SAS Urban Survival Handbook (124 page)

From the late 1970s it became clear that some STDs, such as herpes (which can become chronic) and hepatitis B (which can be fatal), could not be cured with drugs. With the recognition of the HIV virus and AIDS in 1982, STDs became even more life-threatening.

All recent partners of an infected person should be traced by an STD clinic, especially since these contacts could be infected with a type of sexually-transmitted disease which shows no obvious symptoms. The confidential tracing and treatment of anyone who has had recent sexual contact with the person being treated is essential to the control of STDs.

SAFER SEX

Sexual intercourse is only completely safe if both you and your partner have never had sex with anyone else and if neither has ever had an STD (which could have been contracted nonsexually). Safe sex was traditionally practised by anyone wishing to avoid contracting any STD, but is now IMPERATIVE with the recognition of HIV and AIDS. To reduce the likelihood of contracting any STD you should:

• ◑ Never have unprotected sexual intercourse, except with a monogamous partner whose sexual history and HIV status is known to you.
  
• ◑ Always use a condom and spermicidal jelly. Novelty condoms (coloured, flavoured, or textured) tend to he less reliable than the thicker varieties. Remember that oil-based lubricants like petroleum jelly and baby oil can damage the rubber. Water-based lubricants should be used.
  
• ◑ Reduce the number of your sexual partners.
  
• ◑ Remember that prostitutes have a high rate of infection. They should ensure that their clients use a condom, to protect both the client and themselves.
  

WARNING

Sex is a high-risk activity unless it is mode ‘safe’. NEVER have penetrative sexual intercourse with a casual partner without using a condom (see Safer sex). Couples wishing to have children should seek medical advice.

High-risk sex

Transference of body fluids may lead to transmission of STDs or HIV, if one or more partners carry them:

• ◑ Unprotected vaginal or anal intercourse. Remember that secretions will still be exchanged even if the unprotected penis is withdrawn before ejaculation.
  
• ◑ Any sexual activity that draws blood from the genital area or breaks or chafes the skin.
  
• ◑ Putting the fingers (aggressively), hand or object into the vagina or rectum before, during or after sexual intercourse. This may damage the lining of the vagina or rectum and increases the risk of STD/HIV transmission.
  

Low-risk sex

Little or no risk of STD or HIV transmission:

• ◑ Oral/genital contact. The risk is increased if the woman is menstruating or the man ejaculates into his partner’s mouth.
  
• ◑ Oral/anal contact. Infections such as gonorrhoea can be passed on in this way.
  
• ◑ Sharing ‘sex toys’.
  
• ◑ Putting one or more fingers (gently) into the vagina or anus.
  

Very-low-risk sex

Minimal transfer of body fluids:

• ◑ Penis/body contact or vagina/body contact.
  
• ◑ Mutual or group masturbation.
  
• ◑ Sex toys used with, but not shared with, a partner.
  
• ◑ Urination in sex.
  

No-risk sex

No transfer of body fluids:

• ◑ Masturbation on your own.
  
• ◑ Sex toys used on your own and not before vaginal or anal intercourse.
  
• ◑ Touching or massaging, not in the genital/anal area.
  
• ◑ Bondage or beating. Breaking the skin increases the risk.
  

AIDS

Acquired immune deficiency syndrome is not a single disease, but a group of infections and cancers caused by HIV (human immunodeficiency virus). AIDS has an extremely high fatality rote, but the number of people infected with the HIV virus who go on to develop the condition is statistically very low. HIV is believed to be a life-long infection, which can manifest in a variety of ways—from no symptoms at all to severe damage to the immune system. This means that the body has only limited protection from the diseases and infections it may come into contact with.

SYMPTOMS
Minor symptoms of HIV infection include inflamed skin, particularly on the face, rapid weight loss, diarrhoea, fever and oral condidiasis (thrush). Diseases that tend to be more acute in HIV-infected patients include shingles, tuberculosis and herpes simplex infections. The brain may also be affected, causing disorders like dementia. Fullblown AIDS includes various cancers, diseases of the immune system, pneumonia, diarrhoea, candidiasis and chronic or persistent herpes simplex.

ACTION
Diagnosis for AIDS is based on a positive result to an HIV test (note that there is no such thing as an ‘AIDS test’), along with the presence of characteristic infections and tumours. So far, there is no cure or vaccination against the disease, although research continues. According to the form their illness takes, patients respond in varying degrees to antibiotic drugs, antiviral drugs, anticancer drugs and radiotherapy.

REMEMBER
The most useful treatment for anybody with HIV infection or AIDS is practical help with their everyday lives, if and when they need it, and reassurance and companionship. Bear in mind that it is the person with AIDS who is in danger—infections such as measles and chicken pox have serious consequences because of the deficient immune system. Normal non-sexual human contact poses NO risk to the non-infected person.

AVOIDING AIDS
There are only three ways‘ to contract HIV infection:

• ■ Sexual contact, especially unprotected vaginal and anal intercourse. Not all sexual activities carry a risk.
  
• ■ Mother to baby, before and perhaps during childbirth. Very rarely, HIV antibodies can be transmitted by breastfeeding.
  
• ■ Shared needles and syringes. This includes sharing needles to inject drugs, use of medical equipment for more than sue patient and, in rare cases, the re-use of acupuncture, tattooing and body-piercing needles without proper sterilization.
  

In the past, HIV is known to have been transmitted through blood transfusions, and blood products to treat haemophiliacs. Today, all donated blood, semen and organs are meticulously screened for HIV and any othe infections and blood products are heat-treated. Nevertheless, people in high-risk groups should NOT donate blood, semen or organs such as kidneys.

REMEMBER
The HIV virus is not transmitted through insect bites, coughing or sneezing, cuddling, dry kissing, mouth-to-mouth resuscitation, nor by sharing lavatory seats and household utensils, such as drinking glasses, crockery and cutlery.

HIGH-RISK GROUPS
People most at risk of contracting HIV infection are:

• ■ Promiscuous men and women, particularly if they have numerous sexual partners without using condoms.
  
• ■ Men and women who believe they are not at risk and have casual sexual intercourse without using condoms.
  
• ■ Prostitutes, and their clients, if they do not use condoms.
  
• ■ Subsequent partners of both of the above.
  
• ■ Intravenous drug users and their partners (male or female).
  
• ■ Bisexual or homosexual men and their partners, if they have causal sexual intercourse without using condoms.
  
• ■ Hospital patients who receive unscreened blood transfusions or blood products—including haemophiliacs—although treatment of blood and blood products should now rule this out.
  
• ■ People who undergo surgery in some Third World countries, where equipment may be scarce and must be re-used.
  
• ■ People who have unprotected casual sex in areas where there is a very high incidence of HIV infection, such as central Africa and Haiti (and most major cities).
  

REMEMBER
Anyone who thinks they may have been exposed to HIV can request a blood test. However, it would be wise to obtain counselling to determine whether you really need to have the test done and how to prepare yourself for the news of a positive result. Also bear in mind that you may have to wait
at least
three days (perhaps a lot longer) for the result.

Because the HIV virus takes time to manifest itself in a detectable form, someone who has only recently come into contact with the disease may have a negative result in an HIV test and consider themselves free of the disease—but they may be positive. Those in high-risk groups should follow a negative result with another test about six months later. Some people who are HIV positive do not develop full-blown AIDS for several years—others remain HIV positive, but do not go on to develop AIDS.

If you are HIV positive or have AIDS, you will have to be monitored every three months or so to check that the T-cells (the helper white blood cells) are at o safe level. You can help to keep the number of T-cells high by eating well, exercising and making sure that you get plenty of rest. For practical help, advice and friendship contact your local AIDS help group.

CANDIDIASIS

Also known as thrush. A fungal infection caused by
Candida albicans.
It affects moist body tissues such as mucous membranes, especially in the vagina but also penis, anus or mouth. Candidiasis, as an STD, is transmitted by sexual contact with an infected person. When antibiotic drugs are taken or when the body’s resistance to infection is lowered (after or during a serious illness, for example), the fungus may multiply rapidly.
Candida albicans
is usually found in moist body tissue—it’s only when it gets out of control that a problem develops. It can also spread from one moist body area to another and can sometimes affect the gastrointestinal tract.

SYMPTOMS Vaginal candidiasis
commonly appears as a thick white discharge that takes the appearance of cottage cheese. May be accompanied by itching and discomfort on passing urine, although some women have no such symptoms.
Penile candidiasis
is quite rare, and is more likely to infect an uncircumcised penis, causing inflammation and soreness under the foreskin.
Oral candidiasis
may appear as creamy-yellow sensitive patches anywhere in the mouth.
In babies
candidiasis takes the form of an irritating rash with white flaky patches in the general nappy area.

ACTION
Seek medical attention. Vaginal pessaries or creams containing anti-fungal drugs are usually required. These should be applied to the affected a reas as directed. It is recommended that sexual partners are treated at the same time, to prevent reinfection. Women who suffer repetitive bouts and who take oral contraception should consider changing to another, non-hormonal type. Oral candidiasis should be treated with a special mouthwash. In most cases, condidiasis is relieved or ‘cured’ very quickly and simply, but tends to return. Areas prone to infection should be kept clean and dry.

CYSTITIS

By no means classed as an STD, but may be linked to infections caused by sexual intercourse—or may be mistaken for an STD. An inflammation of the lining of the bladder, usually caused by bacterial infection. In women, bruising of the urethra caused by overenthusiastic intercourse can also lead to cystitis. Recent research has cast doubt on the safety of vaginal deodorants and bubble-baths. Both may lead to irritation and cystitis. Links are being explored with bladder cancer.

SYMPTOMS
Burning or stinging pain when passing urine, frequent urge to pass urine but with only small amounts passed, cloudy or bloody urine, chills, fever and nagging pain in the lower abdomen.

ACTION
Seek medical attention. Drink large quantities of water to flush out the bladder, but not excessively to the point where you feel ill. Drinking water with a teaspoon of sodium bicarbonate about four times a day will increase the alkalinity of the urine—anyone with high blood pressure or heart trouble should consult their doctor first. Painkillers may help, but do not take over-the-counter remedies for more than 48 hours. If symptoms persist seek medical assistance again, as cystitis may spread to the kidneys. Pregnant women are particularly at risk from kidney infections. Prompt treatment with antibiotic drugs will usually settle the infection within 24 hours.

REMEMBER
Women who have repeated attacks of cystitis should urinate as soon as possible after sexual intercourse. Sometimes similar symptoms may be caused by a sexually-transmitted infection—if you have had a recent change of sexual partner or if your partner develops similar symptoms, see your doctor or visit an STD clinic.