Sexual Health
HIV Positive People and Sexually Transmitted Infections (STIs)
HIV attacks the immune system, which your body uses to fight infections. When the immune system is compromised, there are a few things one should consider:
- An STI may be more severe and difficult to treat. Viral infections such as herpes or warts are more likely to recur.
- Infection with another STI can dramatically increase the amount of HIV in your body because the immune system is trying to fight both the HIV and the STI.
- An increased HIV viral load not only signifies greater risk to one's health, but it could be falsely interpreted by a doctor as HIV drug failure (if one is on medications at the time.) Talk to your physician about possible STIs you may have encountered before switching any medications.
- An increased viral load can make it easier to transmit HIV to another person.
Syphilis
Description
Syphilis is a sexually transmitted bacterial infection that infects your blood.
Symptoms
Syphilis usually follows three stages, each with different symptoms:
- During the first stage (primary syphilis), symptoms can appear within one to 12 weeks after exposure. They include a painless, open sore on the mouth, sex organs, or anus. It's common for symptoms to go unnoticed. These sores can be "hidden" in the rectum and last about one to five weeks. Sores go away, but syphilis is still in the blood.
- During the second stage (secondary syphilis) symptoms show up six weeks to six months after the sores appear. These can be manifested by flu–like symptoms, swollen lymph glands, sore throat, patchy hair loss, muscle aches, fatigue, weight loss, and a rash anywhere on the body.
- Latent syphilis – If untreated, syphilis moves from the secondary to the latent (hidden) stage, when no symptoms are present. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the tertiary (third) stage.
- Tertiary or late syphilis – About 15 to 30 percent of people infected with syphilis who don't get treatment will develop complications known as tertiary, or late, syphilis. In the late stages, the disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original infection.
Prevention
Syphilis is transmitted by giving and receiving oral or anal sex and by direct contact with an infected person. A person can easily transmit the disease to sexual partners during stages one and two. Only areas protected by latex or other such barriers are protected from infection. Avoid touching any sore or rash. Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated two– to five–fold increased risk of acquiring HIV if exposed to that infection when syphilis is present.
Testing and Treatment
A blood test is used to detect syphilis, though it can take up to four months to detect the disease. If detected early, syphilis can be cured with antibiotics. If the disease progresses to the tertiary stage any damage to the nervous system, heart, skin, or other organs is not reversible and may lead to long–term health problems. Partners should be treated at the same time. A person can be re–infected after treatment.
Additional Information
In Minnesota, a disproportionate number of those diagnosed with syphilis in recent years were also infected with HIV.
Chlamydia
Description
Chlamydia is a sexually transmitted bacterial infection.
Symptoms
It's common not to show any symptoms, so it's important for anyone who is sexually active to get screened on a regular basis. If symptoms appear, they can show up between 7 – 21 days after exposure. For men, symptoms may include: eye irritation; watery, white pus from the penis; burning or pain during urination; anal discomfort; or testicular pain or tenderness.
Prevention
Chlamydia is easily transmitted by giving or receiving oral or anal sex, or It by touching an infected area and then your own genitals or anus. Someone who does not show any symptoms can still transmit the disease. Using condoms and latex gloves can help prevent acquiring the disease, as can washing your hands after sex.
Testing and Treatment
Testing usually involves swabs and/or urine tests for Chlamydia in your penis, rectum and throat. It can be detected as early as two–to–five days after exposure. Chlamydia can be treated by an appropriate antibiotic prescribed by a physician. Home remedies are not effective. Partners should also be treated at the same time.
Additional Information
Having Chlamydia can make it easier to transmit or acquire additional diseases. If left untreated, it can result in infertility or other serious infections of the urethra and testicles.
Gonorrhea
Description
Gonorrhea is a sexually transmitted bacterial infection. It often occurs at the same time as Chlamydia.
Symptoms
Like Chlamydia, it's common not to display any symptoms of the infection. If they appear, they usually begin between two to seven days after exposure. Symptoms may include a thick, whitish discharge (pus) from the penis; burning or pain during urination or bowel movement; and anal discomfort, itching or discharge. Even if the symptoms clear up, the infection may remain.
Prevention
Chlamydia is easily transmitted by giving or receiving oral or anal sex, or by touching an infected area and then your own genitals or anus. Someone who does not show any symptoms can still transmit the disease. Using condoms and latex gloves can help prevent acquiring the disease, as can washing your hands after sex.
Testing and Treatment
Testing usually involves swabs and/or urine tests for gonorrhea in your penis, rectum and throat. It can be detected as early as two to five days after exposure. Gonorrhea can be treated by an appropriate antibiotic prescribed by a physician, though a person can be re–infected after treatment. Partners should also be treated at the same time.
Additional Information
Having gonorrhea makes it easier to transmit or acquire an additional infection. Left untreated, it can result in ulcers in the anus or throat as well as serious infections in the testicles.
Human Papilloma Virus (HPV)
Description
Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it.
Symptoms
Most people with HPV do not develop symptoms or health problems from it. In 90 percent of cases, the body's immune system clears HPV naturally within two years. But sometimes, certain types of HPV can cause genital warts on the penis or on the anus or rectum. Rarely, these types can also cause warts in the throat. Other HPV types can cause cancer of the penis, anus, head and neck. The types of HPV that can cause genital warts are not the same as the types that can cause cancer. There is no way to know which people who get HPV will go on to develop cancer or other health problems. There is a greatly increased incidence of anal cancer among HIV positive gay and bisexual men that is related to HPV infection.
Prevention
HPV is common and most people get it soon after they start having sex. HPV is passed on by skin–to–skin contact with an infected person even when that person has no signs or symptoms. It is also possible to get more than one type of HPV. Warts may not always appear in the place where the skin contact occurred. Condoms can reduce the risk of transmission, but do not always cover the infected areas.
Testing and Treatment
Most people have no signs or symptoms of HPV and clear the virus within two years of becoming infected. Among gay men with HIV there is a greatly increased incidence of anal cancer and some physicians recommend an annual anal pap smear that can screen for cells that may become cancerous over time. There is some evidence that HIV positive men may also be more likely to develop genital warts and these are sometimes hard to treat. The warts themselves can be treated, but the virus cannot be cured. Doctors can remove warts by freezing, burning, using a laser, or by applying warts paints or creams. Recurrences can occur and treatment can require several visits. DO NOT use over the counter wart medications on genital or anal warts. Again, the HPV viruses that cause genital warts are not linked to HPV viruses that can cause anal or penile cancers.
Hepatitis
Description
Hepatitis is many diseases caused by a virus, most commonly A, B or C. It may be sexually transmitted.
Symptoms
Hepatitis A symptoms can occur within 15 – 50 days after exposure. They include:
- fever and flu–like symptoms
- loss of appetite
- abdominal discomfort
- yellow eyes and skin
- dark urine or light–colored stool
- nausea or vomiting
- fatigue
Hepatitis B symptoms can occur within 45 – 180 days after exposure. They include the same symptoms as Hepatitis A plus pain in the muscles and joints.
Hepatitis C is usually asymptomatic. 80 percent of people infected with hepatitis C show no symptoms, but when they do manifest, they are the same as type A.
Prevention
There are effective vaccines that prevent against the infection of hepatitis A and B. Currently, there is no vaccine that protects against hepatitis C. For those that have not already done so, it is highly recommended that they ask get the hepatitis A and B vaccine from their primary care physician.
- Hepatitis A can be passed through fecal–oral (food–borne) transmission, and through rimming (oral sex performed on an anus) and anal fingering.
- Hepatitis B can be passed through anal and oral sex. It can also be passed through sharing needles for injecting drugs, body piercing, tattooing, and sharing personal items such as razors, tooth brushes, nail clippers, and pierced earrings.
- Hepatitis C is spread the same way as type B, but it is most commonly spread through sharing needles for injecting drug use.
Testing and Treatment
A blood test is used to detect all three types of hepatitis. It can take about a month after exposure for a test to show infection in hepatitis A and B. Most people will show positive for hepatitis C infection about 40 days after infection.
- If exposed to hepatitis A, an immune globulin injection may be given within 14 days of exposure; however, there is no effective treatment to shorten the course of an acute infection.
- For hepatitis B, an immune globulin injection can be given within seven days of an exposure or 14 days after sexual contact.
- There is no vaccine available for type C; however, a physician can prescribe medications to treat the infection.
Additional information
- Hepatitis A causes no long–term liver damage, and usually does not result in death; however, the liver processes medications, so hepatitis A could affect a person's ability to metabolize medications. This should be of particular concern to those living with HIV. Having had the disease produces lifelong immunity against re–infection.
- Hepatitis B can lead to chronic liver disease, cirrhosis, liver cancer and death. A compromised immune system (as a result of HIV infection) can also increase the likelihood of becoming a chronic carrier. Carriers are also able to infect others. Less than one percent of people die during the acute phase of the infection.
- Becoming a chronic carrier of hepatitis C is more likely than with as type B. Hepatitis C carries the same risks as type B.
Herpes
Description
Herpes is a sexually transmitted infection caused by the herpes–simplex virus (HSV). There are two types of HSV. The first, HSV–1 is usually found around the mouth and is known to cause cold sores. There second one, HSV–2, is usually found around the genitals and ass. However, both types can be found in any of those places.
Symptoms
Symptoms, if they are going to occur, usually manifest between within 30 days of exposure, but it can take months or even years. The first outbreak is usually the most severe with subsequent episodes being milder. The initial infection is often accompanied by fever, headache and swollen lymph nodes. Symptoms also include small, painful blisters on the sex organs, mouth or anus. The blisters progress to sores that crust over and heal within one to two weeks. There may be itching or burning on the skin where blisters are about to appear.
Prevention
Condoms can reduce the risk of transmission, but do not always cover the infected area. HSV can be transmitted both sexually and non–sexually during skin–to–skin contact. It can be transmitted when no symptoms are present.
Testing and Treatment
Herpes can be detected with a blood test, but is often diagnosed when the initial sores occur. While blisters heal, the infection remains and persists for life. Some individuals have very few or no outbreaks while others have frequent ones. There is currently no cure available for herpes, but outbreaks may be prevented or their duration reduced by taking a daily antiviral medication.
Research shows that people with genital herpes are two to three times more likely to acquire HIV and they are also more likely to transmit HIV infection to others. The immunologic response at the site where herpes ulcers form act as a target for HIV infection even after the ulcers have disappeared. People who are dually infected with HIV and HSV–2 may also be especially likely to transmit the HIV virus to others during genital herpes flare–ups.
Testing is recommended for those considered at high risk for getting and transmitting the virus, including people with multiple sex partners and people who are HIV positive.
Molluscum Contagiosum
Description
Molluscum Contagiosum (molluscum) is caused by a pox virus.
Symptoms
Molluscum lesions appear between one week and six months after exposure. They form as bumps on the skin on or around the genitles, thighs and ass that can be flesh–colored, clear, pink, or yellow. These bumps usually contain a cheese–like material. Usually there are 15–20 bumps but there may more.
Prevention
Molluscum can be transmitted via sexual and non–sexual skin–to–skin contact. Only an area covered by latex is protected from the virus. Molluscum can also be transmitted by contaminated sports equipment such as gym mats and contaminated bath towels, if towels are shared without washing. Scratching or shaving over the affected area can also spread molluscum. However, sexual contact is the most common means of transmission in adults, and to help prevent transmission, examine your partner's skin and wash thoroughly after sex.
Testing and Treatment
Molluscum is visually confirmed by a health care provider. Upon diagnosis, molluscum is usually treated by applying Liquid Nitrogen to the bumps. When liquid Nitrogen is used there may be mild discomfort the first few days after treatment. Often, several treatments are needed. Also, new lesions may not be visible at the time of treatment, so a follow–up exam should be scheduled.
Additional information
Early treatment is important since molluscum lesions can grow and spread over time. People living with HIV are at particular risk for larger lesions and greater spread. It is possible to get molluscum more than once. It is also possible for the infection to come back on its own.
Pubic Lice
Description
Pubic lice (sometimes called "crabs") are small, wingless crablike insects often the size and color of small freckles. They live on human blood and cling to the hair of the pubic or genital regions. Sometimes they are found under arms, on eyelashes and moustaches. They can live ONLY on humans but can survive without a host for one or two days.
Symptoms
Pubic lice show up three days to several weeks after exposure. They can cause intense itching. A close look should show tiny, brown lice and/or white eggs attached to the hair.Prevention
Pubic lice are spread by close, physical contact. This includes sex and sharing bedding, clothes and towels. There is no way to prevent the initial infection.
Testing and Treatment
Pubic lice are visually detected after symptoms have begun. You can treat yourself with genital lice shampoos that can be purchased at a drug store. FOLLOW DIRECTIONS CAREFULLY. Also, recently used clothing and linens must be washed in hot water and dried in a hot dryer, or dry–cleaned.
Additional Information
Pubic lice can be completely cured. However, they can be contracted again. There are no known serious effects, except perhaps an infection from scratching.
Scabies
Description
A very small mite (smaller than pubic lice) that burrows under the skin causes scabies.
Symptoms
Symptoms do not develop immediately. Rather, the body slowly develops an "allergic" reaction to the deposits of the female mite under the skin and symptoms begin three to four weeks later. The most common symptoms are a rash or itching caused by the borrowing of the mites. The mites prefer warm area such as the armpits and groin, but they are also commonly found in the spaces between the fingers and toes. If a person has had scabies before, the symptoms will begin sooner.
Prevention
Scabies are transmitted through close personal contact of a prolonged nature such as sleeping in the same bed with an infected person, or having sex with someone that has scabies. Casual contact outside of families is not likely to transmit scabies. Treatment for sex partners of the last month and close household contacts is recommended.
Testing and Treatment
Scabies are visually confirmed by a healthcare professional. Scabies can be treated:
- Before bed, bathe or shower and dry thoroughly. Apply Lindane (Kwell) lotion from the neck down, covering the entire body surface. Bathe or shower the next morning. Do not repeat treatment.
- Put on clean clothes, wash recently used clothes and linen in hot water and detergent. Then dry in a very hot dryer. For non-washable clothing, dry clean or seal in a plastic bag for three weeks to allow the mites to die.
- Symptoms may persist for about two weeks after the mite has been killed.
- If a secondary infection, fever, or spreading rash develops, call your clinic.
- The Lindane (Kwell) lotion may irritate the skin with temporary worsening of the itching.