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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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