Botulism

Diagnosis and treatment

Diagnosis is usually based on clinical history and clinical examination followed by laboratory
confirmation including demonstrating the presence of botulinum toxin in serum, stool or food, or
a culture of Clostridium botulinum from stool, wound or food. Misdiagnosis of botulism
sometimes occurs as it is often confused with stroke, Guillain-Barr syndrome or myasthenia
gravis.
Antitoxin should be administered as soon as possible after a clinical diagnosis. Early
administration is effective in reducing mortality rates. Severe botulism cases require supportive
treatment, especially mechanical ventilation, which may be required for weeks or even months.
Antibiotics are not required (except in the case of wound botulism). A vaccine against botulism
exists but it is rarely used as its effectiveness has not been fully evaluated and it has
demonstrated negative side effects.

Prevention
Prevention of foodborne botulism is based on good practice in food preparation particularly
preservation and hygiene. Botulism may be prevented by the inactivation of the bacterial spores
in heat-sterilized (e.g. retorted) or canned products or by inhibiting bacterial growth in other
products. Commercial heat pasteurization (vacuum packed pasteurized products, hot smoked
products) may not be sufficient to kill all spores and therefore the safety of these products must
be based on preventing bacterial growth and toxin production. Refrigeration temperatures
combined with salt content and/or acidic conditions will prevent the growth of the bacteria and
formation of toxin.
The WHO Five Keys to Safer Food serve as the basis for educational programmes to train food
handlers and educate the consumers. They are especially important in preventing food poisoning.
The Five Keys are:

keep clean

separate raw and cooked

cook thoroughly

keep food at safe temperatures

use safe water and raw materials.

'Botox'

The bacterium Clostridium botulinum is the same bacterium that is used to produce Botox, a
pharmaceutical product predominantly injected for clinical and cosmetic use. Botox treatments
employ the purified and heavily diluted botulinum neurotoxin type A. Treatment is administered
in the medical setting, tailored according to the needs of the patient and is usually well tolerated
although occasional side effects are observed.

Key facts

Clostridium botulinum is a bacterium that produces dangerous toxins (botulinum toxins)

under low-oxygen conditions.

Botulinum toxins are one of the most lethal substances known.

Botulinum toxins block nerve functions and can lead to respiratory and muscular
paralysis.

Human botulism, caused by ingestion of contaminated food, is a rare but potentially fatal
disease if not diagnosed rapidly and treated with antitoxin.

Foodborne botulism is often caused by eating improperly processed food. Homemade

canned, preserved or fermented foodstuffs require extra caution.

Overview

Human botulism is a serious, potentially fatal disease. However, it is relatively rare. It is

an intoxication usually caused by ingestion of potent neurotoxins in contaminated foods.
Person to person transmission of botulism does not occur.
Clostridium botulinum produces spores that are heat-resistant and exist widely in the
environment, and in the absence of oxygen they germinate, grow and then excrete toxins.
There are seven distinct forms of botulinum toxin, types AG. Four of these (types A, B,
E and rarely F) cause human botulism. Types C, D and E cause illness in other mammals,
birds and fish.
Botulinum toxins are ingested through improperly processed food in which the bacteria
or the spores survive and produce the toxins. Though mainly a foodborne intoxication,
botulism can also be caused by intestinal infection in infants, wound infections, and by
inhalation.

Clostridium perfingens
Clostridium perfringens (C. perfringens) is a spore-forming gram-positive bacterium
that is found in many environmental sources as well as in the intestines of humans
and animals. C. perfringens is commonly found on raw meat and poultry. It prefers
to grow in conditions with very little or no oxygen, and under ideal conditions can
multiply very rapidly. Some strains of C. perfringens produce a toxin in the intestine
that causes illness.
How common is C. perfringens food poisoning?

C. perfringens is one of the most common causes of foodborne illness in the United States. It is
estimated that it causes nearly a million cases of foodborne illness each year.

What are the symptoms of C. perfringens food poisoning?

Persons infected with C. perfringens develop diarrhea and abdominal cramps within 6 to 24
hours (typically 8-12). The illness usually begins suddenly and lasts for less than 24 hours.
Persons infected with C. perfringens usually do not have fever or vomiting. The illness is not
passed from one person to another.
Who is at risk of C. perfringens food poisoning?

Everyone is susceptible to food poisoning from C. perfringens. The very young and elderly are
most at risk of C. perfringens infection and can experience more severe symptoms that may last
for 1-2 weeks. Complications including dehydration may occur in severe cases.
How is C. perfringens infection diagnosed?

Laboratories diagnose C. perfringens food poisoning by detecting a type of bacterial toxin in

feces or by tests to determine the number of bacteria in the feces. A count of at least 106 C.
perfringens spores per gram of stool within 48 hours of when illness began is required to
diagnose infection.
How is C. perfringens treated?

Oral rehydration or, in severe cases, intravenous fluids and electrolyte replacement can be used
to prevent or treat dehydration. Antibiotics are not recommended.
What causes C. perfringens food poisoning?

Although C. perfringens may live normally in the human intestine, illness is caused by eating
food contaminated with large numbers of C. perfringens bacteria that produce enough toxin in
the intestines to cause illness. C. perfringens spores can survive high temperatures. During
cooling and holding of food at temperatures from 54F140F (12C -- 60C), the spores
germinate and then the bacteria grow. The bacteria grow very rapidly between 109F-- 117F
(43C --47C). If the food is served without reheating to kill the bacteria, live bacteria may be
eaten. The bacteria produce a toxin inside the intestine that causes illness.
What are common food sources of C. perfringens?

Beef, poultry, gravies, and dried or pre-cooked foods are common sources of C. perfringens
infections. C. perfringens infection often occurs when foods are prepared in large quantities and
kept warm for a long time before serving. Outbreaks often happen in institutions such as
hospitals, school cafeterias, prisons, and nursing homes, or at events with catered food.
How can C. perfringens food poisoning be prevented?

To prevent the growth of C. perfringens spores that might be in food after cooking, foods such as
beef, poultry, gravies, and other foods commonly associated with C. perfringens infections
should be cooked thoroughly to recommended temperatures, and then kept at a temperature that
is either warmer than 140F (60C) or cooler than 41F (5C); these temperatures prevent the
growth of C. perfringens spores that might have survived the initial cooking process. Meat

dishes should be served hot right after cooking. Leftover foods should be refrigerated at 40F or
below as soon as possible and within two hours of preparation. It is okay to put hot foods directly
into the refrigerator. Large pots of food like soup or stew or large cuts of meats like roasts or
whole poultry should be divided into small quantities for refrigeration. Foods should be covered
to retain moisture and prevent them from picking up smells from other foods. Leftovers should
be reheated to at least 165F (74C) before serving. Foods that have dangerous bacteria in them
may not taste, smell, or look different. Any food that has been left out too long may be dangerous
to eat, even if it looks okay.

Urinary Tract Infections FAQ

Facts about urinary tract infections

Every year, 8-10 million visits to doctors occur because of urinary tract infections.

The bacteria that cause urinary tract infections are treated with bacteria-fighting drugs
called antibiotics.

Women are usually more prone to urinary tract infections than are men or children.

One to 2 percent of children develop urinary tract infections.

Young children have the greatest risk for kidney damage due to urinary tract infections.

People who get one or more urinary tract infections may need further testing to make sure
they do not have other health problems.

What is the urinary tract?

The urinary tract makes and stores urine, one of your body's liquid waste products. The kidneys
produce one-and-a-half to two quarts of urine every day by removing waste and water from the
blood. The urine travels from the kidneys down two narrow tubes, the ureters. It is then stored in
a balloon-like container called the bladder.
In an adult, the bladder can hold 10 to 20 ounces of urine (about as much liquid as in one can of
soda). When the bladder is about half full, you may begin to feel the need to empty it by
urinating. Urine is carried out of the body through the urethra, a tube that begins at the bottom of
the bladder. The end of the urethra is near the top of the vagina in women. In men the urethra
passes through the prostate gland and exits at the tip of the penis.
Normal urine contains no bacteria (sometimes referred to as "germs"), but bacteria do cover your
skin and are present in large numbers in the rectal area and in your bowel movements. Bacteria

may, at times, get into the urinary tract (and the urine) and may travel up the urethra into the
bladder. When this happens, the bacteria cause infection and inflammation of the bladder. In
other words, they multiply causing irritation, swelling and pain. Bladder infection, also called
cystitis, is the most common urinary tract infection.
If the bacteria travel upward from the bladder through the ureters and reach the kidneys, you may
develop a kidney infection, also known as pyelonephritis. Kidney infections are much less
common but often more serious than bladder infections.
What are the signs of a urinary tract infection (UTI)?
When you have a urinary tract infection, the lining of the bladder and urethra becomes irritated,
just as the inside of your nose or throat does when you have a cold. The irritation can cause pain
in your abdomen and pelvic area and may make you feel the need to constantly empty your
bladder.
Your need to urinate may seem urgent; but when you try to do so, you may produce only a few
drops of urine. In addition, you may feel a burning sensation as the urine comes out. It may even
be hard to control; in fact, some urine may leak onto your clothing. You may notice that the urine
has an unpleasant odor or a cloudy look. At times, bladder infections may also cause low back
pain, fever or chills.
Kidney infections produce fever and back pain much more commonly than do bladder infections.
If a kidney infection is not treated promptly, the bacteria may spread to the bloodstream and
cause a life-threatening infection.
In an infant or young child, the signs of a urinary tract infection may not be clear, especially if
the child is too young to tell you how he feels. Instead, the child may be irritable, not eat as much
as usual, have a fever or loose bowel movements, or just not seem healthy. If the symptoms last
more than a day, they may signal the need to see a doctor.
How do I know if I have a urinary tract infection?
Only by consulting a doctor can you find out for certain whether you have a urinary tract
infection. If there is blood in the urine, you should see us right away. Because bloody urine is not
normally caused by an infection, it may mean you have a different urinary tract problem.
We will determine if you have a urinary tract infection by examining samples of your urine under
a microscope. If an infection is present, we may also perform a urine culture, a process in which
bacteria from infected urine are grown in a laboratory. The germs can then be identified and
tested to see which drugs will provide the most effective treatment. It often takes a day or two,
however, to complete this testing.
How are these infections treated?

Urinary tract infections are treated with antibiotics (infection-fighting drugs), which are
generally taken by mouth. We will choose a drug that treats the bacteria most likely to be causing
your infection. Once the test results are in, however, we may switch you to another antibiotic;
one that is more effective against the particular bacteria found in your urine.
The number of days you must take medication and the number of doses you must take each day
depend, in part, on the type of infection you have and how severe it is. You will usually have to
take the medicine for at least two to three days and possibly for as long as several weeks. The
daily treatment schedule we recommend depends on the specific drug prescribed. It may call for
a single dose each day or up to four daily doses.
A few doses of the antibiotic may relieve you of the need to urinate often and most of the pain
from a bladder infection. It may be several days, however, before the bladder infection and its
symptoms vanish completely. In any case, it is important to take the medicines as prescribed by
your doctor and not to stop them simply because the symptoms have gone away. If urinary tract
infections are not fully treated, they frequently return.
When you have a urinary tract infection, you should drink fluids whenever you are thirsty. It is
not necessary to drink large amounts, but you should make certain that your body has the liquid
it needs. If the urinary tract infection is severe, it may involve the kidneys. In that case, antibiotic
drugs may have to be injected. Hospital treatment with medication given intravenously (injected
directly into the bloodstream) is sometimes necessary.
Why do some people get UTIs more often than others?
Some people, mainly women, develop urinary tract infections because they are prone to such
infections the way other people are prone to getting coughs or colds. Urinary tract infections are
much less common in men and children than in adult women.
A number of factors may increase a person's risk of getting a urinary tract infection. Some of
these factors include:

Having certain diseases (such as diabetes) or an abnormal urinary system

Recently having had a medical instrument inserted into the urethra

Sexual contact

A urinary tract infection in a man or child may be the sign of an abnormal urinary tract.
Will I need further testing after the infection is gone? Once your infection has cleared, we may
recommend that you have additional tests. The tests are performed to assure that there are no
abnormalities in the urinary tract that might result in kidney damage from urinary tract
infections. Certain types of patients are most likely to need the tests.
These types include:

Young children

Men

People who have frequent urinary tract infections, or UTIs that won't go away with treatment

People who had fever with the infection

People who had blood in the urine

What other conditions may feel like a urinary tract infection?

The symptoms of a urinary tract infection may resemble those of other urinary tract diseases.

Urethritis may be either an inflammation or an infection of the urethra. When infection is present
in the urethra, the condition is often due to bacteria passed by sexual contact.

Interstitial cystitis is a bladder irritation found mainly in adult women. Its cause is not known.

Urinary stones sometimes develop in the bladder, irritating it and causing symptoms similar to
those of urinary tract infection. On occasion, the stones have bacteria inside that trigger hard-tocure infections.

Bladder tumors (cancerous or noncancerous growths), when present, may irritate the bladder.
The symptoms often include a frequent need to urinate and possibly blood in the urine.

Prostatitis is an inflammation or infection of the male gland, the prostate, which surrounds the
urethra just below the bladder. In adult males, prostate disorders may cause symptoms that
resemble those of urinary tract infections.

Do urinary tract infections have long-term effects?

Urinary tract infections in most adults can be successfully treated without causing long-term
problems. Young children have the greatest risk for kidney damage from urinary tract infections.
Such damage may lead to poor kidney function, high blood pressure, and other problems. For
this reason, it is important that children with urinary tract infections receive prompt treatment
and careful checkups. Pregnant women with a history of repeated urinary tract infections should
have their urine tested often. Urinary tract infections during pregnancy can cause serious kidney
infections in the mother and possible risks for the baby.
What steps can I take to reduce my risk of getting a urinary tract infection?
The following are steps you can take to reduce your risk of getting a urinary tract infection:

Don't postpone. Urinate when you feel the urge.

Don't rush. Take the time when you urinate to empty your bladder completely.

Respond to your body's signals of thirst by drinking enough water or other liquids every day.

Urinate after having sex.

Use condoms during intercourse.

Do I Have An STD?
As a general rule, it's very difficult to self-diagnose an STD. If you're experiencing any fever,
burning or pain while urinating, swelling, or strange discharge you should speak to your primary
care physician (see Common STD Symptoms. ) If you suspect you have an STD, you may want
to speak to your last partner to see if they've been having similar symptoms. Never wait if you
think you have an STD! Most of them can be handled with a simple round of antibiotics if caught
early enough.

What Is An STD?
STD is an acronym meaning sexually transmitted disease. These diseases can be contracted
through any sort of sexual contact, even if there is no direct intercourse. Some STDs can be
transmitted by other means, such as sharing needles with someone who is infected, but that type
of transmission is more uncommon.

Are There Cures For STDs?

Good news yes! Most STDs are very easy to treat, especially if you go to your doctor
immediately after noticing the symptoms. There are, unfortunately, a few STDs that cannot be
cured, such as HIV/AIDS and some forms of Hepatitis, but these STDs can be controlled with
medication. It's important to note that an STD like Syphilis only shows symptoms for a brief
time, before lying dormant and ravaging your body without any outward signs therefore it's
imperative that you visit your doctor immediately if you notice any uncomfortable, unpleasant,
or painful changes in your body after sexual activity.

What Are The Signs and Symptoms of STDs?

STDs have a wide variety of signs and symptoms ranging from completely innocuous to very
obvious. There are dozens of possible tells for each type of STD and this fact can make a
diagnosis difficult. Some of the more common symptoms may include:

Painful Urination Any time you experience difficulty when trying to urinate, or a
burning sensation, you may be showing symptoms of Chlamydia or Gonorrhea; this

uncomfortable feeling is very common in both. If the urine is also dark and foul smelling,
you may also have a Urinary Tract Infection, or the STD may be affecting your kidneys
you should always seek medical attention for any abnormalities during urination.

Excessive Itchiness This is a very common symptom of Scabies. If the itchiness is such
that you're beginning to break the skin in an effort to relieve it, and you're finding it
difficult to fall asleep or being woken in the night, you need to visit a doctor. Scabies
often presents with small, visible, black bugs on the skin. It's very easy to treat, and can
often be relieved with a simple topical cream.

Genital discharge Any time you have excessive, foul-smelling, or strangely colored
genital discharge you need to visit your doctor. It's common to have strange discharge
with Gonorrhea and Chlamydia, and other STDs such as Syphilis have been known to
present with this sign as well. For women, this could be a sign of Vaginosis, which tends
to come along with an STD.

Bumps or Warts These are very common signs of Genital Warts. These bumps may
come in any manner of sizes, colors, and shapes. It's never normal to have bumps on your
genitals, or in the genital area, and you should see your doctor. Genital Wartsare not
relegated to directly on the genitals, strange bumps on any part of your body that you've
involved in sexual activity warrant a trip to your primary care physician.

Rash This sign is most often attributed to Syphilis. The rash may be anywhere on your
body, any size and any color. You should immediately go to a doctor if you see any sort
of rash on your skin to rule out second stage Syphilis. It's also possible to see this sign
with Scabies, and in some cases with Crabs, both brought on by skin irritation from the
parasites.

White Spots White spots, especially in the pubic hair, is a very common sign of Crabs
and, less often, Scabies. You should rule out dandruff if you aren't experiencing any other
symptoms such as itchiness or redness; but if you are experiencing either additional
symptom a trip to your doctor is in order.

Unpleasant Odor Often, an infection comes with a cloying odor. It's most common for
this odor to come with discharge, or it may just be a radiating smell. If you begin to
notice a strange smell emanating from your genital area you should immediately contact
your doctor to rule out an STD or Urinary Tract Infection.

Can I Get An STD More Than Once?

Yes. Some STDs will give you a natural resistance to reinfection, but there is nothing stopping
you from catching the STD once again. The only way you will be protected from catching the
STD a second time, is by practicing safe and responsible sex.

Can I Get An STD From A Public Toilet?

This is a very common urban myth, believed by a lot of the general public. It's been suggested
that this is possible, but so rare that there are no proven examples of it actually happening. You
would have to sit on the toilet seat moments after someone else did, or the virus would die from
lack of biological matter. As a general rule, a quick wipe of the toilet seat is enough to protect
you although some prefer to line the seat with toilet paper.

I Have An STD; Did My Partner Cheat On Me?

It is possible, but not the only explanation. If you and your partner have been in a monogamous
relationship for a significant amount of time, one of you may have had this STD the entire time
without any flare-up until now. Some diseases, such as Syphilis can lie dormant for as long as
twenty years.

How Do I Avoid Contracting An STD?

The honest truth? Abstinence is the only way to avoid contracting an STD with absolute
certainty. However, abstinence is for many people not a choice they're willing to make, therefore
the second best method is the proper use of a condom. A condom can protect against most STDs,
except for Genital Warts which can be spread by direct contact with your partner's genital area.
You should always receive regular, full STD testing while that won't protect you from
contracting STDs, it will catch any that you already have and both allow you to receive treatment
and keep you from passing the STD on to your partner.

How Many People Have STDs?

The most commonly given answer to this question is one out of four people. It should be noted
that some people choose to treat their STDs at home without ever seeing a doctor, which means
the numbers are often lower than the true count.

Can I Get An STD If I'm A Virgin?

If you're a virgin who is not in any way participating in sexual activity, the chances of you
contracting an STD are astronomical. However, many people use virgin as a term for not
participating in anal or vaginal sex. Many men and women claim to be virgins even if they're
involving themselves in oral sex, which isn't true. A virgin is someone engaging in zero sexual
activity with a partner. If you're in any way engaging with a partner orally, or even just
touching your chances of an STD will increase dramatically.

Do All STDs Have Signs or Symptoms?

No. It's possible to have an STD, and never show any outward signs, or feel any symptoms. Or,
in some cases, you may feel the symptoms but not attribute them to an STD. For example,
Syphilis is well known for having mild flu-like symptoms during the first stage and very minor
signs during the second stage, often never alerting a carrier to the infection. This is why it's
important to get frequent STD testing, to make sure you haven't contracted an asymptomatic
STD.

Are Condoms Effective Against All STDs?

Condoms are not, unfortunately, effective against all STDs. Some, such as Genital Warts, are not
relegated to just the penis or vagina and those are the two places protected by a condom.
However, condoms are extremely effective against most STDs and wearing one is an excellent
way to prevent the vast majority.

Can I Get An STD Even If My Partner Has No Symptoms?

An STD with no symptoms is referred to as asymptomatic and is unfortunately very common.
Your partner may simply not realize what the discomfort is if their pain tolerance is high, or they
may attribute it to the wrong cause. In some cases, the STD may simply be dormant and
symptoms may come later. It's important to ask that your partner receive STD testing before you
ever engage in intercourse, for your own protection.

Are Cold Sores Really Herpes?

Yes; they're termed Herpes Simplex and are fairly common. It's possible to pass this type,
Virus-1, on by kissing or by performing oral sex. Often Herpes Simplex isn't transmittable if
there isn't a breakout, but in some cases it may still be passed to your partner. Therefore you
should be very careful if you get cold sores and should discuss the possibility with your partner
before ever engaging in activity.

Can I Get An STD From Kissing?

Generally it's not going to happen with anything other than Herpes. However, if you're kissing a
partner who has Gonorrhea of the throat, it may transmit to you. Kissing is, mostly, not a
common method of STD transmission but again you should be open with your partner, ask
questions, and seek testing if you notice anything awry.

Can I Get An STD By Engaging In Oral Intercourse?

Unfortunately, yes, you can. It's a popular myth, especially among younger age groups, that oral
sex will keep you from contracting any STDs and it's simply untrue. You can contract Gonorrhea
via oral sex, only it will affect your throat instead of your genital area. Herpes and Genital Warts
can both be passed along orally, affecting your throat, mouth, and lips instead of genitals. You
may also contract Scabies using this method, as you will be very close to your partner's skin.
Syphilis is also a concern with oral sex, as many people have small cuts in their mouths from
chewing too quickly or biting into a sharp chip, and then may be directly contacting a small
infected lesion without realizing it. Therefore, oral sex is no less likely to leave you with an STD
than vaginal or anal sex.

Should I Get Tested For An STD?

If at any time you suspect you have contracted an STD, you absolutely need to go to a doctor. It's
recommended that sexually active men and women also participate in annual testing to be sure
they have a clean bill of health. If you switch partners often, it's also been suggested that you
should receive testing before beginning a new relationship.

Genital Warts (HPV) Overview

Genital warts are flesh-colored or gray growths found in the genital area and anal region in both
men and women. Genital warts are sometimes referred to as condyloma acuminata or venereal

warts. They represent the most common sexually-transmitted disease caused by a virus. The
warts are caused by the human papillomavirus (HPV). Infection with genital warts may not be
obvious.
Genital warts affect both men and women and can occur at any age.

Most patients with genital warts are between the ages of 17-33 years. Genital warts are
highly contagious. There is around a 60% risk of getting the infection from a single
sexual contact with someone who has genital warts.

In children younger than three years of age, genital warts are thought to be transmitted by
nonsexual methods such as direct manual contact. Nevertheless, the presence of genital
warts in children should raise the suspicion for sexual abuse.

Up to 20% of people with genital warts will have other sexually transmitted diseases (STDs).
Genital Herpes FAQ
Most Frequently Asked Questions

What is genital herpes?

How did I catch genital herpes?

How will genital herpes affect my relationships?

What are the symptoms?

Do the symptoms return?

What can my partner and I do to reduce the risk of transmission?

Is there a cure?

Can I catch this virus from toilets and bath towels?

How do I know if I have genital herpes?

Where can I get more information and advice?

What is genital herpes?

Genital herpes is a common infection generally transmitted through sexual contact. It is caused
by one of two members of the herpes virus family, which also includes the viruses causing
chickenpox, shingles, and glandular fever.

Genital herpes is usually caused by infection with herpes simplex virus type 2 (HSV-2). Genital
herpes can also be caused by HSV-1, the virus which more usually causes facial herpes,
including cold sores on the lips.
Genital herpes, for most people, is an occasionally recurrent, sometimes painful condition for
which effective treatment is available. Generally, it is not life-threatening and has no long-term
repercussions on one's general physical health.
Anyone who is sexually active is at risk of catching genital herpes, regardless of their gender,
race or social class.
How did I catch genital herpes?
Genital herpes can be transmitted through direct contact with an infected blister or sore, usually
through sexual contact. It can also be transmitted when there are no symptoms present.
HSV-2 infection is usually passed on during vaginal or anal sex. HSV-1 is usually transmitted to
the genital area by oral sex (mouth to genital contact).
If you have only just been diagnosed as having genital herpes and are in a monogamous
relationship, this does not necessarily mean that your partner has been unfaithful to you, or
sexually promiscuous in the past.
It is possible for a person to carry the virus without knowing that they have it, since up to 80% of
people who are infected with HSV-2 show no signs of the infection. So it is very easy for a
person to unwittingly transmit the infection to their partner.
The symptoms of the infection vary greatly between individuals. It might be totally unnoticeable
in one person, but cause severe blistering in their partner.
Since the genital herpes virus can be transmitted through oral sex as well as vaginal sex, it is also
possible to have caught the virus from a cold sore on your partner's mouth or face. It is possible
to pass the virus on even if they did not have a cold sore present at the time of contact.
Alternatively, you may have contracted the virus from a previous sexual partner, perhaps even
several years ago. The virus can remain inactive in the body for long periods, so this may be the
first time it has caused symptoms. Or, previous symptoms may have been so slight that the
herpes condition went unnoticed or was dismissed (e.g.. a mild rash, itching or tingling).
How will genital herpes affect my relationships?
Because of the stigma wrongly attached to genital herpes, it can sometimes take a great deal of
courage to tell your partner that you have the infection. If you have not already told your partner
and need advice on how to do this please read our Herpes Talk section.

You may find that the honesty and trust brought about by discussing genital herpes strengthens
your relationship and brings you closer together. Support and understanding can help to
overcome much of the anxiety that you may be feeling about genital herpes.
A good long-term relationship must be based always on honesty and trust. While some people
may experience an unsupportive response, most have found their partners are both supportive
and understanding.
What are the symptoms?
If you are having your first episode of genital herpes, you are likely to feel generally unwell and
have fever, headache, and general joint and muscle aches, as well as irritation in the genitals.
This may last for several days, during or after which reddened areas may appear on the genitals.
These may develop into painful blisters, which then burst, leaving sores which gradually heal,
usually without scarring.
The severity of this first episode varies between individuals, but for some people it may be
severe and last for up to three weeks if not treated. These symptoms should quickly resolve with
treatment.
Do the symptoms return?
The symptoms of genital herpes may reappear from time to time. This is because once the viral
infection is acquired, it stays permanently in the body. Most of the time the virus remains
inactive, but every so often it may reactivate and cause another outbreak.
Each individual is different - some people never have a recurrence. Others may have recurrences
several times a year. However, recurrent outbreaks are usually shorter and less severe than the
first episode.
Certain events or situations can trigger recurrences, and you may be able to avoid or reduce the
trigger factors, which may include stress at work or home, fatigue, ill health, loss of sleep,
friction due to sexual intercourse, and menstruation in women.
If you have frequent or severe episodes of genital herpes, or if the recurrent outbreaks are
causing a lot of anxiety for you, then you may benefit from taking oral antiviral medication,
medicinal herbs, nutrients or a clinically tested ointment that can help to improve the symptoms.
What can my partner and I do to reduce the risk of transmission?
If you take the necessary precautions, the chance of transmitting the virus to your partner is
small. Genital herpes does not have to mean complete abstinence from sex or a reduced
enjoyment of sex.

The risk of transmitting the virus can often be reduced (sometimes by half) by using condoms.
The continued use of condoms in a long-term relationship is a personal decision that only you as
a couple can make. Most people find that as the importance of the HSV infection in their
relationship is seen in perspective, that condom use can become less relevant if this is the only
reason condoms are being used.
However, at all costs couples should try to avoid sexual intercourse during an active episode of
herpes, because this is when the virus is most likely to be transmitted. This period includes the
time from when your partner first has warning signs of an outbreak, such as tingling or burning
in the genitals, until the last of the sores has healed. Also, sexual activity prolongs the healing of
the episode.
Transmission risk is increased if there are any breaks in the skin, for example, if you have thrush
or small abrasions from sexual intercourse, often due to insufficient lubrication. It can be helpful
to use a lubricant specifically for sexual intercourse and avoid sex if you have thrush. Sexual
lubrication is helpful right at the start of sexual activity.
You will find more information about thrush and candida in the Female Herpes Issues section.
Sores in other areas, such as the buttocks and thighs, can be just as contagious as those in the
genital area, and care should be taken to avoid direct contact with such sores during sex.
At other times, there is still a small risk of transmitting the infection, even if your partner is
showing no signs of genital herpes. You can read detailed information about this in the Herpes
Viral Shedding section. If you or your partner has a cold sore, it is advisable to avoid oral sex as
this can spread the virus to the genitals.
You cannot catch genital herpes by sharing cups, towels or bath water, or from toilet seats. Even
during an outbreak, it is only skin to skin contact with the parts of your partner's body which
have the sores which you need to avoid. You can still cuddle, share a bed, or kiss.
What is the best treatment for genital herpes?
This is a personal choice. Some people prefer not to take prescription drugs due to the potential
for side-effects and the expense, especially if they are not necessary. More and more people are
focusing on correcting the problems which can trigger an outbreak, such as a vulnerable immune
system or an inappropriate diet. There are also particular herbs, nutrients and ointments which
can be helpful.
You can read about different options available in the Herpes Treatment section.
For many people with genital herpes, the physical consequences of the infection are far
outweighed by the emotional feelings it sometimes brings with it. There are many
misconceptions about genital herpes, including the belief that it is associated with promiscuity,
and these have given it a reputation which may cause you to feel angry and shocked by the

diagnosis. You may feel betrayed by your partner, or by a previous partner who may have
transmitted the infection.
Anxiety, guilt, loss of assertiveness and fear of rejection are also common emotions. The support
of a partner, friend, or family member can be very important in helping you to deal with these
feelings and to minimize the effect of genital herpes on your life.
If you are feeling lost or need a little bit of guidance and support please read our Positive
Thinking section.
Is there a cure for herpes?
Although the herpes virus is relatively easy to kill in a laboratory dish the problem arises because
this virus hides itself inside an apparently normal host nerve cell until it has multiplied itself and
is ready to migrate. This is when an outbreak occurs and the blisters appear.
Total cure is not out of the question and has been observed many times by patients and
physicians. The sooner a treatment can begin after infection the greater the chance of overcoming
the virus, so whatever treatment you decide on begin it soon and stick to it for a time. Besides the
various treatments examined in the Herpes Treatment section, close attention to diet and boosting
the immune system is recommended.
Can I catch herpes from toilets, or sharing soap, bath towels, etc?
It is considered by the CDC and all health care organizations that the spreading of genital herpes
through inanimate objects, such as soap, towels, clothing, bed sheets, toilet seats, and spa
surfaces is highly unlikely because the herpes virus cannot live very long outside of the body.
In theory this virus will die very quickly once the temperature drops or the moisture around the
virus dries up, but a scenario can be suggested where the temperature and moisture holds on long
enough for the virus to survive outside the body for several minutes.
This could arise where an infected person leaves the virus in droplets of warm urine on the toilet
seat and someone uses that toilet seat within a few minutes and has a cut that comes in contact
with that pool of warm urine. To avoid this scenario wipe the toilet seat before using.
How do I know if I have genital herpes?
The usual symptoms of genital herpes begin with feeling generally unwell. You may have fever,
headache, and general joint and muscle aches, as well as irritation in the genitals. This may last
for several days, during or after which reddened areas may appear on the genitals. These may
develop into painful blisters, which then burst, leaving sores which gradually heal, usually
without scarring.
Signs of infection vary greatly between individuals and it is possible for you to show only mild
symptoms that are not so easily recognizable as being genital herpes. These may include itching

in the genital area, small cracks in the skin around the genitals, or reddened patches of skin in the
genital area, thighs or buttocks, or you may have no symptoms at all.
Consult your doctor if you think you might be showing signs of the infection. Until recently,
diagnosis could only be made by clinical symptoms and swabs to detect the virus during an
active episode. However, blood tests are becoming commercially available that can distinguish
between HSV-1 and HSV-2 antibodies.
The time taken to develop antibodies after initial infection is normally 8 to 12 weeks. It is also
important to know that false positives and false negatives can occur with these tests.
Blood tests cannot definitively diagnose herpes, they can tell you whether or not you are infected
with HSV-1 and / or HSV-2, but cannot identify the site of infection. A swab taken from a genital
site test is also required. If this tests positive, that is, the virus is detected, the diagnosis of genital
herpes is confirmed. For more information visit the Herpes Diagnosis section.
Where can I get more information and advice?
After you have read this information, you might have specific questions or concerns. Your doctor
should be able to answer such questions or recommend other experts who can provide advice and
support. Continue to go back to your doctor until all your queries about genital herpes are
answered.
In some areas, there are local genital herpes support groups that can be a valuable source of
information and support. Ask your doctor if there is such a group in your area or look through
our list of Support Groups.

Gonorrhea
What is gonorrhea?

Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is caused by Neisseria gonorrhoeae,

a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract,
including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in
women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the
mouth, throat, eyes, and anus.
How common is gonorrhea?

Gonorrhea is a very common infectious disease. CDC estimates that more than 700,000 persons in
the U.S. get new gonorrheal infections each year. Only about half of these infections are reported to
CDC. In 2006, 358,366 cases of gonorrhea were reported to CDC. In the period from 1975 to 1997,
the national gonorrhea rate declined, following the implementation of the national gonorrhea control
program in the mid-1970s. After several years of stable gonorrhea rates, however, the national

gonorrhea rate increased for the second consecutive year. In 2006, the rate of reported gonorrheal
infections was 120.9 per 100,000 persons.
How do people get gonorrhea?

Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not
have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from
mother to baby during delivery.
People who have had gonorrhea and received treatment may get infected again if they have sexual
contact with a person infected with gonorrhea.
Who is at risk for gonorrhea?

Any sexually active person can be infected with gonorrhea. In the United States, the highest
reported rates of infection are among sexually active teenagers, young adults, and African
Americans.
What are the signs and symptoms for gonorrhea?

Some men with gonorrhea may have no symptoms at all. However, some men have signs or
symptoms that appear two to five days after infection; symptoms can take as long as 30 days to
appear. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or
green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles.
In women, the symptoms of gonorrhea are often mild, but most women who are infected have no
symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a
bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning
sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods.
Women with gonorrhea are at risk of developing serious complications from the infection, regardless
of the presence or severity of symptoms.
Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness,
bleeding, or painful bowel movements. Rectal infection also may cause no symptoms. Infections in
the throat may cause a sore throat but usually causes no symptoms.

What are the complications of gonorrhea?

Untreated gonorrhea can cause serious and permanent health problems in both women and men.
In women, gonorrhea is a common cause of pelvic inflammatory disease (PID). About one million
women each year in the United States develop PID. The symptoms may be quite mild or can be very
severe and can include abdominal pain and fever. PID can lead to internal abscesses (pus-filled
pockets that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage the fallopian
tubes enough to cause infertility or increase the risk of ectopic pregnancy. Ectopic pregnancy is a

life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian
tube.
In men, gonorrhea can cause epididymitis, a painful condition of the ducts attached to the testicles
that may lead to infertility if left untreated.
Gonorrhea can spread to the blood or joints. This condition can be life threatening. In addition,
people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people
with gonorrhea can transmit HIV more easily to someone else than if they did not have gonorrhea.
How does gonorrhea affect a pregnant woman and her baby?

If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes
through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening
blood infection in the baby. Treatment of gonorrhea as soon as it is detected in pregnant women will
reduce the risk of these complications. Pregnant women should consult a health care provider for
appropriate examination, testing, and treatment, as necessary.
How is gonorrhea diagnosed?

Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample
for testing from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send
the sample to a laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be
diagnosed in a laboratory by testing a urine sample. A quick laboratory test for gonorrhea that can be
done in some clinics or doctors offices is a Gram stain. A Gram stain of a sample from a urethra or a
cervix allows the doctor to see the gonorrhea bacterium under a microscope. This test works better
for men than for women.
What is the treatment for gonorrhea?

Several antibiotics can successfully cure gonorrhea in adolescents and adults. However, drugresistant strains of gonorrhea are increasing in many areas of the world, including the United States,
and successful treatment of gonorrhea is becoming more difficult. Because many people with
gonorrhea also have chlamydia, another STD, antibiotics for both infections are usually given
together. Persons with gonorrhea should be tested for other STDs.
It is important to take all of the medication prescribed to cure gonorrhea. Although medication will
stop the infection, it will not repair any permanent damage done by the disease. People who have
had gonorrhea and have been treated can get the disease again if they have sexual contact with
persons infected with gonorrhea. If a persons symptoms continue even after receiving treatment, he
or she should return to a doctor to be reevaluated.
How can gonorrhea be prevented?

The surest way to avoid transmission of STDs is to abstain from sexual intercourse, or to be in a
long-term mutually monogamous relationship with a partner who has been tested and is known to be
uninfected.

Latex condoms, when used consistently and correctly, can reduce the risk of transmission of
gonorrhea.
Any genital symptoms such as discharge or burning during urination or unusual sore or rash should
be a signal to stop having sex and to see a doctor immediately. If a person has been diagnosed and
treated for gonorrhea, he or she should notify all recent sex partners so they can see a health care
provider and be treated. This will reduce the risk that the sex partners will develop serious
complications from gonorrhea and will also reduce the persons risk of becoming re-infected. The
person and all of his or her sex partners must avoid sex until they have completed their treatment for
gonorrhea.

Chlamydiasis

Chlamydiasis, usually referred to simply as Chlamydia, is a sexually transmitted infection (STI)

caused by a bacterium called Chlamydia trachomatis. It can be transmitted during vaginal, anal,
or oral sex. Hence, men who perform sex with men are also at a risk of developing the disease.
Chlamydia can be more easily transmitted in a teenage girl or younger woman as her cervix
(opening of the uterus) is less matured as compared to an older woman. Many people with
Chlamydia may be asymptomatic in the early stages. Therefore, Chlamydia is also referred to as
a silent disease.
In the early stages of the disease, patients may exhibit few or no symptoms at all. Symptoms
usually start appearing only after one to three weeks of exposure. Symptoms differ in men and
women. Men with Chlamydia may have a discharge from their urethra or a burning sensation
while urinating. They may also complain of itching over the head of the penis. Rarely, they could
have a testicular swelling with pain.
Women with Chlamydia may complain of abnormal vaginal discharge or a burning sensation
while urinating, lower abdominal discomfort, lower back pain, feverishness with or without
nausea, pain during sexual intercourse, and bleeding in between menstrual periods. Chlamydia is
essentially caused by a type of bacteria called Chlamydia trachomatis. Although commonly
spread through sexual intercourse, Chlamydia can also be transmitted from a pregnant woman to
her unborn child.
Chlamydia can be easily treated using antibiotics. Chlamydia patients that are HIV positive are
also treated in the same way. It is advisable to avoid sexual intercourse till the disease is
completely treated. Women are at a greater risk of contracting the infection. Having multiple sex
partners increases the risk manifolds and also increases the possibility of suffering from some
other sexually transmitted disease (STD). Women who have been treated for Chlamydia should
get tested again after three to four months of treatment.

The infection can be prevented by avoiding multiple sex partners. Males should use latex
condoms and females must use polyurethane condoms during sexual intercourse to reduce the
chances of getting infected. The best way to prevent Chlamydia is by restricting yourself to a
single sexual partner. This will help to prevent almost all the sexually transmitted diseases.
Women are advised not to use douches as these are known to decrease the number of good
bacteria present in the vagina.
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It
has often been called the great imitator because so many of the signs and symptoms are
indistinguishable from those of other diseases.
How Common is Syphiis?

In the United States, health officials reported over 36,000 cases of syphilis in 2006, including 9,756
cases of primary and secondary (P&S) syphilis. In 2006, half of all P&S syphilis cases were reported
from 20 counties and 2 cities; and most P&S syphilis cases occurred in persons 20 to 39 years of
age. The incidence of P&S syphilis was highest in women 20 to 24 years of age and in men 35 to 39
years of age. Reported cases of congenital syphilis in newborns increased from 2005 to 2006, with
339 new cases reported in 2005 compared to 349 cases in 2006.
Between 2005 and 2006, the number of reported P&S syphilis cases increased 11.8 percent. P&S
rates have increased in males each year between 2000 and 2006 from 2.6 to 5.7 and among
females between 2004 and 2006. In 2006, 64% of the reported P&S syphilis cases were among
men who have sex with men (MSM).
How do people get syphilis?

Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur
mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and
in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant
women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread
through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or
eating utensils.
What are the signs and symptoms in adults?

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late
complications if they are not treated. Although transmission occurs from persons with sores who are
in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may
occur from persons who are unaware of their infection.
Primary Stage
The primary stage of syphilis is usually marked by the appearance of a single sore (called a
chancre), but there may be multiple sores. The time between infection with syphilis and the start of
the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm,
round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts
3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the
infection progresses to the secondary stage.

Secondary Stage
Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically
starts with the development of a rash on one or more areas of the body. The rash usually does not
cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or
several weeks after the chancre has healed. The characteristic rash of secondary syphilis may
appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the
feet. However, rashes with a different appearance may occur on other parts of the body, sometimes
resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis
are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may
include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle
aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without
treatment, but without treatment, the infection will progress to the latent and possibly late stages of
disease.
Late and Latent Stages
The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear.
Without treatment, the infected person will continue to have syphilis even though there are no signs
or symptoms; infection remains in the body. This latent stage can last for years. The late stages of
syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear
10 20 years after infection was first acquired. In the late stages of syphilis, the disease may
subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels,
liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty
coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This
damage may be serious enough to cause death.
How does syphilis affect a woman and her baby during pregnancy?

The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how
long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby
born dead) or of giving birth to a baby who dies shortly after birth. An infected baby may be born
without signs or symptoms of disease. However, if not treated immediately, the baby may develop
serious problems within a few weeks. Untreated babies may become developmentally delayed, have
seizures, or die.
How is syphilis diagnosed?

Some health care providers can diagnose syphilis by examining material from a chancre (infectious
sore) using a special microscope called a dark-field microscope. If syphilis bacteria are present in
the sore, they will show up when observed through the microscope.
A blood test is another way to determine whether someone has syphilis. Shortly after infection
occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and
inexpensive blood test. A low level of antibodies will likely stay in the blood for months or years even
after the disease has been successfully treated. Because untreated syphilis in a pregnant woman
can infect and possibly kill her developing baby, every pregnant woman should have a blood test for
syphilis.
What is the link between syphilis and HIV?

Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection
sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV if exposed to that infection
when syphilis is present.
Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes, such as
syphilis, disrupt barriers that provide protection against infections. The genital ulcers caused by
syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex,
increase the infectiousness of and susceptibility to HIV. Having other STDs is also an important
predictor for becoming HIV infected because STDs are a marker for behaviors associated with HIV
transmission.
What is the treatment for syphilis?

Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic,
will cure a person who has had syphilis for less than a year. Additional doses are needed to treat
someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other
antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that
will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not
repair damage already done.
Because effective treatment is available, it is important that persons be screened for syphilis on an
on-going basis if their sexual behaviors put them at risk for STDs.
Persons who receive syphilis treatment must abstain from sexual contact with new partners until the
syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they
also can be tested and receive treatment if necessary.
Will syphilis reoccur?

Having syphilis once does not protect a person from getting it again. Following successful treatment,
people can still be susceptible to re-infection. Only laboratory tests can confirm whether someone
has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be
obvious that a sex partner has syphilis. Talking with a health care provider will help to determine the
need to be re-tested for syphilis after being treated.
How can syphilis be prevented?

The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to
abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner
who has been tested and is known to be uninfected.
Avoiding alcohol and drug use may also help prevent transmission of syphilis because these
activities may lead to risky sexual behavior. It is important that sex partners talk to each other about
their HIV status and history of other STDs so that preventive action can be taken.
Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are
covered or protected by a latex condom, as well as in areas that are not covered. Correct and
consistent use of latex condoms can reduce the risk of syphilis, as well as genital herpes and
chancroid, only when the infected area or site of potential exposure is protected.

Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are no more effective than
other lubricated condoms in protecting against the transmission of STDs. Use of condoms lubricated
with N-9 is not recommended for STD/HIV prevention. Transmission of an STD, including syphilis
cannot be prevented by washing the genitals, urinating, and/or douching after sex. Any unusual
discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex
and to see a doctor immediately.