STD Awareness: Is Syphilis Making a Comeback?

men syphilisBefore antibiotics, syphilis was the most feared sexually transmitted disease (STD) out there. It was easy to get, quack cures were ineffective and often unpleasant, and it could lead to blindness, disfigurement, dementia, or even death. When we were finally able to zap infections away with drugs like penicillin, it seemed like we’d finally won the battle against this scourge. Whereas syphilis rates were highest before antibiotics became widespread in the 1940s, by 2000 we saw a low of 2.1 cases of syphilis per 100,000. At the dawn of the new millennium, many scientists thought the United States was at the dawn of the complete elimination of syphilis.

Using condoms, regular STD testing, and limiting sex partners are the best ways for sexually active people to stay healthy.

Must all good things come to an end? They shouldn’t have to, but in the case of syphilis, the Centers for Disease Control and Prevention (CDC) has announced that syphilis rates are rising, with incidence doubling since 2005. In the United States, there are now 5.3 cases of syphilis per 100,000 people, but that number is a bit misleading because it represents an average across the general population. When you break the population down by age, race or ethnicity, gender, or sexual orientation, that rate might be much higher or much lower. For example, syphilis rates are actually on the decline among women (at only 0.9 cases per 100,000), but among men it is 9.8 per 100,000. In fact, most new syphilis cases — 91.1 percent of them, to be precise — are in men, most of whom are gay or bisexual.

Syphilis is rising the most dramatically among men in their twenties, especially among men who have sex with men (MSM). While some wonder if syphilis is growing among twenty-somethings because this group didn’t live through the early era of AIDS, when HIV was seen as a death sentence and safer sex practices were more common, it might also be due to the fact that STD rates are higher among young people in general. Continue reading

Endometriosis Treatment

endo medsIt’s still March, so it’s still Endometriosis Awareness Month! Today we’ll be looking at endometriosis treatment questions and answers. If you missed the first two posts in this series, you can click to read more about an overview of endometriosis as well as info about diagnosing endometriosis.

Why are there so many treatment options? Which one is best?

There are so many options because there is no “magic bullet” option — that is, no single treatment that works best for everyone. The two main categories of treatment include medication and surgery, but each option has its own benefits and drawbacks. When deciding on the best option for a given individual, some helpful questions to consider might be:

  • Do I have any current health concerns that would render some treatments unsafe? What types of health risks are acceptable to me?
  • Am I currently trying to conceive, or will I be in the next six to 12 months? Will I ever want to be pregnant in the future?
  • Aside from significant health risks, what types of factors — side effects, treatment frequency or duration, cost — would make a treatment difficult for me? How long do I need this treatment to last before I can reevaluate?

For specific questions, your best bet is to check with your health care provider. Continue reading

Diagnosing Endometriosis

If you missed it, you can read the previous post explaining the basics of endometriosis here. In this post, we’ll look a little more at how endometriosis is diagnosed as well as some current barriers to diagnosis.

Wait. So you’re telling me that killer cramps of doom aren’t normal? If I did suspect I had endo, how would I go about getting diagnosed?

Endometriosis diagnosis is a tricky thing in that there’s no in-office procedure that can definitively determine whether someone has the condition or not. However, because the “gold standard” test is laparoscopy with biopsy — a surgical procedure — many health care providers prefer to do some in-office tests before recommending laparoscopy. The most common such procedures are pelvic exams and ultrasounds, which may allow a provider to see or feel if the endometrial lesions have formed cysts (known as “endometriomas”), but won’t pick up on smaller lesions.

Another complicating factor is that endometriosis isn’t the only cause of either dysmenorrhea or chronic pelvic pain. Other causes can include uterine fibroids, pelvic floor dysfunction, pelvic inflammatory disease, irritable bowel syndrome, and interstitial cystitis.

Even with laparoscopy, diagnosis isn’t necessarily straightforward. Not only is it a surgical procedure, which carries with it extra expense and risk, but even then, presence of the disease is often missed or underestimated. Seeking out a doctor who specializes in endometriosis can minimize this, but of course, due to geographic, cost, or other access issues, this isn’t always possible. Continue reading

March Is Endometriosis Awareness Month

As my ever-creative title suggests, March is Endometriosis Awareness Month. I have endometriosis (“endo” for short), and I like this month because I know plenty of people in my life who could definitely use some more awareness as to what endometriosis is and how it impacts the lives of those who have it.

So what is endometriosis, anyway?

Endometriosis is a condition where the endometrium, the lining of the uterus, grows outside the uterus — often on the ovaries, bladder, bowel, and/or lining of the pelvic area. This can be a problem for two reasons. One is that during menstruation, there’s nowhere for this “rogue endometrium” (not a technical term) to go, not having a way to the cervix and vagina and all. This can cause pain — most often pain during menstruation — as well as a buildup of tissue that remains throughout subsequent cycles, where even more “rogue endometrium” is added to it. The other is that the endometrial lesions can contribute to infertility, particularly if the endo obstructs the ovaries or fallopian tubes.

That doesn’t sound like fun. Is endometriosis rare?

Surprisingly, no. Exact numbers are hard to come by because a lot of cases are thought to go undiagnosed (which is part of the reason for this whole “awareness month” thing). But the estimate is that endo affects just over 10 percent of people with ovaries during their reproductive years — and about 30 to 50 percent of such people who have problems with infertility or pelvic pain. Odds are pretty good that you personally know someone with endometriosis, even if you don’t (or they don’t!) know they have it. Continue reading

STD Awareness: Antibiotic-Resistant Syphilis

Treponema pallidum under a microscope. Image: Dr. Edwin P. Ewing, Jr., CDC

The image to your right, with lively yellow splotches against a pale green background, is not a long-lost Jackson Pollack piece, and the dark squiggly lines aren’t strands of paint haphazardly splattered onto a canvas. In fact, those squiggly lines are magnified images of the spiral-shaped bacteria species Treponema pallidum. You might not have heard of T. pallidum, but you’ve probably heard of syphilis, the sexually transmitted disease (STD) that these bacteria cause. While syphilis isn’t as common as other STDs, like chlamydia and HPV, it’s still out there, and occasionally communities experience outbreaks. It’s always best for sexually active people to be screened for STDs and practice safer sex.

The evolution of syphilis strains that are resistant to certain antibiotics underscores the need to use antibiotics properly.

Syphilis can inflict serious long-term damage — in fact, before the introduction of antibiotics, syphilis was the worst STD out there! Known as the Great Pox when it descended upon Europe 500 years ago, it could cause large and painful boils. Eventually, natural selection led to T. pallidum’s evolution into a form with milder symptoms, which benefited the bacteria by enabling its less boil-ridden (and presumably more attractive) human hosts to spread it farther and wider. Nevertheless, the symptoms of syphilis, if present, still include infectious sores, and when the disease goes untreated, it can cause severe, possibly fatal, damage to the nervous system.

Back in the day, there were myriad inadequate “treatments” for syphilis, ranging from straight-up quackery to the use of partially effective but toxic chemicals such as mercury. But a century ago, in 1912, a new arsenic-based chemical called Neosalvarsan was hailed as a “magic bullet.” Unfortunately, this treatment took weeks or even more than a year to administer — and had dangerous side effects. Quack treatments continued to flourish, and it wasn’t until the widespread adoption of penicillin in the 1940s that an effective cure with few side effects was available.

But natural selection endures; in fact, by flooding T. pallidum’s habitat with certain antibiotics, we’ve created an environment that favors the organism’s evolution against us. While not as immediately threatening as antibiotic-resistant gonorrhea, syphilis has been quietly evolving resistance to some of the antibiotics we use to treat it. This underscores the importance of using antibiotics correctly and emphasizing safer-sex practices, such as using latex condoms during vaginal or anal intercourse and during oral contact with a penis. Continue reading

STD Awareness: Intestinal Parasites

Editor’s Note: If you’re wondering if there is a sexually transmitted disease (STD) that causes maggots, please see our new article, “Is There an STD That Causes Maggots?”

This colorized scanning electron micrograph shows Giardia lamblia reproducing asexually. Image: Stan Erlandsen, CDC’s Public Health Image Library

Most sexually transmitted diseases are caused by bacteria or viruses, but some are caused by organisms that are classified as completely different lifeforms. Trichomoniasis, for example, is caused by a protozoan organism; protozoa occupy their own kingdom, separate from plants, animals, and bacteria. Intestinal parasites are often protozoan organisms, but can also include parasitic worms (which are members of the animal kingdom). They are spread through contact with fecal matter — and as such, they can be transmitted sexually as well as nonsexually. Intestinal parasites are usually transmitted by fecal contamination of food or water, and are most common in areas with insufficient sewage treatment and untreated water in the wilderness. Some pathogens, however, have low infectious doses, making their sexual transmission more likely.

What has eight flagella and can live in your intestines?

Oral contact with the anus, also called anilingus or rimming, is the primary means of the sexual transmission of these pathogens. Putting fingers or hands in your mouth after they have had contact with the anus is also risky. Other modes of transmission include oral sex, as genitals can be contaminated with feces, as well as sharing sex toys and other equipment. For these reasons, it is very important to use dental dams or latex gloves during contact with the anus; to clean the anus before engaging in rimming; to clean or use condoms on shared sex toys; and to use condoms or dental dams during oral sex. Continue reading

STD Awareness: Cytomegalovirus and Molluscum Contagiosum

Most sexually transmitted diseases (STDs) are caused by microorganisms – lifeforms that are too small to be seen without a microscope. Many STDs, however, are caused by viruses, which technically aren’t even alive. Rather, viruses are pieces of genetic information that are stored in protein capsules. When these capsules come into contact with a host cell, the genetic information is able to enter the cell and hijack its machinery so that the host cell manufactures copies of the virus, as well as potentially harmful viral proteins. Many well-known STDs, such as herpes and HIV/AIDS, are caused by viruses, but this month we will focus on two lesser-known viral STDs, cytomegalovirus and molluscum contagiosum. Your local Planned Parenthood health center, as well as other clinics, health departments, and private health-care providers, can help you get a diagnosis and treatment for these STDs.

Cytomegalovirus leaves granules inside its host cells called inclusion bodies, pictured here. Photograph from the CDC’s Public Health Image Library.

Cytomegalovirus leaves granules inside its host cells called inclusion bodies, pictured here. Image: Public Health Image Library, CDC


The bad news is that most people are infected with cytomegalovirus (CMV) at some point in their lives. About 80 percent of the U.S. population is estimated to be carriers, about 4 in 10 Americans are infected with CMV before puberty (usually through contact with saliva), and adults can be reinfected through sexual activity. The good news is that among healthy adults, a CMV infection usually does not have any symptoms, though if they do they could seem like a mild case of mono. Being reinfected with the virus later in life also carries with it only a small risk for symptoms in healthy adults.

And back to the bad news: While an infection with cytomegalovirus usually does not have symptoms, if someone is infected while pregnant it can harm the fetus. About 1 in 100 U.S. babies is infected with CMV, but usually doesn’t show symptoms. Every year in the United States, around 5,500 babies are born with symptomatic cytomegalic inclusion disease (CID). Symptoms of CID vary, but the most severe include mental retardation and hearing loss. If the mother was already infected before conception, there is a 2 percent chance the virus will be transmitted to the fetus; however, if the infection occurs during pregnancy, this risk jumps into the 40 to 50 percent range. Continue reading