Deciding to be tested for HIV is usually a difficult step. Even for those who believe they are at low risk, the process can be nerve wracking. A person must be emotionally ready to be tested, because obviously the test results may be life altering. That person must be tested because he is ready to be tested, not because he feels pressured by someone else. A person who is going to be tested should consider how she will react if the results are positive or if they are negative. Anyone considering having an HIV test should consider these questions:

— Do you want to bring someone with you when you get your results?

— Before you are tested, do you want to tell a friend or sexual partner that you are going to be tested?

— Do you have someone to talk with after you are tested?

— If you test negative, what will you do in the future to lower your risk of becoming infected?

If you test positive, the person who gives you your results should be able to offer referral to a clinic that cares for persons infected with HIV (if the facility where you are tested does not provide that care) and also, if you wish, refer you to support services to address psychological issues. It is also a good idea to have the test repeated if a positive result is obtained, especially if you are at low risk for infection, on the chance that there was an error at the laboratory.

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incidence: common

cause: virus (hepatitis A)

symptoms: nausea, yellowing of the skin, diarrhea

treatment: none (usually resolves on its own)

WHAT IS IT?

Hepatitis A is a virus that causes infection and inflammation of the liver. It has been recognized since the 1960s as a virus distinct from hepatitis B. One often hears of outbreaks of hepatitis A associated with improper food handling in restaurants, but hepatitis A can be transmitted sexually as well, especially through oral-anal contact. So far, hepatitis A and hepatitis B are the only sexually transmitted infections that can be prevented with a vaccination.

HOW COMMON IS IT?

Approximately 30,000 people are diagnosed with hepatitis A each year in the United States, but the Centers for Disease Control estimates that over 100,000 new cases may occur each year in this country. Most of these cases are not the result of sexual transmission. Many people are symptom free or do not seek care for their symptoms.

It is estimated that by the time they reach young adulthood, 15-25 percent of the people in the United States have been infected with hepatitis A, usually by consuming contaminated food or water. As people age, the likelihood that they have acquired hepatitis A increases, with blood tests of more than 75 percent of adults over age seventy showing infection. In the industrialized world, improvements in sanitation have decreased the number of people infected in childhood, whereas in developing countries, where sanitation and water quality may be inadequate, childhood infection is still very common. In many countries, more than 90 percent of children are infected by age five. Infection in childhood may not be a bad thing: most children who become infected with hepatitis A are symptom free, whereas most adults are symptomatic, and although fatalities are rare from hepatitis A, most of the deaths that do occur are in newly infected adults. People who have not been vaccinated or received immune globulin (see the next section) prior to travel to areas of the world where hepatitis A is very common are at increased risk of infection as well.

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If a woman becomes pregnant while she is infected with certain STDs, or acquires them during the pregnancy, there is an increased risk that she will not be able to carry the pregnancy to term. For example, gonorrhea and chlamydia can cause preterm delivery, miscarriage, premature rupture of the membranes, and infection in the uterus after the delivery. Syphilis, which will be discussed in more detail later in this chapter, can also cause miscarriage and preterm labor. By a common and usually benign infection of the vaginal area (which is usually not considered a sexually transmitted infection), can cause similar problems in pregnancy, as can trichomoniasis, which is a sexually transmitted vaginal infection.

The herpes virus, which causes a very common genital infection that is often symptom free and thus remains undiagnosed, can adversely affect pregnancy. Infection during the first trimester increases a woman’s risk of miscarriage. A woman who becomes infected with herpes while she is pregnant is at risk of transmitting the virus to the child (either in the womb or at delivery), especially if she becomes infected during the last trimester of the pregnancy. For women with a history of genital herpes who become pregnant, this happens much less frequently.

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You will usually be asked about your understanding of sexually transmitted infections—what causes them, how they are transmitted, and so on—and be given a chance to have all your questions answered. This is a great time to get accurate information about STDs; with that information, you can make changes in your life that will put you at lower risk for acquiring an STD.

If your health care provider does not bring up these questions, you may want to bring up the topic yourself. Here are examples of ways in which you might start off the discussion:

— “I have just started a new relationship, and my partner and I have decided that we want to be tested for sexually transmitted diseases.”

— “I have concerns about sexually transmitted infections.

There are a few questions I want to ask you.”

— “Is there anything unusual that you noticed during the examination today? I have concerns about sexually transmitted infections.”

In addition to the questions listed, you will be asked about your medical history regarding nonsexually transmitted infections or other illnesses. You will be asked what medications you take and if you are allergic to any medications. You will be asked if you have taken any antibiotics within the last month or so, since this may influence which tests are done and when. (If you took an antibiotic within the previous few weeks, you may test negative for certain bacterial STDs even if you do have the infection.)

If you are a woman, you will be asked when your last period was, if you have ever been pregnant, and if so, how the pregnancy turned out. Did you have the baby, lose the baby (a spontaneous abortion), or have an abortion (an induced abortion)? You will also be asked when you last had a Pap smear and if you’ve ever had an abnormality on a Pap smear (the section on genital warts in Part II explains why this question is important).

Before you leave the office or the clinic, try to express all your concerns. Nevertheless, it may take a while during the visit before you feel comfortable, and it’s possible that you’ll overlook something. Find out how to contact your health care provider after you leave. That way you can call if any more concerns or questions occur to you later.

If your health care provider does not seem to have the answers you are looking for, or if you feel uncomfortable for any reason, you may want to consider a visit to another clinic or health care provider to get the help you need.

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The cervix is a round structure that sits at the end of the vaginal canal. It is visible during a gynecological examination, and a woman can sometimes feel the cervix herself by inserting one or two fingers into the vagina. It looks like a small doughnut. The cervix has an opening, called the os, through which menstrual blood flows during a period. For fertilization to occur, sperm must pass through the os and into the uterus and Fallopian tubes, to reach the egg released by the ovary during ovulation.

Two types of cells are found on the cervix. The columnar cells are on the inside of the cervix, and they are also found inside the uterus. Sometimes these cells are seen on the outside of the cervix (a condition called ectopy), especially in younger women and women who are taking birth control pills. As women age, these cells move into the cervix and can only be reached with an instrument such as the brush used to collect cells for a Pap smear. These cells may become inflamed and move to the outside again when a woman has an infection of the cervix (called cervicitis).

The second type of cell is the squamous cell. These are located on the outside of the cervix and are also found in the vagina. The place on the cervix where the columnar cells and the squamous cells come together is called the transformation zone or squamocolumnar junction. It is here that precancerous or cancerous changes can occur, and cells for a Pap smear are taken from the transformation zone during screening for cervical cancer.

The cervix can become infected with STDs. Cancer of the cervix can also occur; it is caused by certain strains of the human papillomavirus, which also causes genital warts. Pap smears are an excellent screen for cervical cancer and are part of the yearly examination recommended for all sexually active women. During the Pap smear, cells that are removed with a brush from the cervix are sent to a laboratory for examination under a microscope.

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