Anal Pleasure and Health: A Guide for Men, Women and Couples (38 page)

Treatment with antibiotics is highly effective. Whenever possible, recent sexual partners should be notified and also treated.

Using condoms for anal or vaginal intercourse helps to prevent infections (Holmes, 2004). In addition, sexually active women, especially those 25 and under, should be tested yearly. Official guidelines do not call for regular testing of men, but a typical STD screening will detect chlamydia.

GONORRHEA. Similar to chlamydia in many ways, gonorrhea is also caused by a bacteria that can be transmitted through giving or receiving anal or vaginal intercourse as well as oral sex. Gonorrhea infections of the throat are relatively rare compared other forms of gonorrhea. Male ejaculation is not required for transmission because the bacteria is passed via mucous membranes. In 2006, more than 350,000 cases were reported in the United States, but actual infections are estimated to be double that number. After many years of reduced infections, gonorrhea has been on the rise in recent years, particularly among younger people, a disturbing sign that the frequency of unprotected intercourse is increasing.

Like chlamydia, gonorrhea is often asymptomatic (true of more than half of all cases of rectal gonorrhea). If there are going to be symptoms, they'll usually be noticed within 2-5 days (as long as 30) for a man, or 10 days for a woman. When the urethra is infected, symptoms usually include burning or a pus-like discharge.

Acute rectal gonorrhea may cause discomfort or pain, a discharge from the anus during bowel movements, bleeding, and occasionally diarrhea. When rectal gonorrhea goes untreated, as it often does, complications such as a rectal abscess may follow. In the meantime, a male who has unprotected anal intercourse with this person stands a good chance of developing urethral gonorrhea.

When gonorrhea remains untreated for quite a long time, the bacteria may eventually spread to the blood and joints. Normally, however, by the time serious symptoms appear, gonorrhea will have finally been diagnosed and treated. Another significant problem with untreated gonorrhea is that it makes it easier for HIV to be transmitted.

Gonorrhea is easily diagnosed and treated with antibiotics. However, treatment-resistant strains of the bacteria are being seen more often. Those with gonorrhea often have chlamydia as well, requiring simultaneous treatment for both. Sexual activity should be avoided until the infection has been eliminated as determined by a follow-up examination. Recent sexual partners should be notified and treated, if possible.

Once again, consistent and proper use of condoms for anal or vaginal intercourse offers effective protection. Screening for STDs, very important for all sexually active, non-monogamous people, will detect gonorrhea.

SYPHILIS. Syphilis is also caused by a bacteria that is transmitted through intimate contact with mucous membranes or perhaps a skin abrasion, usually somewhere on the genitals, mouth, or anus. While infection rates have gradually been improving (until recent years), syphilis rates are sixteen times higher for African Americans compared to the general population. Infection rates are growing among gay men and young people.

Syphilis transmission can occur during intercourse (vaginal or anal) or oral sex. Once a person is infected, the disease progresses, if left untreated, through four stages:

• Primary stage. A single sore called a chancre usually appears at the infection site-in or around the genitals or anus, or occasionally on the lips or mouth-10-90 days after infection. The chancre heals by itself within a month. But the syphilis bacteria is still present and can be transmitted to others.

• Secondary stage. A wide range of skins symptoms appear between 17 days to more than six moths following infection. Most common are rashes anywhere on the body or "syphilitic warts" on the genitals or anus. Or the person may simply feel vaguely ill. Obviously, these symptoms can easily mistaken for other things. In 2-6 weeks the symptoms clear up on their own, but the disease continues if left untreated.

• Latent stage. There are no symptoms for up to thirty years. Meanwhile, the syphilis bacteria is gradually attacking various organs. Luckily, syphilis is virtually always discovered and treated before or during this stage. But damage already done is permanent.

• Late stage. This is where the damage becomes severe and obvious, including cardiovascular problems, blindness, and serious mental illnesses. Luckily, syphilis rarely goes untreated this long in the developed world. But many historical figures appear to have died or gone crazy from late stage syphilis.

Various blood tests are used to detect syphilis, depending on its stage. Standard STD screening will detect syphilis. Treatment is with penicillin or another antibiotic. Follow-up examinations are required to assure a complete cure. During treatment, sexual contact should be avoided and recent partners should be notified and examined whenever possible.

Consistent use of condoms for intercourse (vaginal or anal) reduces, but doesn't eliminate, the risk of infection (Shlay, 2004). This is because the bacteria can enter the body through nearby mucous membranes not covered by the condom. A condom can be used for fellatio, or cut and flattened out for use as barrier (plastic wrap works too) during cunnilingus or rimming.

GENITAL AND ANAL HERPES. The threat of herpes infections burst into public consciousness during the sexually adventurous 1970s. Following a relatively brief period when antibiotics appeared to be triumphant over most STDs, here was an infection that invaded the body for life. The ideal of unfettered sex was shattered. In a sense, the herpes scare foretold the radical changes in sexual behavior that would soon become essential for preventing HIV. More than 45 million Americans are currently living with herpes, about one in five. Male-tofemale transmission is more common, thus more women are infected than men.

Herpes is a viral infection caused by two of the many viruses of the herpes "family."*
Herpes simplex type 1 (HSV-1) is typically responsible for cold sores, fever blisters and facial herpes, but it can also infect the genital area. The vast majority of genital or anal herpes infections are caused by herpes simplex type 2 (HSV-2). Both types are spread by skin-to-skin contact with infected areas. This is how HSV can be transmitted to a newborn baby during delivery.

Most infected people have minimal or no symptoms. Some people have one or more blisters around the anus or genitals within two weeks of infection. The blisters then break, leaving sores that take 2-4 weeks to heal. During the "primary episode," with or without symptoms, HSV is being shed, and thus contact with the infected area(s) can easily transmit the disease. There may also be flu-like symptoms, including fever.

This first outbreak of herpes symptoms is usually the worst, and often the last. But there may be periodic outbreaks, which tend to be far less severe. Luckily, even for those with recurring herpes outbreaks, the frequency and severity usually decreases over time. No one knows for sure what causes herpes flare-ups, or why some people are troubled by them with distressing regularity while others are hardly bothered at all. Possible factors include: physical trauma or friction at the point of infection, exposure to ultraviolet light (sunbathing), lowered resistance (which often occurs when fighting off another disease), emotional stress, or elevated body temperature (sitting in a hot tub or sauna, for example).

There are periods between outbreaks when HSV is "latent." The person is symptom-free, but the virus remains in the body. Prior to a herpes flare-up, some people experience flu-like symptoms or itching at the point of infection. This pre-outbreak period is known as the herpes prodrome. HSV is especially contagious during the prodrome and throughout the outbreak until the sores have healed completely. At these times, sexual interaction should be avoided, especially activities anywhere near the infected area. It important throughout an outbreak to avoid touching the lesions and to wash one's hands frequently and thoroughly, because they can unwittingly spread HSV to other areas of the body, occasionally even the eyes. Eye infections, however, are almost always caused by HSV-1.

Unfortunately, herpes can be transmitted even with no symptoms present, or even if a person isn't aware that they have it. There's no cure for herpes. Treatment is focused on reducing the severity, duration, and frequency of outbreaks with antiviral medications and lifestyle changes, especially stress reduction.

Herpes can be diagnosed visually when typical symptoms are present. A sample can also be taken for a viral culture. Results can show which type of HSV a person has. But there are a lot of false negatives because active virus may not be in the sample.

Blood testing for HSV antibodies in the blood can also be inconclusive or wrong. Many "false positives" for HSV-2 occur among those with HPV-1 when older "IgM" blood tests are used, causing unnecessary distress. These tests give quicker results, but can't distinguish between HPV types. Newer "gG-based" blood tests produce much more accurate results, but it can take a few months for antibodies to show up for these tests. Visit www.ashastd.org/ herpes for more details about the complexities of HSV testing.

HSV infections can be linked with HIV/AIDS in two ways. Not only are people with suppressed immunity more likely to be infected with herpes, but the presence of HSV lesions makes it easier for a person to be infected by HIV in the first place. People with AIDS are especially at risk because their immune systems are unable to control the virus and, consequently, their outbreaks are often severe or debilitating. Infections may even spread to unexpected places, including internal organs.

Condoms offer some protection between outbreaks. But since the infected area isn't necessarily covered by a condom, people don't always know when an outbreak is coming, and they may be contagious without symptoms, this protection is far from foolproof. A recent study concluded that condoms reduce herpes infection rates by about one-third (Martin, 2009)-helpful, to be sure, but far from reliable.

It's easy to see why those living with herpes often need a tremendous amount of information and support. The Herpes Resource Center (www. ashastd.org/hexes), operated by the American Social Health Association, is invaluable for those concerned about herpes.*

GENITAL AND ANAL HPV (HUMAN PAPILLOMAVIRUS). HPV, short for human papillomavirus, is the most common of all STDs. In the US there are more than six million new HPV infections each year. According to best estimates, 75% of men and women will acquire an HPV infection at some time in their lives. There are more than 70 types of HPV, some of which cause warts on hands, feet, or other body parts. About 30 types are sexually transmitted and can infect the skin and mucous membranes of the genitals, anus, and rectum in both sexes, and also the cervix (the opening to the uterus located at the back of the vagina) in women. Luckily, 90% of HPV infections are cleared by a person's own immune system within two years. Those with impaired immunity due to HIV, chemotherapy, or other infections are less able to fight HPV.

Some "low-risk" HPV types cause genital or anal warts, but usually not cancer. These may appear weeks or months (but sometimes years) after exposure and generally don't cause cancer. Warts are bumps, single or in a group, small or large and, especially in moist areas, may look like a miniature cauliflower. Anal or genital warts can spread; those around the anus may enter the anal canal or rectum. HPV infections may start in the rectum or vagina when exposure results from unprotected anal or vaginal intercourse. Exterior warts can be seen and/or felt. Internal ones can't be seen, but may be felt with a finger. But most people aren't aware that they have them.

Warts can be surgically removed or treated by freezing with liquid nitrogen (cryotherapy) or burning with acid or an "electric needle" (electrocautery). Unfortunately, anal warts can recur after treatment, or after they appear to have cleared up on their own.

"High risk" HPV infections don't cause warts, but can cause cancer of the penis in men, anal cancer in either sex, or cancers of the vulva, vagina, or cervix in women. Cervical cancer is by far the most common cancer caused by HPV. It can be especially deadly because there aren't any noticeable symptoms until the cancer is quite advanced. This is why annual Pap smears (simple tests for pre-cancerous cell changes of the cervix) are essential for women. Although no HPV screening is currently approved for men, some experts recommend anal pap smears for gay and bisexual men because they're 17 times more likely to develop anal cancers than heterosexual men.

Happily, there's now a vaccine called Gardasil that protects girls from four types of HPV that cause 70% of cervical cancers and 90% of genital warts. To be effective, however, the vaccine must be given before sexual activity begins, because it doesn't cure existing infections; it's solely a preventive measure. Ages 11 or 12 are ideal for vaccination, but is approved for girls and women ages 9-26. Research is under way to determine the safety and effectiveness of a similar vaccine for men and boys.

Condoms offer some protection against HPV, but contact with the virus is possible outside of the covered area. Reducing the number of partners also can lower one's risk of exposure significantly.*

HEPATITIS. Hepatitis is an inflammation of the liver caused by five different viruses. In the US, most cases are primarily caused by three types: A (HAV), B (HBV), and C (HCV). Symptoms of a hepatitis infection range from none (or hardly noticeable) to extremely severe. These may include: loss of energy or appetite, depression, confusion, body or joint aches, nausea, diarrhea, abdominal pain, rashes or itching on the skin, swollen glands, fever, chills, sweats, reduction in tolerance for alcohol, dark urine or clay-colored stools. In more serious cases, there may be jaundice, in which the skin and eyes turn yellow. But even if there aren't any symptoms, the infected person is still contagious.

• Hepatitis A (HA) is primarily transmitted by oral contact with contaminated feces, which can sometimes be in food, water, and other drinks. HAV is easily spread when young children, some of whom are still in diapers, gather together as in daycare settings. Like many adults, even older children may not wash their hands after bowel movements. Whereas adults may contaminate food this way, children are more likely to put their hands in their mouths.