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To determine the extent to which the offender’s partner or victim participated in the various sex acts, we had recourse to two chief sources of evidence: the account given to the authors by the offender himself during the interview session, and the official records. The latter often included testimony given in court by the object or by witnesses, as well as the record of various interrogations of the offender by officials and the prison intake staff. After summarizing the offender’s account and then the official reports, we will examine the degree and direction of discrepancies between the two reports on the same case. This latter step is necessary because of the extent to which no-data cases permeate the sample of offenses at this point.

The offender report. Reaction on the part of the object of an offense can range, of course, from clear-cut encouragement to strong resistance. With sexual behavior as the basic topic of the history, the description of the sex-offense circumstances fitted very naturally into the interviewing framework. Nevertheless, there were certainly some occasions when the offender sought to rationalize his behavior in his own eyes by his description of the object’s response, and it is instructive to examine the data with this in mind.

Relationships described as mixed are of two kinds: they shift either from an attitude of resistance to one of encouragement, or vice versa. Actually there were only four offenses in which resistance was described as giving way to encouragement—twice in aggression vs. adult females and twice in incest offenses (one in each of the two older object groups). In a sample of over 1,200 offenses on which such data are available this is indeed a tiny minority and a surprising finding, considering the popularity of the Don Juan theme as depicted in moving pictures, ordinary paperback novels, comic books, and pornography. It reflects a closer sense of reality than do the popular forms of current erotic media. From this negative finding one might infer that these offenders lack an image of themselves as successful wooers, at least in the episodes that led to their convictions as sex offenders.

The second pattern of mixed response in which the offender describes the other person as at first encouraging his sexual advances and then resisting them, can also be used to help justify his illegal actions, since it can shift some of the responsibility for them to his partner or victim. And it is indeed in offenses involving those that can truly be termed “victims,” particularly in the case of adult women, that this pattern of response is most often reported. In our sample, a total of 23 aggressions against women are thus depicted by the offenders, and a single additional instance was cited in the aggressions vs. minors category. There is also a small sprinkling of cases in the remaining nine offense subgroups.

The entire problem of a consenting relationship in the realm of sex is raised again at this point. Generally males do not seek out females who do not show some interest in them. The grounds of this reciprocated interest may be various—a desire for companionship or a date, a sandwich at the drive-in, a chance to go to the movies, a drink, a car ride, or a stimulating flirtation ending in necking, petting, or coitus. The point at which the female decides to go no further is a delicate one, and contingent on many factors which may well be outside; the man’s range; of perception. That a male’s drive and need to achieve a sexual physical release is not matched in degree by most females is generally acknowledged. Hence in order to keep out of trouble, males, unless they are successful mind readers, must acquire a set of controls and an ability to face frustration, which for the most part is not true for females. While in many social groups a girl is taken out on the premise that she is experienced and willing, the fact is obvious that those who are experienced may in a specific case be unwilling. To be sure, some males may not have to face this situation very often, which may in part explain their inability to handle it when it does arise. Thus a sexually aroused and temporarily frustrated but determined male may find himself with a rape charge as did undoubtedly some of the 15 per cent cited earlier.

Considering next the offenses in which the man reported that he received only encouragement, one finds the aggression cases ranking comparatively low, and the heterosexual and homosexual offenses, except for those involving children, very high, ranging from 83 to 95 per cent. To a lesser extent the same relationship holds true of incest offenses. Although one might think at first that the offender was simply trying to whitewash his offense in his account of it, his description of what happened was frequently accurate, as his partner and other witnesses also testified. In cases where there was little difference in age between offender and object there was a clear tendency for the object to encourage the offender and to participate willingly in the sexual contact. Complaints in these cases were usually made by relatives or others, not by the object. This opens up the entire question of victimology, which has in recent years been a topic of considerable interest. To what degree is an offense triggered by the advances, either overt or implied, of another person? The offense as an event is certainly not acceptable to the social mores, yet it is not the stereotyped offender-victim situation. The “victim” is often a willing sexual partner and even sometimes a seductive one, but if this person is under a certain age our social ethics definitely necessitate legal protection of this “object-victim” in such a situation.

Next are the cases in which the offender did not say that he was actually encouraged, but stated that the object was passive and did not object to his sexual overtures. This attitude is ascribed most often to the young and inexperienced (those under twelve years of age), except in father-daughter incest, in which the incidence ranges higher, though nowhere nearly so high as in cases of incest against child daughters, which keeps the pattern again consistent. When an offender reports that a child was nonresistant or passive or that she seemed “not to mind” or even enjoyed the sexual contact, one is apt to picture fright or ignorance as ingredients in the situation. Since the children were not interviewed in the present study, we have no cross-check on this point, except as developed later when reports on the same cases are matched.

Lastly, coming to the cases in which the offender admits that he met with resistance, one can see from the table that all three aggression categories are very high, with about two thirds so reporting, and all other offense groups are consistently low. As a rule, the average offender does not see himself as a villain. But again in all nonforce offenses vs. children there is a definite trend toward the offender’s admitting resistance by the: child. This pattern is consistent and the percentages among the pedophilic offenses are higher than in offenses vs. either minors or adults.

To summarize, it is apparent that while offender groups vary in the degree of cooperation they ascribe to the object of their offense, they are consistent in certain respects. In the majority of aggression offenses the object is described as offering resistance; in from two thirds to 95 per cent of the incest, heterosexual, and homosexual offenses vs. minors and adults the object is seen as having given encouragement. In offenses vs. children, except for aggression offenses, there was encouragement, or at least passive behavior, in well over three fourths of the cases. In all these groups resistance is given a minor role but is consistently evident.

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We have also calculated the proportions of each group who had been convicted as adults of some sort of offense, sexual or not, by particular ages. Whether or not the conviction was under juvenile or adult court proceedings is disregarded; we only specify the offender be aged sixteen or more. We realize that the age at which any one offender will be convicted for the first time is largely adventitious, but the data should give us some idea of how rapidly particular groups became involved with the law.

First convictions come early in life. By the end of their sixteenth year 18 per cent of the prison group had been convicted of some offense, by age twenty nearly three fifths, by age thirty about four fifths, and by age forty nine out of ten of the prison group had been convicted. Only three sex-offender groups match or surpass this meteoric rise in percentages. The aggressors vs. minors and adults, and the peepers equal or exceed the prison group by every age from eighteen on, reaching the 90 per cent level by age thirty. The other sex-offender groups display a much slower rate of involvement, the incest offenders being particularly tardy. Since ultimately all offenders were convicted, the tardy groups necessarily must accelerate their pace in later life. Thus we see that all three incest-offender groups increase as much as 20 percentage points in five years, while the increments of the groups involved at earlier ages are smaller.

The above picture gives no inkling of the severity of the offense. To measure this we calculated the percentages of individuals who by various ages had had convictions resulting in incarceration for a year or more. We are aware that the length of sentence is often dependent upon the age of the offender, his cooperativeness in court, his prior record, the type of offense, and a number of sub judice matters including the state of the judge’s viscera at the time of sentencing; nevertheless we feel it has more significance than a misdemeanor-felony distinction, since a misdemeanor in one jurisdiction or at one time may well be a felony at another place or period. Furthermore, a not inconsiderable number of felony charges are reduced to misdemeanors upon pleas of guilty or upon agreement to a bench rather than a jury trial.

Once again we find that more of the prison group served one year or more in earlier life than most sex-offender groups. The proportions of the prison group are nearly one fifth by age eighteen, one half by twenty-six, and three fifths by forty. Only the heterosexual aggressors exceed this record: two of the three aggressor groups pass the 50 per cent level before age twenty-three, and all three have passed the two-thirds level by age thirty. The peepers, who showed a rapid involvement in terms of any conviction, are less impressive in terms of convictions leading to a year or more of imprisonment. Although they tend to surpass the other sex offenders in early life, they lag behind the aggressors and prison group and ultimately end with a rather modest percentage.

The influence of the type of sex offense is only partly masked in these calculations. Note that sex offenders against children and minors tend to have more men with one-year-plus sentences than offenders against adults of either gender. Similarly the high percentages of all aggressor groups show that the use of force in sex, regardless of the age of the victim, is enough to warrant a substantial sentence.

Having broached the subject, we should now consider the cumulative incidence of the specific types of sex offenses for which the sex-offender groups were named. The incest offenders are by definition the most retarded group: a substantial amount of aging is involved in getting married, producing a daughter, and rearing her to a given age. Consequently we find that half of the incest offenders vs. children had not committed their incest offenses until their early thirties, the incest offenders vs. minors not until the late thirties, and the incest offenders vs. adults do not attain the halfway mark until their midforties

The groups that accumulate their offenses most quickly are the aggressors vs. minors and adults, and the peepers. These reach or pass the 50 per cent level by age twenty-three, and the 80 per cent level by age thirty.

The offenders, aggressors, and homosexual offenders vs. children definitely tend to commit their type offenses later than those who aggress or offend against older persons. The heterosexual offenders and aggressors vs. children do not pass the 50 per cent mark until their early thirties, whereas the heterosexual offenders and aggressors vs. minors and adults reach that point in their early to middle twenties. Among homosexual offenders the trend is less clear; nevertheless the homosexual offenders vs. children reach the halfway mark at an older age (about thirty) than do the homosexual offenders vs. adults. This trend is, of course, reversed among the incest offenders where the age of the daughter and father are linked.

Turning now to the age of the average (median) individual at conviction, for any offense, sexual or not, we see that the average (median ) prison-group male was 19.6 years old when first convicted as an adult for any offense. Only one sex-offender group (the peepers) equals this youthfulness, and only one (the aggressors vs. minors) had a younger median individual. Aside from these three teen-age convict groups, in nine of the remaining 12 sex-offender groups the average man was convicted in his early twenties (twenty to twenty-five years old). Remaining are the three incest-offender groups whose median individuals were convicted for the first time at ages twenty-nine, thirty-five, and thirty-eight.

A similar picture appears when one considers the median age at which the first conviction resulted in imprisonment for a year or more. Comparing the age at first conviction and the age at first conviction resulting in a year or more of prison, one sees that the former occurs about two to three years before the latter in the majority of groups. This gap reflects an increasing severity of offense with increasing age and also, undoubtedly, the leniency often shown to first offenders. The exceptions to the generality are two incest-offender groups where the gap amounts to as much as four and a half years, and the offenders vs. adults, for whom the first conviction and the conviction resulting in a year’s imprisonment occurred within a year.

The conviction for the sex offense for which a group is named always occurs later, speaking in terms of averages, than either the first conviction or the first conviction resulting in a year’s imprisonment. The first sex-offense convictions for the average males of the various groups occurred between the ages of twenty-two and forty-six—that is, anywhere from two and a half to 12 years after his first conviction for any offense. Early criminal activity, as measured by first conviction, seems linked with early conviction for sex offense. For instance, the peepers and aggressors vs. minors, who among the sex offenders were the youngest when first sentenced, were also the youngest when sentenced for their specific sex offense. Similarly, there is a correlation between late involvement in crime and late conviction for sex offense: the incest offenders are the prime example. Despite these chronological relationships, the time gap between first conviction and first sex-offense conviction shows no clear trends for the various groups.

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Calculation of the percentage of men who had married only once provides some highly interesting figures. The first eight ranks are occupied by persons whose offenses were directed at minors or adults; in the first five ranks are those whose sexual objects were adults only (or chiefly adults as in the case of peepers and exhibitionists). All aggressors and all offenders vs. children fall in the lower half of the rank-order, i.e., were more prone to experience separation or divorce followed by remarriage.

The groups with the highest proportion of men who were married only once owe this distinction to quite diverse factors. In the case of the control group, which is in first place with 81 per cent, it seems primarily a matter of conformance to the mores plus considerable deliberation in selecting a wife. The second-place homosexual offenders vs. adults probably owe their position to their homosexual component: one marriage was enough, and if it failed, they had no strong incentive to try again. For the third-place peepers, on the other hand, it is presumably a matter chiefly of their youth—they simply have not had time enough for many of them to have contracted more than one marriage.

A study of brief unsuccessful marriages reveals some wide inter-group differences. Using as the criterion marriages that lasted two years or less and ended in separation or divorce, one sees that the aggressors, homosexual offenders, peepers, and prison-group males have more such marriages than the control group and the incest offenders. This is all the more striking when one realizes that the peepers, aggressors vs. minors, and prison group are our three youngest groups, whereas the incest offenders vs. adults and minors are our oldest and therefore had more time for multiple marriages and divorces. Many diverse influences are here operative. For example, a very large (41 per cent = second in rank) proportion of the ever-married homosexual offenders vs. adults had one brief marriage ending in separation or divorce, yet very few (4 per cent) had two. Again this can be explained by their homosexuality which accounts not only for the brevity and termination of their first marriages but accounts for their lack of desire to remarry. The numerous brief marriages of the prison group and the aggressors are in large part due to their early involvement in crime with consequent imprisonment and disruption of marriage.

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To be considered in this study of prepubertal sex life is the infrequent phenomenon of prepubertal sexual relations with adults. The term “relations” includes not only physical contact but also solicitation by words, gestures, or other sexual approach. These may be psychologically quite as important as physical contact. The term “adult” is here meant to signify anyone fifteen or over who, in addition, was at least five years older than the interviewee at the time of the relationship.

Adult females only rarely encourage sexual activity with prepubertal males: such behavior is completely at odds with our cultural picture of the male as the instigator of activity and the sexually dominant partner. Furthermore, the vast majority of adult females have not entertained the idea that a prepubescent male could make a satisfactory, or even adequate, sexual partner. Our impression is that the females who do encourage small boys are generally sexually experienced females (at least in relation to the male) who are either hard pressed for heterosexual activity or who have an odd, in some ways almost maternal, desire to impart to the boy some knowledge of the pleasures of adult sexuality. Such a female seems to envision herself in the role of a kindly tutor, the experienced woman guiding the boy into the “proper” paths, the priestess presiding over the initiation of a neophyte.

Between 0 and 16 per cent of the members of different groups had had some sexual relationship with an adult female prior to puberty. Since such a relationship more often than not is instigated by the female, it is not surprising to find no particular trends in the percentages—for example, all tripartite groups are scattered widely. The control group is next to the bottom of the rank-order.

Solicitation or encouragement by females is generally quite effective: the great majority of boys who had any sexual relationship with an adult female had physical contact with her. Again no particular patterns are visible. However, in a study of what percentage had coitus, an act in which real participation by the boy is required, some interesting facts emerge. The prison group had the second largest number of boys (7 per cent) who had prepubertal coitus with adult females, and in third place are the heterosexual offenders vs. minors who, be it noted, had the highest percentage of boys with any sort of sexual relationship with adult females. In fourth place are the heterosexual aggressors vs. adults. Then follow six groups (including all the homosexual offenders and two of the three incest offenders) in the 4 per cent area. Toward the bottom of the list are the heterosexual offenders vs. adults and the control group. At the very bottom with no members involved are the heterosexual aggressors vs. minors, the peepers, and the exhibitionists. The latter are of special interest, since 12 per cent (the second largest percentage recorded) had some sexual relationship with adult females, but only 8 per cent (a rather marked decrease) had physical contact, and none had coitus. This discrepancy between opportunity and activity is uniquely large. The aggressors vs. minors and the peepers had so few members involved with adult females that the absence of coitus is not too surprising.

It is of interest to note (despite sample size and small range) that the three groups that rank high in prepubertal coitus with adult females (the prison group, the heterosexual offenders vs. minors, and the heterosexual aggressors vs. adults) also rank high or fairly high in measures of postpubertal coitus, e.g., median number of premarital partners and accumulative; incidence of premarital coitus in the early and middle teens.

In our society sexual overtures toward boys are much more often made by adult males than by adult females. From 8 to 35 per cent of the members of the various groups had been thus approached. The three groups whose members were most commonly approached are the homosexual offenders. While such overtures by adults may have reinforced the boys’ homosexual inclinations, in the majority of cases the boys had had previous homosexual experience with other boys; one cannot wholly blame the adults for the boys’ subsequent sexual orientation. Indeed, an experienced homosexual adult can through preliminary conversation and observation rather readily determine what boy among a number would be most receptive; thus one can say that in many cases the boy’s pre-existing homosexuality brought on the solicitation. It is also possible that the poor relationship which existed between the homosexual offenders and their fathers may have rendered the boys more vulnerable to friendly overtures by adult males.

Following the homosexual offenders, the prison group and the heterosexual aggressors vs. minors had the next largest proportion who were solicited by adult males. Note that both groups also rated just below the homosexual offenders in the percentages with homosexual prepubertal play with other boys—i.e., they too were relatively “ripe” for an approach. The group with the fewest members solicited was the control group.

Obviously an approach does not always result in a physical sexual relationship. Overt physical contact with an adult male was experienced by from 4 to 28 percent of our comparative groups. Again the three homosexual-offender groups lead, followed by the prison group. The heterosexual aggressors vs. minors, however, had physical contact less often despite the relatively large number of approaches made to them; in fact, only 1 out of every 3 continued to that point. This is a low ratio. The corresponding ratio for the homosexual offenders vs. adults and minors is about 8 out of 10. In other groups the ratio varies chiefly from 2 to 7 out of 10. Clearly, while more homosexual than heterosexual approaches are made to boys by adults, the homosexual approaches are more often rejected.

Only a small number of the incest offenders had prepubertal contact with adult males, and the control group fewest of all; these groups also experienced relatively few approaches.

As in the case of prepubertal sexual relationships with adult females, there is a positive correlation between prepubertal relationships with adult males and subsequent behavior after puberty. The five groups with the most experience before puberty (the three homosexual-offender groups, the prison group, and the heterosexual aggressors vs. minors) also occupy the five top positions in a rank-order of those ever experiencing homosexual contact after puberty. The reticence exhibited by the aggressors vs. minors in following up prepubertal homosexual opportunities with adults seems to vanish when they themselves become adult—especially in prison.

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At the time of the offense that resulted in his first peeping conviction, the average (median) peeper was 23.8 years old. Peeping is chiefly a young man’s avocation, calling for some agility and fleetness of foot. A middle-aged man may have strong voyeuristic desires, but is less inclined to scale fences or run foot races with irate husbands and neighbors. About two thirds of the offenses were committed by men who had never married, one quarter were by married men, and the remainder were by men who were separated, divorced, or widowed. The proportion of currently married men need not give rise to the question, “Why didn’t they look at their wives if they wanted to see a naked woman?” since we have pointed out that the peepers generally avoid spying upon females who are available as sexual partners. Nearly 95 per cent of the women were strangers, 1 to 2 per cent were acquaintances, and 4 per cent were friends. Not one was a relative. Moreover, such a question ignores the universal attraction (to males) of the “new or different” woman. Even a burlesque stagehand, a carnival man, or a gynecologist will stop or slacken his pace at least momentarily to look at a pretty girl undressing before her window.

Forty-six per cent of the peeping offenses were first sex offenses, 22 per cent were second, 15 third, 8 fourth, and 9 fifth or more. These figures undoubtedly would have shown a larger number of multiple convictions had it not been for the youthfulness of the peepers as a whole.

Their age may explain in part the low incidence of neurosis and psychosis prior to the offense (1 per cent, the smallest percentage on record). Unless one assumes that peeping is ipso facto evidence of some degree of psychopathology, the peepers are our mentally healthiest group. On the other hand, the awareness of the prison and court psychologists and psychiatrists of the common urge to peep may have prevented them from including in their records any comments or terms which would label these peepers as neurotic. However, this explanation does not account for the absence of peepers with records of previous treatment or incarceration in mental institutions.

Alcohol and drugs played little or no role in the offense behavior. We have no evidence of drug use, and only 16 per cent of the peepers were drunk (and an additional 10 per cent mildly intoxicated) at the time.

There were no copartners in the offenses. Adolescents may peep in groups, but, as we have pointed out, the adult peeper is almost always alone.

Despite the fact that peeping, more than any other sex offense, is intrinsically dependent upon chance, only 7 per cent of the offenses were wholly opportunistic and 89 per cent were clearly premeditated. Basically the convicted peeper is out looking for opportunities, not waiting for them. He does not patrol the sidewalk patiently waiting to see a girl with her window shade up; he leaves the public paths, trespasses on private property, and peers into windows.

Peepers are almost always on the outside looking in. Only 6 per cent of the offenses were committed by men who entered or were already within buildings in order to gratify their voyeurism. We feel that if a man goes into a residence to peep, the probability is great that he is

more of an aggressor than a peeper or that he is one of the confused persons who mix theft with peeping. One hesitates to call them burglar-peepers since their skills fall so far short of even semiprofessional status.

Considering only the three quarters of the offenses for which we have information about the degree of risk involved, it appears that the peepers were quite cautious. We judged that only 6 per cent behaved so as to make apprehension probable. Nine out of ten risked possible, but not probable, arrest, and a few (4 per cent) were so careful that apprehension was most unlikely. Despite this the peepers are commonly caught because they are so often “going against the law of averages.” Although arrest in any one peeping foray is unlikely, arrest becomes progressively more certain if a man peeps frequently enough.

The nemesis of the peeper is, ironically, the unforeseen onlooker— the neighbor, the passer-by, the accidental witness. In 44 per cent of the offenses the onlooker reported the matter. The girl or woman herself accounted for 13 per cent of the arrests, and her friends and relatives for the same amount. The police, usually alerted by previous complaints, brought 30 per cent of the cases to an end. However, all these percentages are based upon only half of our sample of offenses; for the other half the reporting person or discoverer was unknown.

Nearly two thirds of the offenses were fully admitted to the authorities, and slightly over two thirds were admitted to us. One quarter to one fifth of the men denied their behavior, and between 5 and 7 per cent claimed to have been too drunk or otherwise non compos mentis to recall it. The substantial proportion of denials of a common and excusable behavior seems odd until one recalls how easy it is to deny peeping: mistaking one house for another, looking for a friend, being wrongly accused while taking a nocturnal stroll—all these and still other alibis are easy in offenses where the object can seldom make a positive identification and where the alibi may be genuine.

The final pleas, however, are not too different from those of various other offenders: 78 per cent guilty, 17 per cent not guilty, and 5 per cent no plea.

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It is not yet clear whether it makes sense to take medications if an exposure has occurred in other than in a work setting, such as during unprotected sexual contact. Some health care centers are offering this option to persons who have experienced a very-high-risk sexual exposure. However, there is some concern that offering this treatment after an unsafe sexual experience may lead people to engage in riskier sexual practices. This possibility will need to be monitored as time goes on, and studies of postsexual and post-injection drug use exposure are under way.

If the medications are started, and then the person from whom the body fluid came is ultimately found not to be infected with HIV then the medications can be discontinued.

Whether or not a person opts to use these medications, follow-up blood tests for HIV are recommended at six weeks, three months, and six months after exposure. A person testing negative after six months is considered to be negative for HIV (excluding the exceedingly rare possibility that someone may take longer than six months to convert to positive status). When a person believes that he or she may have been exposed to HIV it is a good idea to practice safer sex with partners or consider abstaining from sex altogether until testing has shown negative results. This again must be an individual decision, following recommendations made based on the level of risk to which the person has been exposed.

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Hepatitis C is most often transmitted through contact with infected blood. Persons at especially high risk for hepatitis C infection are injection drug users, hemodialysis patients, and anyone who received multiple blood transfusions before 1990 (as did many people who have hemophilia). About 90 percent of posttransfusion hepatitis was caused by hepatitis C before the blood supply began to be screened for the disease in 1990. It is estimated that up to one out of every ten people who received a transfusion in the 1970s and 1980s was infected with hepatitis C. Since screening has been put in place, however, transfusion-related hepatitis has become rare.

Sharing needles in injection drug use poses a high risk of transmission. Tattooing with an unclean needle can also transmit hepatitis C. The chances of becoming infected from a needle-stick injury are estimated to be between 3.5 and 10 percent.

There is some debate about how easily hepatitis C can be transmitted sexually, although hepatitis B and HIV are almost certainly easier to transmit sexually than hepatitis C. Recent studies, however, indicate that sexual transmission of hepatitis C may be easier than was previously thought. Semen and vaginal secretions carry sufficient quantities of the virus for transmission. The risk increases with the duration of the relationship, and male-to-female transmission is more effective than female-to-male, as with most of the viral STDs. Transmission among same-sex couples has not been adequately studied. Those who have multiple sexual partners have a higher risk for hepatitis C infection than those with fewer partners. Combining these research findings with the fact that it is still unclear through which means many people infected with hepatitis C became infected, we must assume that sexual transmission is a possibility and that it may play a more important role than previously thought in the spread of the disease.

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There are several ways to test for chlamydia. Which method is appropriate for you depends on a number of factors, including which tests are handled routinely by the laboratory in your area, the cost of the tests, and which test your health care provider prefers. None of the tests is 100 percent accurate; accuracy can be affected by how well the specimen is stored on its way to the laboratory and the skill of the provider in collecting the specimen, among other factors.

The oldest way to test for chlamydia is to culture for it—that is, to rub a suspected infected area with a swab and try to grow the chlamydia in a special solution. Chlamydia is hard to grow in solution, however, so this test may have low accuracy. Other tests, called “non-culture tests,” were subsequently developed that looked either directly for proteins from the surface of the chlamydia (enzyme-linked immunosorbent assay [ELISA] and direct fluorescent-antibody assay [DFA]), or indirectly for the genetic material of the chlamydia (DNA probes). Yet these tests also missed many people who were infected.

Newer tests, the polymerase chain reaction and the ligase chain reaction (PCR and LCR, respectively), look directly for the genetic material of the bacterium and have over 90 percent accuracy, far better than that of the other tests. (This means that the test correctly identifies 90 out of 100 people who are infected.) The LCR can be performed from either swabs or urine in both men and women. These tests have now become the tests of choice in detecting genital chlamydia infection in men and women. For throat or anal chlamydia, however, culture is still the preferred test. The conjunctiva can be tested using the nonculture tests (ELISA, DFA, and DNA assays). Blood tests that look for antibodies, or the body’s immune response to previous infection with chlamydia, result in a positive test.

When someone is found to have chlamydia, decisions about what kind of medication is to be used, how long it is to be used, and what land of follow-up is necessary depend on the extent of the infection. In order to determine the extent of the infection, a physical examination is needed in addition to the screening test. For women, a pelvic examination must be done as part of the screening. Some women may test positive for chlamydia and have no evidence of infection on examination, whereas others have cervicitis or PID. In men who test positive for chlamydia, an examination may show no evidence of infection, or there may be signs of urethritis, epididymitis, or prostatitis.

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Education about STDs must be started early and include information about abstinence, as well as ways to protect oneself from becoming infected with an STD if one is sexually active. More and more young people are becoming sexually active at younger ages. Whether or not this is a good thing, it is a fact: teenagers account for about three million of the twelve million people infected with STDs in the United States each year, and two-thirds of those infected each year are younger than twenty-five.

Abstinence (not having sex) until you are older and better informed is the best solution.

Waiting to have sex allows a young person to develop as an individual and to focus on school and other interests. Young people who are already sexually active, however, need information on how to protect themselves from infection and pregnancy. Studies have shown that children who take sex education classes are actually less likely to engage in sexual activity, and if they do, they are more likely to use condoms. Education about STDs and safe sex is the first step in helping prevent infection.

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A cervix infection (mucopurulent cervicitis) can be caused by bacteria (such as gonorrhea and chlamydia), viruses (such as herpes), and protozoan infections (such as trichomonas). Unusual bleeding, including bleeding between periods and after intercourse, can occur from a cervix that is irritated for any reason. Other cervix conditions, such as cancer or a polyp (a small, noncancerous growth on the cervix), may sometimes also cause bleeding. A Pap smear is used to detect cervical cancer.

Anne, 36, had had regular periods all her life, “like clockwork, every 28 days.” After two pregnancies, she had a tubal ligation about three years ago. She and her husband recently divorced, and Anne was once again in the dating game.

Anne began seeing Brian about two months ago, and they had sex on their third date. They discussed STDs and condom use before becoming intimate and decided that since neither of them had had many sexual partners in their lifetimes, and they both “looked clean,” they didn’t need to use condoms. Anne wouldn’t become pregnant because her tubes had been tied.

Soon Anne began experiencing burning and itching on her labia, and intercourse was painful. She also noticed a fishy odor every now and then, and blood on the toilet tissue after she urinated. She talked it over with Brian, who had no symptoms and suggested that she see her gynecologist.

After a thorough examination, Anne’s gynecologist diagnosed trichomoniasis. Tests were performed for gonorrhea and chlamydia, and both were negative. Both Anne and Brian were surprised that Brian could have had the infection without symptoms. They were treated with antibiotics, and both of them decided to have tests for other STDs to be sure that they didn’t have any other diseases.

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