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1. Winer RL, Hughes JP, Feng Q et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006; 354(25):2645-2654.

2. Weller SC, Davis-Beaty K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003255.

3. Ahmed S, Lutalo T, Wawer M, et al. HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda. AIDS. 2001; 15(16):2171-2179.

4. Warner L, Stone KM, Macaluso M, Buehler JW, Austin HD. Condom use and risk of gonorrhea and chlamydia: A systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006; 33(1):36-51.

5. National Institutes of Health. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease Prevention. Bethesda, MD: National Institutes of Health, US Dept of Health and Human Services; 2001. Available at:http://www.niaid.nih.gov/about/organization/dmid/Documents/condomreport.pdf. Accessed May 18, 2011.

6. Steiner MJ, Dominik R, Rountree RW, Nanda K, Dorflinger LJ. Contraceptive effectiveness of a polyurethane condom and a latex condom: a randomized controlled trial. Obstet Gynecol. 2003; 101(3):539-547.

7. Warner L, Steiner MJ. Male condoms. In: Hatcher RA, Trussell J, Nelson AL, Cates W, Jr., Stewart FH, Kowal D, eds. Contraceptive Technology. New York, NY: Ardent Media, Inc; 2007:297-316.

8. Crosby RA, DiClemente RJ, Wingood GM, Lang D, Harrington KF. Value of consistent condom use: A study of sexually transmitted disease prevention among African American adolescent females. Am J Public Health.2003; 93(6):901-902.

9. Manlove J, Ryan S, Franzetta K. Contraceptive use and consistency in U.S teenagers’ most recent sexual relationships. Perspect Sex Rep Health. 2004; 36(6):265–275.

10. Buchacz K, van der Straten A, Saul J, Shiboski SC, Gomez CA, Padian N. Sociodemographic, behavioral, and clinical correlates of inconsistent condom use in HIV-serodiscordant heterosexual couples. J Acquir Immune Defic Syndr. 2001; 28:289–297.

HPV Vaccine

 

The FDA has approved three vaccines against certain types of HPV. Here is a summary:

  • In 2006, Gardasil® was approved for protection against four HPV types: 6, 11, 16, and 18.
  • In 2009, Cervarix® was approved to protect against two HPV types: 16 and 18.
  • In 2015, Gardasil®9 was approved to protect against nine HPV types: 6, 11, 16, 18, 31, 33, 45, 52, and 58.[8]


All three HPV vaccines provide protection against HPV types 16 and 18, the cause of approximately 70% of cervical cancers. In addition, the four and the nine-type vaccines provide protection against HPV types 6 and 11, which are responsible for 90% of the cases of genital warts. The nine-type vaccine also provides protection against five other cancer-causing types (HPV 31, 33, 45, 52, 58) which account for about 15% of cervical cancers.

HPV vaccines cannot protect if the patient has already contracted the HPV types included in the vaccines. Short-term studies have shown that the four-type vaccine is highly effective in preventing precancerous disease and genital warts caused by the HPV types included in the vaccine, but the study period was not long enough to assess the potential impact on the incidence of cervical cancer. Similar studies showed the nine-type HPV vaccine to have similar effectiveness.

A study reported in Feburary19, 2015 New England Journal of Medicine, reported that both the 4 and 9-type vaccines had similar adverse event rates (local and systemic).[9] For patients who received either vaccine, approximately 90% of the adverse events were injection site related and 4% systemic. Systemic symptoms such as fever, fatigue, dizziness, nausea, vomiting, diarrhea, myalgia, and arthralgia were reported in both the vaccine and placebo arms of clinical trials. More severe adverse events, such as persistent headache, high blood pressure, gastroenteritis, and bronchospasm were described in no more than 0.5%.[10] Long-term observational studies report no increased risk of autoimmune, venous thromboembolic, or neurologic disease among individuals who receivedthe HPV vaccine. However, some medical professionals have concerns about the effectiveness and long term safety of the vaccine that are currently not resolved by the research.[11] For more information, visit New Concerns about the Human Papillomavirus Vaccine[12].

Reports thus far are inconclusive whether vaccinating adolescents against a sexually transmitted infection such as HPV will promote sexual activity.[13]

The Centers for Disease Control (CDC) recommends the following:[14],[15]

"HPV vaccine is recommended for routine vaccination at age 11 or 12 years. ACIP (Advisory Committee on Immunization Practices) also recommends vaccination for females aged 13 through 26 years and males aged 13 through 21 years not vaccinated previously. Vaccination is also recommended through age 26 years for men who have sex with men and for immunocompromised persons (including those with HIV infection) if not vaccinated previously."


​[8] Joura, E. A., Giuliano, A. R., Iversen, O., Bouchard, C., Mao, C., Mehlsen, J., … Luxembourg, A. (2015). A 9-Valent HPV Vaccine against Infection and Intraepithelial Neoplasia in Women. New England Journal of Medicine, 372(8), 711-723. doi:10.1056/nejmoa1405044
[9] Ibid.
[10] Jorge, S., & Wright, J. (2016). Update: HPV prevention. Contemporary OB/GYN. Retrieved fromhttp://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/update-hpv-prevention?page=0,0&cfcache=true
[11] American College of Pediatricians. (2016, January). Human Papillomavirus Vaccination. Retrieved from http://www.acpeds.org/the-college-speaks/position-statements/health-issues/human-papilloma-virus-vaccination
[12] The American College of Pediatricians. (2016, January). New Concerns about the Human Papillomavirus Vaccine | American College of Pediatricians. Retrieved from http://www.acpeds.org/the-college-speaks/position-statements/health-issues/new-concerns-about-the-human-papillomavirus-vaccine
[13] American College of Pediatricians. (2016, January). Human Papillomavirus Vaccination. Retrieved from http://www.acpeds.org/the-college-speaks/position-statements/health-issues/human-papilloma-virus-vaccination
[14] Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices. (2015, March 27). Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a3.htm
[15] Centers for Disease Control. (2016, July 21). HPV Vaccines: Vaccinating Your Preteen or Teen. Retrieved from http://www.cdc.gov/hpv/parents/vaccine.html


What is Hepatitis B?


*Hepatitis B is a liver disease that results from infection with the Hepatitis B virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth.

Hepatitis B can be either acute or chronic. Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection can — but does not always — lead to chronic infection. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body. Chronic Hepatitis B is a serious disease that can result in long-term health problems, and even death.

The best way to prevent Hepatitis B is by getting vaccinated.

*From the Centers for Disease Control, 4/2014

What is Pelvic Inflammatory Disease (PID)?


*Pelvic inflammatory disease (PID) is a clinical syndrome that results from the ascension of microorganisms from the cervix and vagina to the upper genital tract. PID can lead to infertility and permanent damage of a woman’s reproductive organs.

Women develop PID when certain bacteria, such as chlamydia or gonorrhea, move upward from a woman's vagina or cervix into her reproductive organs. PID is a serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea. Several types of antibiotics can cure PID.

Antibiotic treatment does not, however, reverse any scarring caused by the infection. For this reason, it is critical that a woman receive care immediately if she has pelvic pain or other symptoms of PID. Prompt antibiotic treatment can prevent severe damage to the reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.

PID is usually treated with antibiotics to provide empiric, broad spectrum coverage of likely pathogens. Recommended regimens can be found in the (Center for Disease Control's) 2010 STD Treatment Guidelines. Health care providers should emphasize to their patients that although their symptoms may go away before the infection is cured, they should finish taking all of the prescribed medicine. Additionally, a woman’s sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.*

*From the Centers for Disease Control, 4/2014

What is Chlamydia?


*Chlamydia is a common STD that can infect both men and women. It can cause serious, permanent damage to a woman's reproductive system, making it difficult or impossible for her to get pregnant later on. Chlamydia can also cause a potentially fatal ectopic pregnancy (pregnancy that occurs outside the womb).

 

You can get chlamydia by having anal, vaginal, or oral sex with someone who has chlamydia.  If your sex partner is male, you can still get chlamydia even if he does not ejaculate. If you’ve had chlamydia and were treated in the past, you can still get infected again if you have unprotected sex with someone who has chlamydia. If you are pregnant, you can give chlamydia to your baby during childbirth.

 

​*From the Centers for Disease Control, 4/2014

What is Gonorrhea?


*Gonorrhea is a sexually transmitted disease (STD) that can infect both men and women. It can cause infections in the genitals, rectum, and throat. It is a very common infection, especially among young people ages 15-24 years.

You can get gonorrhea by having anal, vaginal, or oral sex with someone who has gonorrhea. A pregnant woman with gonorrhea can give the infection to her baby during childbirth.

Untreated gonorrhea can cause serious and permanent health problems in both women and men. In women, untreated gonorrhea can cause pelvic inflammatory disease (PID). Some of the complications of PID are formation of scar tissue that blocks fallopian tubes, ectopic pregnancy (pregnancy outside the womb), infertility (inability to get pregnant), long-term pelvic/abdominal pain. In men, gonorrhea can cause a painful condition in the tubes attached to the testicles. In rare cases, this may cause a man to be sterile or prevent him from being able to father a child.

​Rarely, untreated gonorrhea can also spread to your blood or joints. This condition can be life-threatening. Untreated gonorrhea may also increase your chances of getting or giving HIV – the virus that causes AIDS.

 

*From the Centers for Disease Control, 4/2014

STIs, STDs, and Condom Usage:


*"Condom effectiveness" is the reduction in pregnancy or disease that is attributable to the use of male condoms. For example, the estimated risk reduction offered by consistent condom use for human papillomavirus (HPV) infection is only at best 70% (1), and for HIV, 80%(2). Risk reduction estimates for the more common STIs gonorrhea and chlamydia are even lower   – at 50% (3-5)  Several studies show that condoms can partially reduce the risk of most STIs and pregnancy if used each and every time, but they cannot altogether eliminate the risk of STIs and pregnancy.(5,6)

Even with 100% use, condoms do not completely eliminate the risk of STIs or pregnancy. Furthermore, inconsistent use appears to be the common practice among condom users, especially adolescents. Reported consistent condom use by adolescent females is only about 50% (8,9) and by adolescent males, 63% (8). Very few individuals manage to continue consistent and correct use for any period of time. Even in couples in which one partner is known to be infected with HIV, consistent use is reported by only about half.(10)

Besides consistent use, effectiveness rates of condoms also depend on correct use, i.e., user and method failure. Condom slippage and breakage rates range from 1-6%.(5-7)  In a study that evaluated method failure (failures over which the user has no control), about 2 in 10 men reported their condom had broken or slipped off during use (11).*

While condoms and contraceptives can reduce the risk of pregnancy, abstinence (not having sex) is the only guarantee for preventing unwanted pregnancy or contracting STIs.

*From "Condoms and Contraceptives: Are they effective?", The Medical Institute.   All citations below.

STDs and STIs: What are they?


*The term STD refers to a group of diseases that are spread from person to person during sexual activity.  They are also referred to as sexually transmitted infections or STIs.  The germs that cause an STD can be spread during oral (mouth), anal, or vaginal sex.  Some STDs are spread from skin to skin contact with an infected partner's genital area--not just through intercourse.*

 

*From the Virginia Department of Health, 6/2013

What is sexual health?

Your health is your most important resource.  We hope you found some good information on our website, but there is no substitute for dialogue with and advice from a medical professional.  Think you might be pregnant?  Wondering if you have an STD/STI?  Your free appointment with us includes a consultation with a nurse.  
Call for an appointment:  540-665-9660.

More information on STDs and STIs is available at the Centers for Disease Control website:  www.cdc.gov.
What is Syphilis?


*Syphilis is an STD that can cause long-term complications and/or death if not treated correctly. Symptoms in adults are divided into stages. These stages are primary, secondary, latent, and late syphilis. You can get syphilis by direct contact with a syphilis sore during anal, vaginal, or oral sex. Sores can be found on the penis, vagina, anus, in the rectum, or on the lips and in the mouth. Syphilis can also be spread from an infected mother to her unborn baby.

Syphilis has been called ‘the great imitator’ because it has so many possible symptoms, many of which look like symptoms from other diseases. The painless syphilis sore that you would get after you are first infected can be confused for an ingrown hair, zipper cut, or other seemingly harmless bump. The non-itchy body rash that develops during the second stage of syphilis can show up on the palms of your hands and soles of your feet, all over your body, or in just a few places. You could also be infected with syphilis and have very mild symptoms or none at all.

Syphilis can be cured with the right antibiotics from your health care provider. However, treatment will not undo any damage that the infection has already done.*


​*From the Centers for Disease Control, 4/2014

What is HPV?

*Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types (out of more than 100 total types) that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not know they have it. HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems.

​HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms.A person can have HPV even if years have passed since he or she had sexual contact with an infected person.

​Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV. Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. In these cases, the child can develop recurrent respiratory papillomatosis (RRP), a rare condition in which warts grow in the throat. In children, this is also referred to as juvenile-onset recurrent respiratory papillomatosis (JORRP).

​In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer. Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.

HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer). Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers. There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including individuals with HIV/AIDS) may be less able to fight off HPV and more likely to develop health problems from it.

"From the Centers for Disease Control, 4/2014

What is Genital Herpes?


*Genital herpes is an STD caused by two types of viruses. The viruses are called herpes simplex type 1 and herpes simplex type 2. Genital herpes is common in the United States. In the United States, about one out of every six people aged 14 to 49 years have genital herpes. 

You can get herpes by having oral, vaginal, or anal sex with someone who has the disease. Fluids found in a herpes sore carry the virus, and contact with those fluids can cause infection. You can also get herpes from an infected sex partner who does not have a visible sore or who may not know he or she is infected because the virus can be released through your skin and spread the infection to your sex partner(s).

Genital herpes is a common STD, and most people with genital herpes infection do not know they have it. There is no cure for herpes, but medication is available to reduce symptoms and make it less likely that you will spread herpes to a sex partner.*

​*From the Centers for Disease Control, 4/2014

*Sexual health is a state of physical, intellectual, emotional, social, and spiritual well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or illness. Sexual health is a basic human right. All persons of all ages can be healthy sexual beings. Sexual health is a positive, honest, and respectful approach to sexuality.

​If you are sexually active, your biggest worry may be pregnancy. You may be concerned about how your parents or your boyfriend would react if you became pregnant or about how a pregnancy would affect your personal plans for the future. 

Pregnancy is  a legitimate concern for anyone who is sexually active, but there is an even greater risk:  sexually transmitted infections. Although youth aged 15-24 years comprise only about one quarter of the sexually active population, each year about half of the new cases of STIs are reported in youth 15-24 years old and 1 in 8 new HIV infections occur in this age group.

Abstinence (not having sex) is the only guarantee against unwanted pregnancy.  And a lifelong, mutually monogamous relationship such as marriage is the environment in which sexually active people have the least risk of HIV, STIs, and unintended pregnancy. *

​*from "Guidelines for Sexual Health Education," The Medical Institute, www.medinstitute.org

Sexual Health