy and labor, if at all possible. People with suppressed immune systems may have additional problems caused by herpes.

Back to the Long List of STD/STIs.

STD/STI: Hepatitis (A, B and E)

Hepatitis technically refers to inflammation of the liver, which can have several possible causes. However, there are five viruses that can cause hepatitis, known as Hepatitis A, B, C, D, and E. Of these five, three can be transmitted sexually.

Hep B is the sexual infection most people are familiar with. Vaccinations for Hep B are routinely given to infants and children in the US and some other part of the world. A vaccine for Hep A was developed in the 1990s, and has been given to children in the US since 1995. Hep E is rare in the US and Europe, but common in some areas of Asia. A vaccine for Hep E has been developed in China, but as far as I know it is currently available nowhere else in the world..

Transmission: Hep A and E are both transmitting by ingesting infected feces. These versions of hep are not usually considered STD/STIs, but oral/anal contact during sex or anal sex followed by oral sex can cause infection. Hep B is transmitted through bodily fluids, so infection can occur through any sexual contact.

Prevention: Men who have sex with men, and other folks who routinely engage in anal sex are advised to speak with their doctors about getting vaccinated for Hep A, assuming they were not already vaccinated as children. Use barrier methods prevent direct skin-to-skin contact during sexual activities. Clean your hands well after coming in contact with other people’s bodily fluids or anus. All forms of hep are extremely resilient and can survive outside the body. Surfaces (including sex toys) that might be infected should be cleaned with bleach or boiled (alcohol or other standard disinfectants will not work for hep).

Symptoms: Acute infection with all three forms of Hep most often resemble a severe flu, though sometimes there are no symptoms. Symptoms from Hep A and E usually last about two months and almost always clear up within six months. Symptoms of acute Hep B usually clear up in a few weeks, through chronic infection may develop. Chronic Hep B may not have symptoms, but can cause later complications.

Treatment: Usually acute infection clear up without treatment. If signs of acute liver failure develop (which is rare but possible) treatments include dialysis and liver transplant.

Diagnosis: All forms of hep are diagnosed based on reported symptoms and a blood test.

Complications: In severe cases, hep can result in liver failure and even death. Chronic Hep B can lead to cirrhosis of the liver and other liver related illnesses as a person ages.

With the development of vaccines, hep is less of a concern now than it was twenty years ago. Still, it is a good idea to take precautions if you have not been vaccinated. If you engage in any sexual activity that may involve contact with blood, you should also learn about Hep C.

Back to the Long List of STD/STIs.

STD/STI: Gonorrhea

Colloquially know as “the Clap” or “the Drip,” Gonorrhea is a bacterial infection that is currently giving disease control official around the world nightmares. It has a disturbing ability to develop resistance to antibiotics, and some very unpleasant long-term side effects. Epidemics of gonorrhea are expected to break out eventually, if new antibiotics can’t be developed to combat it. This makes stopping the spread of gonorrhea before infection very important.

Prevention: Condoms, as always. Other barrier methods such as cervical caps will not protect against gonorrhea. Otherwise, abstinence, or only have sexual contact with people who you know are not infected. Gonorrhea can be spread through contact with infected fluids, genitals, anus or mouth. In other words, any and all forms of sexual contact. It can also be spread from mother to child during labor and delivery.

Treatment: Antibiotics. Some strain may be resistant to first-line antibiotics, so it’s important to get retested after treatment to be sure the infection is gone. If it isn’t, you will be treated with second-line antibiotics. Second-line antibiotics will usually be more expensive, take longer to work, or have more severe side effects. But because they are used less often, infections rarely develop any resistance to them.

Symptoms: Symptoms in women are either mild (and often mistaken for something else) or totally absent until complications occur. Early symptoms can include pelvic pain, vaginal discharge, burning during urination and sore throat. Early symptoms in men include penile discharge, burning during urination and sore throat. If symptoms develop, they will appear 2-30 days after infection.

Diagnosis: Gonorrhea can be diagnoses in several way, including urine test, swab test and blood test. A blood test is only effective after the infection has reached the blood stream.

Complications: Complications from gonorrhea include damage to the genitals which can lead to infertility in both men and women, meningitis, and scarring to the infected tissue.

Gonorrhea is one of the STD/STIs that makes regular testing important. The serious complications, lack of symptoms and easy of infections make it vjust plain good sense to try and avoid sexual contact with anyone who is infected, and to get yourself in treatment as early as possible if you are infection.

Back to the Long List of STD/STIs.

STD/STIs: Granuloma Inguinale (Donovanosis)

Granuloma inguinale is rare in the US, with less than 100 cases occurring each year. It is more common in tropical and subtropical areas of the world, especially in regions where antibiotics are not common.

At first glance, granuloma inguinale can resemble several other infections involving some form of genital sore, such as CMV. Unlike CMV sores, granuloma inguinale can and does spread to other regions of the genitals and inguinal area (the folds of skin between the trunk and legs).

Prevention: Don’t have sex with anyone who has visible sores, use condoms.

Treatment: Granuloma inguinale is treated with a three-week course of antibiotics. Early treatment can prevent scarring and loss of genital tissue.

Symptoms: Bright red bumps develop in the genital tissue or anus. Over time the skin of these bumps wears away leaving bright red nodules that may bleed easily, though they are usually painless. Overtime these sores spread, eating away at the genital tissue. Early treatment can prevent scarring and damage to genital tissue.
If you live in a part of the world where granuloma inguinale is rare, you shouldn’t need to worry unless you have a partner from a part of the world where it is more common. If you live in an area where granuloma inguinale is common, you will want to educate yourself about the signs and symptoms so you can get treatment as early as possible. Regardless of where you live, it is always a good idea to avoid sexual contact with any partner who has sores or lesions.

STD/STI: Genital Warts

For the first time in our examination of sexually transmitted infections we say hello to our good friend HPV(human papillomavirus). There are several kinds of HPV, and some of them cause genital warts. Luckily, the information I’ve been able to find suggests that the strains of HPV that cause warts are different from the strains of HPV that contribute to cervical or anal cancer.

Genital warts is one of those sneaky infections – you may not know you have it, and once you know all you can do is treat the symptoms. It is also difficult to protect against. As far as I can tell, genital warts do not create any long-term health problems.

Prevention: Don’t have sex if you or your partner has visible genital warts. Condoms (male or female) protect against infection in the areas they cover, but it is possible to be infected in other regions. As female condoms cover more of the genitals, they provide greater protection. The HPV vaccine provides protection against some forms of HPV that cause genital warts. The vaccine in not recommended for men or women over 26 years old.

Treatment: Treatment is restricted to treating the symptoms. Over-the-counter treatments are ineffective. A doctor can remove the warts using surgery or provide a prescription treatment.

Symptoms: Men who are infected will only have symptoms 10% of the time. Women develop symptoms more than half the time. An infected person can transmit the infection whether or not they have symptoms. When warts develop they can look like small cauliflower, or flesh-colored bumps. Warts can occur pretty much anywhere on or in the genitals and anus, as well as on the lips, mouth and throat. A weakened immune system due to illness, pregnancy, medication or other cause increases the risk of warts developing.

While unsightly when they develop, genital warts are not an STD/STI that we need to be overly concerned with. Realistically, genital warts are no different from warts anywhere else on the body (which are all caused by HPV). So if you wouldn’t freak out about your partner having warts on hir hands, there is no reason to freak out about genital warts.

Back to the Long List of STD/STIs

STD/STI: Cytomegalovirus (CMV)

If you are worried about cytomegalovirus, don’t. I decided to include CMV in this posting series because more information is good, but when it comes to CMV, there isn’t all that much you can do with the information. Nor (for most people) is there any real need to do anything.

CMV is transmitted sexually, but you wouldn’t know it to read about it on most websites. Doctors are far more worried about transmission from mother-to-child during pregnancy. Why? Because for most people (and it is estimated that about 50% of adults are infected by age 35) CMV is a silent infection. It hangs out in your body, not doing much of anything except hiding from your immune system. Unless your immune system is weakened somehow, you won’t even know you have it.

Babies, on the other hand, are born with a weakened immune system (or rather, and immune system that isn’t fully developed) and are at greater risk of actually getting sick from a CMV infection.

Prevention: Preventing CMV infection is a bitch. It is transmitted through contact between bodily fluids and mucus membranes. Like a lot of STD/STIs, right? Well, not exactly. If you shake hands with someone who is having an acute CMV flare up, then rub your itchy eyes, you can get infected. Most infections occur between 10 and 35 years old. Sexual contact is only one of the ways this infection spreads.

However, if an infected person is not having an acute flare up, standard barrier methods should work to prevent transmission during sex. Try to avoid direct contact with bodily fluids and the other person’s mucus membranes, and wash your hands when play time is over.

Treatment: Like chickenpox (CMVs close relative), once you are infected, the infection is permanent. There is no getting rid of this bugger. If an acute infection develops. the normal course is to treat the symptoms. Pain killers and salt water gargles are common recommendations.

People with severely weakened immune systems may be treated with antivirals.

Symptoms: For adults, CMV infection can take 3 forms: dormant, acute or CMV infection in immunocompromised systems. Dormant CMV is when you are infected and the virus just sits there, not doing much of anything. There are no symptoms and no problems.

In acute CMV, a generally healthy person will get a CMV flare-up when their immune system is weakened–such as when they are under a great deal of stress. Acute CMV mimics mononucleosis, with long-term malaise, swollen lymph nodes, and general aches and pains. Like mono, it can last up to 6 weeks and will clear up on its own.

CMV in immunocompromised persons can be scary. Flare-ups can cause pneumonia, encephalitis and more. Some of these dangerous manifestations of CMV are among the AIDS-defining infections

Diagnosis: CMV is usually diagnosed based on symptoms. There is a blood test available to detect the virus, but it is expensive and not widely available. During an acute flare-up a simpler blood test can detect antibodies.

Complications: In a dormant infection, complications aren’t an issue. They are rare in acute infections and usually involve the infection spreading to other areas of the body. CMV in immunocompromised persons is basically one big (and dangerous) complication, with untreated results ranging from blindness to death.
Overall, CMV is not an infection you need to really worry about unless you have HIV, recently had an organ transplant or otherwise have a compromised immune system. That said, there is around a 50% possibility that you are already infected, and getting diagnosed outside of an acute flare-up is nearly impossible. Take precautions when interacting with people who are experiencing flare-ups, and otherwise try not to stress about it.

STD/STI: Crab Lice

Also known as pubic lice, or the crab, the crab lice are a parasite that infects the course hairs of the human body. Normally this means pubic hair, but they can also infect armpit hair, chest hair, eyelashes, and other coarse hair. Most countries don’t require incidences crab lice to be reported, so there is no reliable statistics on how common they are. The best available estimate is that they infect approximately 2% of people worldwide.

Prevention: Not having intimate contact with people who are infected is the best protection. As life can be transmitted through bedding, towels, and other fabrics this is not 100% protection, but it’s definitely your best bet. Several sources recommend practicing safer sex to prevent transmission. I can only assume that this is a default recommendation for all STD/STI’s, as the only barrier method which might provide some protection against lice is female condoms. Basically, unless you are wrapping the entire general area in a plastic bag and having no direct contact, crabs can be transmitted. I do not know of any commercially available protection which actually does cover the entire genital area. And that doesn’t even count the possibility of infection being transmitted from someone’s armpit hairs or sheets.

Treatment: Lice can be gotten rid of with an over-the-counter or prescription shampoo. Eggs are removed by combing with a fine toothed comb. In order to prevent possible reinfection, bedding and towels and any clothing which comes into contact with the infected area should be washed in hot water.

Symptoms: The main symptom of crab lice is a persistent itching in the pubic area, which is usually worse at night. Itching is caused by a reaction to the crab lice saliva. Sometimes, though not always, the skin around the bites will turn blue-gray. A careful examination will find eggs, small white dots, attached to the hair.

Diagnosis: Crab lice are one of the few STD/STIs that don’t require an official diagnosis. If you see the eggs on your pubic hair, you can go down to the drug store and get an over-the-counter treatment. If you do go to a doctor, they will diagnose based on the presence of eggs, itching and if necessary they will look at your hair under a microscope to see the crabs themselves.

Complications: The main complication of a lice infection is scratching yourself or on developing an infection in the scratches. The US National Health Institute recommends that anyone who has crabs be tested for other STD/STI’s, as apparently they are often transmitted together.

Overall, crab lice are more of an annoyance than a serious concern, but I still wouldn’t want to play host to them. For more on STD/STIs, check out the Long List of STD/STIs.

STD/STI: Chlamydia

Chlamydia is the most common bacterial STD/STI in the US, with over 1 million infections reported each year. Given the silent nature of this infection it is likely that it is just as common in other parts of the world. The US Centers for Disease Control and Prevention (CDC) recommends that all sexually active adults be tested for chlamydia at least once a year and more often if they have multiple sex partners.

Prevention: Both male and female condoms can prevent the spread of chlamydia. Chlamydia can be spread through vaginal intercourse, anal intercourse and rarely through oral intercourse. Therefore using barrier methods during any form of sexual interaction is recommended. If you have been diagnosed with chlamydia it is best to avoid sexual contact until you have completed your course of treatment.

Treatment: Chlamydia is treated with a course of antibiotics. At this time, there are no known antibiotic resistant strains of chlamydia. Due to the silent nature of the infection, if someone has been diagnosed with chlamydia all their sexual partners will usually be prescribed antibiotics as well, to prevent any possibility of a cycle of reinfection.

Symptoms: Only 30% of women and 75% of men who are infected with chlamydia will develop symptoms. This means that more than half of those infected will have no indication of their infection.

Symptoms for both men and women include abnormal discharge from sexual organs or rectum, and burning during urination. Women may also experience pain during sex and develop symptoms of pelvic inflammatory disease. Men may develop painful or tender testes.

Diagnosis: Chlamydia is diagnosed through taking cell samples from any and all possible infected areas (penis, cervix, urethra and rectum) and sending them out for testing. In some cases, Chlamydia may be diagnosed with the urine test.

Complications: The most common complications from chlamydia are infection of the urethra or cervix. This can develop into more severe complications for women, untreated cervical infection can spread to the uterus and fallopian tubes leading to pelvic inflammatory disease, and possibly infertility and/or an increased risk of ectopic pregnancy.

If a woman is infected during pregnancy additional possible complications can affect the child. Doreen birth infection can spread to the eyes or throat of the newborn, which can lead to blindness or chlamydial pneumonia.

Chlamydia is one of those infections that makes STD/STI testing so important. If undetected it is easily spread and can have significant long-term consequences. However it is easily detected and easily treated if it is caught before problems develop.
Back to the Long List of STD/STIs

STD/STI: Chancroid

Chancroid is a bacterial infection that is only transmitted through sexual contact. It is rare in the US and other parts of the world with good access to antibiotics. It tends to be very common in developing nations and other parts of the world where antibiotics are difficult to get a hold off.

A white sore with red borders on the head of a penis.
Penile chancroid sore (Image is public domain from CDC)

Prevention: Chancroid is transmitted by direct skin to skin contact of the genitals. Male or female condoms should be effective prevention. If you choose not to use condoms, then do not engage in direct genital contact with anyone who has any kind of sore on their genitals. (That last really should be a ‘Duh’.)

Treatment: Chancroid infections can clear up on their own after a few weeks, but are painful and have potential complications. A single course of antibiotics will normally clear the infection up without any problems. Some chancroid strains have developed a resistance to specific antibiotics, but there is no known strain which is resistant to all antibiotics.

Symptoms: The main symptom of chancroid is a circular sore which develops between three days to two weeks after infection. The sores are round, with clearly defined edges. On the vagina, the source can be found on the outer labia, usually the inner surface but occasionally the outer surface. Sores can develop pretty much anywhere on the penis, including the opening of the penis, or on the scrotum. Chancroid sores resemble the typical sort of primary syphilis. After the sores develop, the lymph glands in the genital area often become swollen.

Diagnosis: Chancroid is usually diagnosed off of a visual examination. If there is some uncertainty as to the diagnosis, sores may be swabbed for testing.

Complications: Urethral fistulas and scarring may develop on the foreskin of an uncircumcised penis. If the infection goes untreated, abscesses from swollen lymph nodes may develop scarring. A chancroid infection may leave you vulnerable to infection by other STD/STI’s, including HIV and syphilis.

Given its restricted geographic range, and very visible symptoms, chancroid is not an STD/STI that many poly-folk need to worry about. If you live in an area where chancroid is common, use condoms and avoid genital contact with people who have open sores. If you don’t live in an area where chancroid is common, you should be doing the exact same thing anyway.