Sexually transmitted disease

Sexually transmitted disease
Classification and external resources
U.S. propaganda poster targeted at World War II soldiers and sailors appealed to their patriotism in urging them to protect themselves. The text at the bottom of the poster reads, "You can't beat the Axis if you get VD." Images of women were used to catch the eye on many VD posters.
ICD-10	A64
ICD-9	099.9
DiseasesDB	27130
MeSH	D012749

	Sexuality portal
	Medicine portal

Sexually transmitted disease (STD), also known as a sexually transmitted infection (STI) or venereal disease (VD), is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex. While in the past, these illnesses have mostly been referred to as STDs or VD, in recent years the term sexually transmitted infections (STIs) has been preferred, as it has a broader range of meaning; a person may be infected, and may potentially infect others, without having a disease. Some STIs can also be transmitted via the use of IV drug needles after its use by an infected person, as well as through childbirth or breastfeeding. Sexually transmitted infections have been well known for hundreds of years.

Classification

Until the 1990s, STDs were commonly known as venereal diseases: Veneris is the Latin genitive form of the name Venus, the Roman goddess of love. Social disease was another euphemism.

Sexually transmitted infection is a broader term than sexually transmitted disease.^[1] An infection is a colonization by a parasitic species, which may not cause any adverse effects. In a disease the infection leads to impaired or abnormal function. In either case the condition may not exhibit signs or symptoms. Increased understanding of infections like HPV, which infects most sexually active individuals but cause disease in only a few has led to increased use of the term STI. Public health officials originally introduced the term sexually transmitted infection, which clinicians are increasingly using alongside the term sexually transmitted disease in order to distinguish it from the former.^{[citation needed]}

STD may refer only to infections that are causing diseases, or it may be used more loosely as a synonym for STI. Because most of the time people do not know that they are infected with an STD until they are tested or start showing symptoms of disease, most people use the term STD, even though the term STI is also appropriate in many cases.

Moreover, the term sexually transmissible disease is sometimes used since it is less restrictive in consideration of other factors or means of transmission. For instance, meningitis is transmissible by means of sexual contact but is not labeled as an STI because sexual contact is not the primary vector for the pathogens that cause meningitis. This discrepancy is addressed by the probability of infection by means other than sexual contact. In general, an STI is an infection that has a negligible probability of transmission by means other than sexual contact, but has a realistic means of transmission by sexual contact (more sophisticated means—blood transfusion, sharing of hypodermic needles—are not taken into account). Thus, one may presume that, if a person is infected with an STI, e.g., chlamydia, gonorrhea, genital herpes, it was transmitted to him/her by means of sexual contact.

The diseases on this list are most commonly transmitted solely by sexual activity. Many infectious diseases, including the common cold, influenza, pneumonia, and most others that are transmitted person-to-person can also be transmitted during sexual contact, if one person is infected, due to the close contact involved. However, even though these diseases may be transmitted during sex, they are not considered STDs.

Cause

Bacterial

• Chancroid (Haemophilus ducreyi)
• Chlamydia (Chlamydia trachomatis)
• Granuloma inguinale or (Klebsiella granulomatis)
• Gonorrhea (Neisseria gonorrhoeae)
• Syphilis (Treponema pallidum)

Fungal

• Candidiasis (yeast infection)

Viral

Micrograph showing the viral cytopathic effect of herpes (ground glass nuclear inclusions, multi-nucleation). Pap test. Pap stain.

• Viral hepatitis (Hepatitis B virus)—saliva, venereal fluids.
  (Note: Hepatitis A and Hepatitis E are transmitted via the fecal-oral route; Hepatitis C is rarely sexually transmittable,^[2] and the route of transmission of Hepatitis D (only if infected with B) is uncertain, but may include sexual transmission.^[3][4][5])
• Herpes simplex (Herpes simplex virus 1, 2) skin and mucosal, transmissible with or without visible blisters
• HIV (Human Immunodeficiency Virus)—venereal fluids, semen, breast milk, blood
• HPV (Human Papillomavirus)—skin and mucosal contact. 'High risk' types of HPV cause almost all cervical cancers, as well as some anal, penile, and vulvar cancer. Some other types of HPV cause genital warts.
• Molluscum contagiosum (molluscum contagiosum virus MCV)—close contact

Parasites

• Crab louse, colloquially known as "crabs" or "pubic lice" (Pthirus pubis)
• Scabies (Sarcoptes scabiei)

Protozoal

• Trichomoniasis (Trichomonas vaginalis)

Transmission probability

The risks and transmission probabilities of sexually transmitted diseases are summarized by act in the table below.^{[6][7][8][9][10][11][12]}

Odds of transmission per unprotected sexual act with an infected person
	Known risks	Possible or unknown risks
Performing oral sex on a man	Chlamydia Gonorrhea(25-30%) Herpes (rare) HPV Syphilis (1%)[9] With ass to mouth practices: Hepatitis A Shigella	Hepatitis B (low risk)[11] HIV (very low risk; 0.01%)[7] Hepatitis C (unknown)
Performing oral sex on a woman	Herpes (1%)	HPV
Receiving oral sex - man	Chlamydia Gonorrhea Non-gonococcal urethritis Herpes Syphilis (1%)[9]	HPV
Receiving oral sex - woman	Herpes MRSA	HPV
Vaginal sex - man	Chlamydia (30-50%)[11] Crabs Scabies Gonorrhea (20%)[12] Hepatitis B Herpes HIV (0.05%)[7] HPV (at least 5%)[10] Non-gonococcal urethritis Syphilis Trichomoniasis	Hepatitis C
Vaginal sex - woman	Chlamydia (30–50%)[11] Crabs Scabies Gonorrhea (50 to 90%)[12] Hepatitis B(50-70%) Herpes HIV (0.1%)[7] HPV (high;[11] at least 5%)[10] Syphilis Trichomoniasis	Hepatitis C
Anal sex - insertive	Chlamydia Crabs Scabies(40%) Gonorrhea Hepatitis B Herpes HIV (62%)[8] HPV Non-gonococcal urethritis Syphilis (14%)[9]	Hepatitis C
Anal sex - receptive	Chlamydia Crabs Scabies Gonorrhea Hepatitis B Herpes HIV (1.7%)[8] HPV Syphilis (1.4%) [9]	Hepatitis C
Oral-anal sex	Amebiasis Cryptosporidiosis(1%) Giardiasis Hepatitis A(1%) Shigellosis(1%)	HPV(1%)

Pathophysiology

Many STDs are (more easily) transmitted through the mucous membranes of the penis, vulva, rectum, urinary tract and (less often—depending on type of infection)^{[citation needed]} the mouth, throat, respiratory tract and eyes. The visible membrane covering the head of the penis is a mucous membrane, though it produces no mucus (similar to the lips of the mouth). Mucous membranes differ from skin in that they allow certain pathogens into the body.^[13] Pathogens are also able to pass through breaks or abrasions of the skin, even minute ones. The shaft of the penis is particularly susceptible due to the friction caused during penetrative sex. The primary sources of infection in ascending order are venereal fluids, saliva, mucosal or skin (particularly the penis), infections may also be transmitted from feces, urine and sweat.^{[14][dubious – discuss]} The amount of contact with infective sources which causes infection varies with each pathogen but in all cases a disease may result from even light contact from fluid carriers like venereal fluids onto a mucous membrane.

This is one reason that the probability of transmitting many infections is far higher from sex than by more casual means of transmission, such as non-sexual contact—touching, hugging, shaking hands—but it is not the only reason. Although mucous membranes exist in the mouth as in the genitals, many STIs seem to be easier to transmit through oral sex than through deep kissing. According to a safe sex chart, many infections that are easily transmitted from the mouth to the genitals or from the genitals to the mouth, are much harder to transmit from one mouth to another.^[15] With HIV, genital fluids happen to contain much more of the pathogen than saliva. Some infections labeled as STIs can be transmitted by direct skin contact. Herpes simplex and HPV are both examples. KSHV, on the other hand, may be transmitted by deep-kissing but also when saliva is used as a sexual lubricant.

Depending on the STD, a person may still be able to spread the infection if no signs of disease are present. For example, a person is much more likely to spread herpes infection when blisters are present (STD) than when they are absent (STI). However, a person can spread HIV infection (STI) at any time, even if he/she has not developed symptoms of AIDS (STD).

All sexual behaviors that involve contact with the bodily fluids of another person should be considered to contain some risk of transmission of sexually transmitted diseases. Most attention has focused on controlling HIV, which causes AIDS, but each STD presents a different situation.

As may be noted from the name, sexually transmitted diseases are transmitted from one person to another by certain sexual activities rather than being actually caused by those sexual activities. Bacteria, fungi, protozoa or viruses are still the causative agents. It is not possible to catch any sexually transmitted disease from a sexual activity with a person who is not carrying a disease; conversely, a person who has an STD got it from contact (sexual or otherwise) with someone who had it, or his/her bodily fluids. Some STDs such as HIV can be transmitted from mother to child either during pregnancy or breastfeeding.

Although the likelihood of transmitting various diseases by various sexual activities varies a great deal, in general, all sexual activities between two (or more) people should be considered as being a two-way route for the transmission of STDs, i.e., "giving" or "receiving" are both risky although receiving carries a higher risk.

Healthcare professionals suggest safer sex, such as the use of condoms, as the most reliable way of decreasing the risk of contracting sexually transmitted diseases during sexual activity, but safer sex should by no means be considered an absolute safeguard. The transfer of and exposure to bodily fluids, such as blood transfusions and other blood products, sharing injection needles, needle-stick injuries (when medical staff are inadvertently jabbed or pricked with needles during medical procedures), sharing tattoo needles, and childbirth are other avenues of transmission. These different means put certain groups, such as medical workers, and haemophiliacs and drug users, particularly at risk.

Recent epidemiological studies have investigated the networks that are defined by sexual relationships between individuals, and discovered that the properties of sexual networks are crucial to the spread of sexually transmitted diseases. In particular, assortative mixing between people with large numbers of sexual partners seems to be an important factor.

It is possible to be an asymptomatic carrier of sexually transmitted diseases. In particular, sexually transmitted diseases in women often cause the serious condition of pelvic inflammatory disease.

Prevention

San Francisco City Clinic a municipal STD testing center in San Francisco.

Main article: Safe sex

Prevention is key in addressing incurable STIs, such as HIV & herpes. Sexual health clinics fight to promote the use of condoms and provide outreach for at-risk communities.

The most effective way to prevent sexual transmission of STIs is to avoid contact of body parts or fluids which can lead to transfer with an infected partner. Not all sexual activities involve contact: cybersex, phonesex or masturbation from a distance are methods of avoiding contact. Proper use of condoms reduces contact and risk. Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom.^[16]

Ideally, both partners should get tested for STIs before initiating sexual contact, or before resuming contact if a partner engaged in contact with someone else. Many infections are not detectable immediately after exposure, so enough time must be allowed between possible exposures and testing for the tests to be accurate. Certain STIs, particularly certain persistent viruses like HPV, may be impossible to detect with current medical procedures.

Many diseases that establish permanent infections can so occupy the immune system that other diseases become more easily transmitted. The innate immune system led by defensins against HIV can prevent transmission of HIV when viral counts are very low, but if busy with other viruses or overwhelmed, HIV can establish itself. Certain viral STI's also greatly increase the risk of death for HIV infected patients.

Vaccines

Vaccines are available that protect against some viral STIs, such as Hepatitis A, Hepatitis B, and some types of HPV. Vaccination before initiation of sexual contact is advised to assure maximal protection.

Condoms

Condoms and female condoms only provide protection when used properly as a barrier, and only to and from the area that it covers. Uncovered areas are still susceptible to many STDs. In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin, thus properly shielding the insertive penis with a properly worn condom from the vagina or anus effectively stops HIV transmission. An infected fluid to broken skin borne direct transmission of HIV would not be considered "sexually transmitted", but can still theoretically occur during sexual contact, this can be avoided simply by not engaging in sexual contact when having open bleeding wounds. Other STDs, even viral infections, can be prevented with the use of latex, polyurethane or polyisoprene condoms as a barrier. Some microorganisms and viruses are small enough to pass through the pores in natural skin condoms, but are still too large to pass through latex or synthetic condoms.

Proper usage entails:

• Not putting the condom on too tight at the end, and leaving 1.5 cm (3/4 inch) room at the tip for ejaculation. Putting the condom on snug can and often does lead to failure.
• Wearing a condom too loose can defeat the barrier.
• Avoiding inverting, spilling a condom once worn, whether it has ejaculate in it or not.
• Avoiding condoms made of substances other than latex, polyisoprene or polyurethane that do not protect against HIV.
• Avoiding the use of oil based lubricants (or anything with oil in it) with latex condoms, as oil can eat holes into them.
• Using flavored condoms for oral sex only, as the sugar in the flavoring can lead to yeast infections if used to penetrate.

Not following the first five guidelines above perpetuates the common misconception that condoms are not tested or designed properly.^{[citation needed]}

In order to best protect oneself and the partner from STIs, the old condom and its contents should be assumed to be infectious. Therefore the old condom must be properly disposed of. A new condom should be used for each act of intercourse, as multiple usage increases the chance of breakage, defeating the effectiveness as a barrier.

Nonoxynol-9

Researchers had hoped that nonoxynol-9, a vaginal microbicide would help decrease STD rates. Trials, however, have found it ineffective.^[17] In fact, the use of nonoxynol-9 can put women at a higher risk of HIV infection.^[18]

Diagnosis

STI tests may test for a single infection, or consist of a number of individual tests for any of a wide range of STIs, including tests for syphilis, trichomonas, gonorrhea, chlamydia, herpes, hepatitis and HIV tests. No procedure tests for all infectious agents.

STI tests may be used for a number of reasons:

• as a diagnostic test to determine the cause of symptoms or illness
• as a screening test to detect asymptomatic or presymptomatic infections
• as a check that prospective sexual partners are free of disease before they engage in sex without safer sex precautions (for example, when starting a long term mutually monogamous sexual relationship, in fluid bonding, or for procreation).
• as a check prior to or during pregnancy, to prevent harm to the baby
• as a check after birth, to check that the baby has not caught an STI from the mother
• to prevent the use of infected donated blood or organs
• as part of the process of contact tracing from a known infected individual
• as part of mass epidemiological surveillance

Not all STIs are symptomatic, and symptoms may not appear immediately after infection. In some instances a disease can be carried with no symptoms, which leaves a greater risk of passing the disease on to others. Depending on the disease, some untreated STIs can lead to infertility, chronic pain or even death.^[19] Early identification and treatment results in less chance to spread disease, and for some conditions may improve the outcomes of treatment.

There is often a window period after initial infection during which an STI test will be negative. During this period the infection may be transmissible. The duration of this period varies depending on the infection and the test.

Diagnosis may also be delayed by reluctance of the infected person to seek a medical professional. One report indicated that afflicted people turn to the Internet rather than to a medical professional for information on STIs to a higher degree than for other sexual problems.^[20]

STD Wizard

The STD Wizard is a publicly available expert system for determining which screening tests, vaccinations, and evaluations are recommended, related to sexually transmitted diseases. The information included within the STD Wizard is based on the Centers for Disease Control and Prevention "Sexually Transmitted Diseases Treatment Guidelines - 2006". The system has English and Spanish language interfaces.

The STD Wizard runs in a web browser. The program asks a series of questions, related to demographics, behaviors, and symptoms. There are potentially over 100 questions, but most users get asked about 20. The exact questions asked depend on the user's responses. Typical questions include:

• Demographics - How old are you, in years?
• Behaviors - Have you had more than one sex partner within the past six months?
• Symptoms - Are you having a discharge from your penis or burning during urination?

Typical recommendations include:

• Screening tests - e.g., HIV screening test
• Vaccinations - e.g., Hepatitis B vaccination
• Evaluations - e.g., Seek medical attention in the next week for rash

Management

High risk exposure such as that which occurs in rape cases may be treated prophylacticly using antibiotic combinations such as azithromycin, cefixime, and metronidazole.

An option for treating partners of patients (index cases) diagnosed with chlamydia or gonorrhea is patient-delivered partner therapy, which is the clinical practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.^[21]

Epidemiology

Age-standardized, disability-adjusted life years for STDs (excluding HIV) per 100,000 inhabitants in 2004.^[22]

  no data

  < 60

  60–120

  120–180

  180–240

  240–300

  300–360

  360–420

  420–480

  480–540

  540–600

  600–1000

  > 1000

STD incidence rates remain high in most of the world, despite diagnostic and therapeutic advances that can rapidly render patients with many STDs noninfectious and cure most. In many cultures, changing sexual morals and oral contraceptive use have eliminated traditional sexual restraints, especially for women, and both physicians and patients have difficulty dealing openly and candidly with sexual issues. Additionally, development and spread of drug-resistant bacteria (e.g., penicillin-resistant gonococci) makes some STDs harder to cure. The effect of travel is most dramatically illustrated by the rapid spread of the AIDS virus (HIV-1) from Africa to Europe and the Americas in the late 1970s.^[23]

In 1996, the World Health Organization estimated that more than 1 million people were being infected daily. About 60% of these infections occur in young people <25 years of age, and of these 30% are <20 years. Between the ages of 14 and 19, STDs occur more frequently in girls than boys by a ratio of nearly 2:1; this equalizes by age 20. An estimated 340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis occurred throughout the world in 1999.^[24][25]

Commonly reported prevalences of STIs among sexually active adolescent girls both with and without lower genital tract symptoms include chlamydia (10–25%), gonorrhea (3–18%), syphilis (0–3%), Trichomonas vaginalis (8–16%), and herpes simplex virus (2–12%).^{[citation needed]} Among adolescent boys with no symptoms of urethritis, isolation rates include chlamydia (9–11%) and gonorrhea (2–3%).^{[citation needed]}

At least one in four U.S. teenage girls has a sexually transmitted disease,^[26] a CDC study found.^[27] Among girls who admitted ever having sex, the rate was 40%.^[28]

AIDS is the single largest cause of mortality in present-day Sub-Saharan Africa.^[29] The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. Approximately 1.1 million persons are living with HIV/AIDS in the United States,^[30] and AIDS remains the leading cause of death among African American women between ages 25 and 34.^[31] Hepatitis B is also classed as a sexually transmitted disease because it can be passed on sexually.^[32] The disease is found globally, with the highest rates in Asia and Africa and lower rates in the Americas and Europe.^[33] Worldwide, an estimated two billion people have been infected with the hepatitis B virus.^[34]

History

1930s Works Progress Administration poster

The first well-recorded European outbreak of what is now known as syphilis occurred in 1494 when it broke out among French troops besieging Naples.^[35] From this centre, the disease swept across Europe, killing more than five million people.^[36] As Jared Diamond describes it, "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months," rendering it far more fatal than it is today. Diamond concludes,"[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today."^[37]

Prior to the invention of modern medicines, sexually transmitted diseases were generally incurable, and treatment was limited to treating the symptoms of the disease. The first voluntary hospital for venereal diseases was founded in 1746 at London Lock Hospital.^[38] Treatment was not always voluntary: in the second half of the 19th century, the Contagious Diseases Act was used to arrest suspected prostitutes.

The first effective treatment for a sexually transmitted disease was salvarsan, a treatment for syphilis. With the discovery of antibiotics, a large number of sexually transmitted diseases became easily curable, and this, combined with effective public health campaigns against STDs, led to a public perception during the 1960s and 1970s that they have ceased to be a serious medical threat.

During this period, the importance of contact tracing in treating STIs was recognized. By tracing the sexual partners of infected individuals, testing them for infection, treating the infected and tracing their contacts in turn, STI clinics could be very effective at suppressing infections in the general population.

In the 1980s, first genital herpes and then AIDS emerged into the public consciousness as sexually transmitted diseases that could not be cured by modern medicine. AIDS in particular has a long asymptomatic period—during which time HIV (the human immunodeficiency virus, which causes AIDS) can replicate and the disease can be transmitted to others—followed by a symptomatic period, which leads rapidly to death unless treated. HIV/AIDS entered the United States in about 1969 likely through a single infected immigrant from Haiti.^[39] Recognition that AIDS threatened a global pandemic led to public information campaigns and the development of treatments that allow AIDS to be managed by suppressing the replication of HIV for as long as possible. Contact tracing continues to be an important measure, even when diseases are incurable, as it helps to contain infection.

References

1. ^ Are sexually transmitted infections (STIs) different from sexually transmitted diseases (STDs)?^{[dead link]}, Frequently asked questions (FAQ) About Sexually Transmitted Diseases (STDs), Ethiopian AIDS Resource Center "Sometimes the terms STI and STD are used interchangeably. This can be confusing and not always accurate, so it helps first to understand the difference between infection and disease. Infection simply means that a germ—virus, bacteria, or parasite—that can cause disease or sickness is present inside a person’s body. An infected person does not necessarily have any symptoms or signs that the virus or bacteria is actually hurting his or her body; they do not necessarily feel sick. A disease means that the infection is actually causing the infected person to feel sick, or to notice something is wrong. For this reason, the term STI—which refers to infection with any germ that can cause an STD, even if the infected person has no symptoms—is a much broader term than STD."
2. ^ Workowski K, Berman S (2006). "Sexually transmitted diseases treatment guidelines, 2006.". MMWR Recomm Rep 55 (RR–11): 1–94. PMID 16888612. http://www.cdc.gov/mmwr/PDF/rr/rr5511.pdf. 
3. ^ Wu J, Chen C, Sheen I, Lee S, Tzeng H, Choo K (1995). "Evidence of transmission of hepatitis D virus to spouses from sequence analysis of the viral genome". Hepatology 22 (6): 1656–60. doi:10.1002/hep.1840220607. PMID 7489970. 
4. ^ Farci P (2003). "Delta hepatitis: an update". J Hepatol 39 (Suppl 1): S212–9. doi:10.1016/S0168-8278(03)00331-3. PMID 14708706. 
5. ^ Shukla N, Poles M (2004). "Hepatitis B virus infection: co-infection with hepatitis C virus, hepatitis D virus, and human immunodeficiency virus". Clin Liver Dis 8 (2): 445–60, viii. doi:10.1016/j.cld.2004.02.005. PMID 15481349. 
6. ^ Department of Public Health, City & County of San Francisco (2011). STD Risks Chart
7. ^ ^{a b c d} Varghese B, Maher JE, Peterman TA, Branson BM,Steketee RW (2002). "Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use". Sex. Transm. Dis. 29 (1): 38–43. doi:10.1097/00007435-200201000-00007. PMID 11773877. 
8. ^ ^{a b c} Jin F et al. (March 2010). "Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART". AIDS 24 (6): 907–913. doi:10.1097/QAD.0b013e3283372d90. PMC 2852627. PMID 20139750. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2852627. 
9. ^ ^{a b c d e} Hoare A (2010). models of HIV epidemics in Australia and Southeast Asia
10. ^ ^{a b c} Burchell A et al. (March 2006). "Modeling the Sexual Transmissibility of Human Papillomavirus Infection using Stochastic Computer Simulation and Empirical Data from a Cohort Study of Young Women in Montreal, Canada". American Journal of Epidemology 169 (3): 534–543. doi:10.1093/aje/kwj077. 
11. ^ ^{a b c d e} Australasian contact tracing manual. Specific infections where contact tracing is generally recommended
12. ^ ^{a b c} Bryan C (2011)INFECTIOUS DISEASE CHAPTER EIGHT SEXUALLY TRANSMITTED DISEASES
13. ^ Virus Pathogenesis, Microbiology Bytes
14. ^ HIV/AIDS Glossary, World Bank
15. ^ Safe Sex Chart, violet blue: open source sex
16. ^ Villhauer, Tanya (2005-05-20). "Condoms Preventing HPV?". University of Iowa Student Health Service/Health Iowa. http://www.uistudenthealth.com/question/default.aspx?q=738. Retrieved 2009-07-26. 
17. ^ Wilkinson D, Ramjee G, Tholandi M, Rutherford G (2002). Wilkinson, David. ed. "Nonoxynol-9 for preventing vaginal acquisition of sexually transmitted infections by women from men". Cochrane Database Syst Rev (4): CD003939. doi:10.1002/14651858.CD003939. PMID 12519623. 
18. ^ Williams, M. Healthy Choices for Fertility Control. CreateSpace, Scotts Valley, CA, 2009. ISBN 1448664721
19. ^ "Male STI check-up video". Channel 4. 2008. http://sexperienceuk.channel4.com/education/about/male-sti-check-up. Retrieved 2009-01-22. 
20. ^ 'The Cringe Report' By Susan Quilliam. Posted: 06/28/2011; J Fam Plann Reprod Health Care. 2011;37(2):110-112.
21. ^ Expedited Partner Therapy in the Management of Sexually Transmitted Diseases (2 February 2006) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE. Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention
22. ^ "WHO Disease and injury country estimates". World Health Organization. 2004. http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html. Retrieved Nov. 11, 2009. 
23. ^ Mary-Ann Shafer, Anna-Barbara Moscicki (2006). Sexually Transmitted Infections, 2006. pp. 1–8. http://www.health.am/sex/more/sexually_transmitted_infections/. 
24. ^ "STD Statistics Worldwide". Avert.org. http://www.avert.org/stdstatisticsworldwide.htm. Retrieved 2011-01-09. 
25. ^ U.S. Medicine Information Central^{[dead link]}
26. ^ "One In Four Teenage Girls In U.S. Has Sexually Transmitted Disease, CDC Study Shows". Science Daily. March 12, 2008.
27. ^ "Sex Infections Found in Quarter of Teenage Girls". The New York Times. March 12, 2008.
28. ^ "CDC study says at least 1 in 4 teen girls has a sexually transmitted disease; HPV most common". The Oklahoman. March 11, 2008.
29. ^ UNAIDS, WHO (December 2007). "2007 AIDS epidemic update" (PDF). http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf. Retrieved 2008-03-12. 
30. ^ "Obama Ends U.S. Travel Ban On Visitors, Immigrants With HIV-AIDS". ABC News. October 30, 2009.
31. ^ "Report: Black U.S. AIDS rates rival some African nations". CNN.com. July 29, 2008.
32. ^ "Hepatitis: Type B (caused by hepatitis B virus)". Minnesota Department of Health.
33. ^ "Hepatitis B". U.S. Food and Drug Administration.
34. ^ "FAQ about Hepatitis B". Stanford School of Medicine. 2008-07-10. http://liver.stanford.edu/Education/faq.html. Retrieved 2009-09-19. 
35. ^ Oriel, J.D. (1994). The Scars of Venus: A History of Venereology. London: Springer-Verlag. ISBN 354019844X. 
36. ^ CBC News Staff (January 2008). "Study traces origins of syphilis in Europe to New World". http://www.cbc.ca/health/story/2008/01/14/syphilis-columbus.html. Retrieved 2008-01-15. 
37. ^ Diamond, Jared (1997). Guns, Germs and Steel. New York: W.W. Norton. p. 210. ISBN 848306667X. 
38. ^ Archives in London and the M25 area (AIM25) London Lock Hospital records
39. ^ Gilbert MT, Rambaut A, Wlasiuk G, Spira TJ, Pitchenik AE, Worobey M (November 2007). "The emergence of HIV/AIDS in the Americas and beyond". Proc. Natl. Acad. Sci. U.S.A. 104 (47): 18566–70. doi:10.1073/pnas.0705329104. PMC 2141817. PMID 17978186. http://www.pnas.org/cgi/pmidlookup?view=long&pmid=17978186. Retrieved March 20, 2010. 

Further reading

• Aral, Sevgi O (2008). Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases. : Springer Singapore Pte. Limited. ISBN 9780387857688. http://books.google.ca/books?id=F1RIOW0x5gAC&lpg=PR1&dq=Sexually%20transmitted%20disease&pg=PR1#v=onepage&q&f=true 
• Faro, Sebastian (2003). Sexually transmitted diseases in women. Lippincott Williams & Wilkins. ISBN 0397513038. http://books.google.ca/books?id=l0xZNxirdx0C&lpg=PP1&dq=Sexually%20transmitted%20disease&pg=PP1#v=onepage&q&f=true 
• Ford, Carol A; Elizabeth Shimer Bowers (2009). Living with Sexually Transmitted Diseases. Facts On File. ISBN 9780816076727. http://books.google.ca/books?id=kSVqn-w8kSUC&lpg=PA17&dq=Sexually%20transmitted%20disease&pg=PP1#v=onepage&q&f=true 
• Sehgal, Virendra N (2003). Sexually Transmitted Diseases (4th ed.). Jaypee Bros. Medical Publishers. ISBN 8180611051. http://books.google.ca/books?id=VORwYIzp__wC&lpg=PP1&dq=Sexually%20transmitted%20disease&pg=PP1#v=onepage&q&f=true 
• Shoquist, Jennifer; Diane Stafford (2003). The encyclopedia of sexually transmitted diseases. Facts On File. ISBN 0816048819. http://books.google.ca/books?id=LFMvJNyVoUgC&lpg=PA177&dq=Sexually%20transmitted%20disease&pg=PP1#v=onepage&q&f=true 

External links

• CDC Sexually Transmitted Diseases Treatment Guidelines, 2010
• Sexually Transmitted Diseases Treatment Guidelines - 2006
• STD photo library at Dermnet
• UNFPA: Breaking the Cycle of Sexually Transmitted Infections at UNFPA
• Sexually Transmitted Infections from the National Institute of Allergy and Infectious Diseases
• STDs In Color: Sexually Transmitted Disease Facts and Photos
• [1]: Sexually Transmitted Diseases in the U.S.