By my second year of residency, I’d begun to notice a disturbing pattern on the A side: During practically every shift, I was diagnosing or treating at least one patient with a sexually transmitted infection. Gonorrhea. Syphilis. Genital warts. Chlamydia. Herpes. And more.
One day I knocked on A3 and entered to find an attractive twenty-five-year-old woman named Danielle. She looked so serene sitting on the examining room table in a bright yellow hospital gown. Her almond-colored face wore a slight smile. Her chart told me part of the story. The rest was left to her mother, Mary Rogers, a chatty, dignified woman who appeared to be in her late fifties. Mrs. Rogers was a retired fourth grade teacher who had worked thirty years in the school system before leaving the classroom to take care of her only child.
“Dr. Davis, I love children,” Mrs. Rogers said soon after our introductions. “I told Danielle to get married and have as many as possible.”
A flash of pain crossed the mother’s face. She stared longingly at her daughter, a younger version of herself, sitting a few feet away, wearing a sweet, clueless smile. Danielle no longer remembered the life she once had. She’d forgotten her job as an assistant communications specialist in the U.S. Army. She’d forgotten her many friends, her apartment address, and her cell phone number. She’d even forgotten the love of her life, the man who’d infected her with genital herpes. When the symptoms appeared, Danielle must have been terrified—so terrified that she didn’t go to the doctor right away. That allowed the virus to progress into a rare, aggressive form called “herpes encephalitis,” which had invaded her brain and destroyed the cells responsible for behavior and memory. By the time Danielle finally sought help, the virus had already begun the destruction that would leave her with the mental capacity of a child, and the damage was irreversible. Mary Rogers had dedicated herself to serving not only as her daughter’s caretaker but as her living, breathing scrapbook.
“Danielle was an ambitious, outgoing young lady with a bright future,” Mrs. Rogers said, suddenly beaming. “She was employee of the month three separate times. She led Bible study every Saturday morning. She only missed one Saturday, and that was to come be with me after I had surgery.”
It seemed important to Mrs. Rogers that I knew her daughter had been a good girl, that she hadn’t always been sick. I nodded and smiled, trying to imagine the vibrant young woman Danielle used to be, but I could think only of what this tragedy had wrought. The nervous system, including the brain, is the body’s hard drive, and damage to it can quickly shut down primary functions, like walking, talking, or thinking. The damage is often debilitating and permanent. For Danielle, there would be no more nights out with the girls, no more job promotions, no wedding, no children. She would have to live the rest of her days trapped in childhood, without the innocence, the fun, or the hope. Unprotected sex had cost her much of her future and had altered her mother’s life as well. If only Danielle had protected herself, if only she had gone to a doctor when the first blisters and swelling appeared, but it was too late for that now. All I could do was treat the symptoms that had brought her to the emergency room that afternoon. I glanced down at the form the triage nurse had prepared and asked Mrs. Rogers about Danielle’s fever.
“She felt warm to me,” her mother said. “And when I took her temperature, it was high. Her doctor always told me to bring Danielle to the hospital if she has a fever or isn’t acting her normal self. Since her disease, she isn’t as reliable with how she feels. Most of the time, I have to guess what’s wrong with her … Danielle used to be so independent. Even as a child she wanted to find her own way. I remember she would pick out her clothes for daycare when she was three. She always wanted to wear her pink rubber boots, with any outfit at all.”
As with my pediatric cases, I had to rely fully on Mrs. Rogers’s description of Danielle’s symptoms to come up with a game plan. The fever had lasted a couple of days so far, and Danielle, who didn’t eat much on a normal day, now ate nothing at all.
I kept probing: “Anything else going on—any vomiting, diarrhea, cough, congestion?”
“Well, she has been pointing to her bladder area, saying it burns,” Mrs. Rogers said. “I’ve noticed she moans when she goes to the bathroom. There also seems to be a strange smell to her urine, which is new.”
It sounded like a bladder infection. I explained to Mrs. Rogers that I was ordering blood work and a urine sample to be sure. Usually, that would have been my signal to move on to the next patient. In emergency medicine, there’s little time to linger, because a new crisis is always waiting. But I pushed aside the hurried feeling in my gut and stood there, in awe of this mother’s dedication. I sensed, too, that she needed a sympathetic, non-judgmental ear.
Doctors had recommended an assisted living center for Danielle, Mrs. Rogers said. But no way would she put her baby girl in some wretched place, where people might not take care of her. Mrs. Rogers reminded me a bit of my own mother, who had been protective in that way, too, when my older sister Fellease got sick.
I was in college when I figured out Fellease had AIDS. Back then, the early nineties, it was still largely viewed among African Americans as a gay white man’s disease (even though the statistics were beginning to tell another story), and there were plenty of examples in the news of victims who were ostracized and mistreated. The not-so-subtle message was: If you had AIDS or knew someone who did, you didn’t talk about it. But turning her back on anyone in a crisis has never been part of my mother’s makeup, especially not her own flesh and blood.
Once, when growing up, I counted fourteen people living under our roof, that small two-bedroom house with just one and a half bathrooms. All around me were sisters, brothers, nieces, nephews, uncles, cousins, in-laws, and close friends, all struggling in some way—either through unemployment, marital issues, drug addiction, or alcoholism—and in need of a place to stay until they could get on their feet. At night, I’d see Moms tossing pillows and bed linens into every open space in the house, even the dining room. Likewise, she ignored relatives or friends who wondered aloud whether you could catch “the AIDS” from a toilet seat or a clean spoon or fork that hadn’t been sterilized in bleach. Her baby girl was welcome, sick or not, and if people had a problem with that, they need not visit.
Fel was a crack addict who moved from place to place, but Moms cooked for her every day, in case my sister swooped in and wanted to eat. Moms also knew right away who the culprit was when things of value suddenly began disappearing from the house. Though my mother fussed and cussed about it, she never shut her doors to her child. I’d see the worry all over Moms’s face when Fel mysteriously disappeared for days at a time.
As for me, I worried about my mother almost as much as I did about my big sister. And it was Moms’s strain I saw in Mrs. Rogers’s face. The puffy, dark circles underneath her eyes announced clearly that she wasn’t getting enough rest.
“Mrs. Rogers, all this must be hard for you,” I said, acknowledging that I saw her suffering, too. She nodded, and tears pooled in her eyes.
“She was in love,” Mrs. Rogers said, as though she could still hardly believe it all. “The boyfriend left as soon as he realized what happened. I called his family, but there wasn’t much I could do.”
Her daughter had been planning to wear her mother’s wedding gown when she walked down the aisle. “If her father was alive today, I know Eddie would beat that boy’s behind,” Mrs. Rogers said. “Look at my poor baby. Never did I plan on this. What mother could plan for this?”
I absorbed her heartbreaking words, letting her talk.
Danielle had been a military brat. The family had traveled the world with Eddie, who’d been a soldier in the U.S. Army. “She wanted to be just like her daddy. That’s all she talked about,” Mrs. Rogers said.
Danielle loved the uniforms, the stripes, the decorum of the army, and as early as high school, she began mapping out a plan for her military future. She enlisted right after her high school graduation, determined to make a career in the U.S. Army, and was well on her way. Sadness and resignation seemed to settle on the mother’s face when she got to this part of the story. It wasn’t supposed to end there. Mrs. Rogers grew quiet.
“I’m so sorry about what happened to your daughter,” I said.
She thanked me. I handed her the urine cup and pointed the way to the bathroom. “The nurse will be in when you get back.”
Within an hour, I had the test results and returned to the room to talk to Mrs. Rogers. Danielle indeed had a bladder infection, I told her. I explained that I was prescribing a regimen of antibiotics that Danielle would have to take twice a day for seven days, but that the two of them should follow up with Danielle’s doctor. The mother seemed relieved by the diagnosis; at least her daughter would soon be out of this particular misery. I wished I could have done more than just treat the bladder infection, but the damage had already been done.
No way should Mrs. Rogers have been taking care of her daughter a second time around. While herpes encephalitis is extremely rare, it can be devastating to those it attacks. I wished in that moment that I could show Danielle’s face and share her story with every young lady out there making bad decisions about sex, often in an empty quest for love and validation—especially African Americans. They’re not the only ones having unprotected sex, of course, or the only ones contracting sexually transmitted infections. But the prevalence of these diseases among black women has been disproportionately high.
Educators report that sexual activity, from oral sex to intercourse, is beginning as early as middle school. My guess is that African American females are no more promiscuous than their peers of other races, but they do, unfortunately, have less access to good healthcare—nearly one-fifth of African Americans have no health insurance, statistics show—sex education, and reliable information, and thus are suffering more.
A study conducted by Dr. Sami Gottlieb, M.D., at the University of Colorado in Denver, showed in the mid-1990s that African American women were at a higher risk than any other group for infection with herpes simplex virus type 2, the most common type of herpes. It was one of the largest studies of its kind, involving questionnaires and blood tests from more than 4,000 people who visited STI clinics in five cities, including Newark, between July 1993 and September 1996.
Most times, when I asked the young women I treated why they didn’t insist on a condom, they said they thought they could trust their partner. It never seemed to occur to them that their partner might not have known he was infected—or worse, just didn’t care. I’ve seen that, too, like the two teenage boys who showed up in the E.R. together one evening for treatment. Both were experiencing penile discharge, and they laughed when I told them they had contracted an STI from their sexual encounter—presumably, from their banter, the same girl. There seemed to be a weird man-code thing going on, because they asked to be treated together. Then, as if it was some kind of honor, they smacked each other high fives when the nurse appeared with a needle and syringe to administer the antibiotic. I told them their partner needed to be notified so she could be treated, too, but they shrugged it off. Their response angered me.
“What if this was your mother or sister?” I asked, hoping that might get through to them.
Smirking, one of the teens responded: “Please, Doc. That ain’t my problem.”
I thought of my own sister and felt a strong urge to smack both of them. I left the room wanting to run to the hospital rooftop with a megaphone, yelling to the young women in my community: “Take control of your own sexuality! Protect yourselves! You’re suffering, dying needlessly!”
Surveillance reports from the Centers for Disease Control and Prevention show significant racial disparities in the rates of sexually transmitted infections. It is worth noting that the source of the CDC’s data is local and state health departments, which tend to base their reports on information from public health clinics. Since such clinics are used more often by minorities than whites, the differences in rates may be skewed. But other population-based surveys also confirm striking racial disparities. The point is, there’s much work to do in convincing young men and women of color that this is a crisis that doesn’t have to be, that they have the power to protect themselves and their partners. Here are the facts:
• In 2010, the rate of chlamydia among black females ages fifteen to nineteen was nearly seven times the rate of white females in the same age group; the rate among black women ages twenty to twenty-four was more than five times the rate of white women the same age; the rate among black males ages fifteen to nineteen was thirteen times that of their white peers; for black men ages twenty to twenty-four the rate was almost eight times that of white men the same age. Among Hispanics, the rate was three times that of whites; for Native Americans and Alaska natives, four times.
• In 2010, 69 percent of all reported cases of gonorrhea occurred among blacks. The rate of gonorrhea among blacks was nearly nineteen times that of whites. For black men, the rate was twenty-two times higher than that of their white peers; for black women, sixteen times. The rate among Hispanics was two times that of whites; for Native Americans and Alaska natives, nearly five times.
• In 2010, the rate of syphilis among black men was seven times the rate of white men; the rate among black women, twenty-one times that of white women. The rate for Hispanics was two times the rate for whites.
• Despite making up only about 14 percent of the U.S. population in 2009, African Americans accounted for 44 percent of new HIV infections that year.
• Compared with other races and ethnicities, African Americans account for a higher proportion of HIV infections at all stages of the disease—from new infections to deaths.
By the end of 2000, my sister Fellease’s health had begun a rapid decline. I’d watched AIDS whittle her down from a robust 160 pounds to less than a hundred, mere skin and bones for a woman her height. She’d lost her teeth and developed vitiligo, white blotches like bleach stains all over her cinnamon-colored skin. Through it all, though, she never lost her zest for life—or her smile.
“I’m still pretty,” she’d say, flashing that big, toothless grin at me, even as AIDS was ravaging her once beautiful face and frame.
“We’re twins.”
Actually, fourteen years separated us. But of my five brothers and sisters, I was closest to her. I was the baby boy Fel never had. When I was growing up, she helped take care of me, bought me treats on demand, and talked the belt out of my parents’ hands many times after I’d misbehaved. She was the cool big sister who kept me up on all the latest music and dances and even covered for me a time or two when I was hanging out somewhere I shouldn’t have been. She always tried to tell me the right thing to do, even when we both knew she didn’t make the best choices herself. When I heard the police were looking for me after I’d been involved with the robbery in my senior year of high school, I called Fel. Terrified that I’d probably just blown any shot at a real future, I anguished over whether I should turn myself in.
“We’ll figure something out,” Fel assured me. She drove me to the police station and talked mightily, trying to persuade the officers to release me into her care since I was a juvenile. Even though they took me into custody anyway, I never doubted that turning myself in that day was the right thing to do.
Fel had dropped out of high school to get married. She then divorced, remarried, and moved to Hawaii with her new husband, who was in the army. There she earned a high school equivalency diploma. Unfortunately, that marriage didn’t last either. I was in the ninth grade when she returned to Newark, got a job, and lived at home on and off. The two of us grew even closer, staying up together many late nights, talking about life and playing board games.
But the streets had already started to claim her. In her room at our parents’ house, I once discovered a burnt spoon and a tiny nip bottle of Bacardi rum that she had transformed into a crack pipe. I never told a soul, but it confirmed what I’d suspected: She was a crack addict. I just kept hoping she’d turn her life around, get a stable job again, find a great guy, have kids. Instead, she became more unreliable and unstable, moving from job to job, living here and there, and disappointing Moms and me again and again. When I discovered one day that money I’d been saving from my part-time job to repair my used car was missing from its hiding spot at home, I confronted Fel. She denied stealing it and denied using drugs, but I knew she was lying. Exasperated, I didn’t speak to her for weeks.
Fel wasn’t an IV drug user, but she was involved with men who were, and one of them undoubtedly infected her during sex. Maybe she didn’t think her man needed to use a condom because she trusted him, as so many women claim. Or maybe, as an addict, she was just doing what it took to get the next high, and safety was the least of her concerns. But anytime you make the choice to practice unsafe sex, you’re vulnerable; you’re taking the risk of sharing whatever infections and diseases your partners and your partners’ partners may have.
Fel didn’t look sick right away; oddly, her hair texture was the first noticeable change. It became suddenly fine and silky. In the hood, the sudden emergence of “good hair” on a person with risky behaviors is suspect.
“She’s got the package,” we’d say, talking in code about one woman or another we suspected was infected with AIDS. Yet, despite the many times we said and heard that, it never occurred to us that AIDS had taken a deadly turn into urban communities. Poor black folks were dying at rates that nearly rivaled that of gay men when the disease first struck, and black women were being hit disproportionately hard. By 2001, AIDS had become the leading cause of death for African American women ages twenty-five to thirty-four, according to the Centers for Disease Control and Prevention, and most of them were being infected through sex with men who had been IV drug users or had sexual encounters with other men.
Fel denied my suspicion about her illness, just like she’d denied the theft and her drug use. I hinted one day that she had “that good hair,” and she knew instantly what I meant. She snapped back that she didn’t have “no HIV.” But time revealed the truth. Back in the early 1990s, before drug cocktails made AIDS more of a terrible chronic illness than a death sentence, the virus killed slowly. Its victims had a certain look: emaciated bodies, sunken eyes, and sometimes even distinctive lesions. They were like walking ghosts with the dreaded “A” on their foreheads. In medical school, I’d fantasized about finding a cure. I wanted to save my sister, and it hurt deeply that I couldn’t.
Just three months after I began my residency at Beth Israel, Fel started showing up in the E.R. with various AIDS-related ailments. She was loud and brash, demanding that the hospital staff bring Dr. Davis, her little brother, to her side. My colleagues thought it was a joke, that she was just another patient from the neighborhood claiming to be related to me to get quicker service, which sometimes happened. Surely, I could practically hear them thinking, Dr. Davis doesn’t have a sister like that. For most of the doctors and nurses, Newark was just where they worked. But for me, it was home, and those people were my mother, my sister, my cousins, my friends. Moms had shown me that you just don’t turn your back on your people. And when I looked at Fel with that silly, toothless grin, what could I do but claim her, love her?
There were days, though, when I just couldn’t tolerate what my sister was doing to herself, and I had let her know it. One evening I was driving her and Moms home from a shopping trip when Fel kept nodding off to sleep. By then, she was gravely ill, but it was obvious to me that she was currently high. She’d slipped off to get her fix and didn’t even care that our mother once again had to witness the aftereffects. I reached over to the passenger side, where Fel sat, and squeezed her hand, hard.
“I want you to wake up right now, or I’m kicking you the hell out of my car!” I demanded, as she struggled to crack her eyes. “You need to cut this shit out!”
After that, she disappeared for a few days, the way she often did when she knew she’d let her family down. Eventually, though, I quit fussing about the drugs and her lifestyle. I stopped trying to be the know-it-all doctor full of advice and warnings about what could happen if she didn’t stop this or that. I tried to focus on just being baby bro, grateful for whatever time the two of us had left. This way, practically every time I saw her, she was her usual, cheery self. And this was the Fel I wanted to remember.
Beneath her smile, I knew she was really scared. She grew weaker with every bout of sickness, eventually not bouncing back as quickly. Sometimes, she would hug me as though she were trying to squeeze the life out of me, right into her own body.
“Marshall, I don’t want to die,” she’d say, holding me tighter than seemed possible for someone so frail. “I don’t want to die!”
I hugged her back, wishing I could offer some assurance. But I braced myself for what I knew would soon come.
In fall 2001, Fellease developed an intestinal infection, which caused a bowel obstruction. Once again, she was admitted to Beth Israel, where she had surgery to remove part of her intestine. She never fully recovered from that, and soon landed at St. Michael’s Medical Center, one of three major hospitals in Newark.
One of their emergency room doctors buzzed me on my cell the afternoon of October 13. Fellease was critical, he said, and the family needed to get there right away. I was in my third year of residency and had made that call to families more times than I could count. I knew automatically what it meant: My big sister was either close to death or already gone. As a doctor, you don’t want to deliver such devastating news over the phone, so you say just enough to get the family there. This time, I was on the other side.
Hang on, Fel, please, hang on. That’s all I could think as I dashed the few miles from my place to my mother’s house and then sped with her and my brother Carlton to the hospital. The ride was so quiet, it felt like all three of us were holding our breaths. When we arrived, I told the security guard in the emergency department waiting room that we’d received a call telling us to come. A nurse suddenly appeared to escort us to Fellease’s room. She paused outside the door and broke the news: My sister had gone into cardiac arrest about an hour earlier, and the medical staff had been unable to revive her.
I took a deep breath, trying to prepare myself mentally to walk into that room.
“I’m sorry for your loss,” the nurse said softly.
Even when you’ve said those words to others a million times, nothing can prepare you to hear them yourself. They made my knees weak. I hadn’t had a chance to say good-bye. My heart ached as I took my mother’s hand and moved quietly with her and Carlton to Fel’s bedside. A breathing tube still hung limply from Fel’s mouth, and her eyes were partially open. The doctor in me leaned over and gently pressed her eyelids shut. The little brother wept.
“Rest in peace,” I whispered, wiping away my tears.
Tears streamed from Moms’s eyes as she stroked Fel’s thin hair. I could only imagine the magnitude of her grief. A parent isn’t supposed to bury a child. No matter the circumstances, losing one must feel like losing part of your future. Carlton touched Fel’s arm. I wrapped my fingers around her cold hand, and for a few moments, the three of us stood there silently, each with our private thoughts and tears.
Fel was just forty-two. I couldn’t help thinking: This didn’t have to be. She didn’t have to die this way.
I tried to conjure up the sound of her voice and the sight of her smile before they were changed by AIDS. I thought about the many times she’d breathed life back into my hopes and dreams when I’d felt deflated, wanting so badly to quit during medical school. Now standing at her deathbed, I wanted to be a miracle worker and do the same for her, bring her back, healthy and whole. But all that anybody could do had been done.
Throughout her life, Fel had been my muse. In death, she is that once again. It is her face I see when I read the dreadful statistics. And it is her loss I feel when I tell young brothers and sisters: “Wrap your stuff up. Protect yourselves. One moment of passion isn’t worth the risk of losing your life.”
The surest way to avoid transmission of STIs is to abstain from sexual contact or to be in a long-term, mutually monogamous relationship with a partner who has been tested and is known to be uninfected. Latex male condoms, when used consistently and correctly, can reduce the risk of transmission.
The most frequently reported bacterial sexually transmitted infection in the United States.
Symptoms: Usually absent or mild and may appear within one to three weeks after exposure; they include abnormal vaginal or penile discharge, burning sensation during urination, lower abdominal pain, low back pain, nausea, fever, painful intercourse, bleeding between menstrual periods, rectal pain, rectal discharge, or rectal bleeding.
Treatment: Antibiotics
A sexually transmitted infection caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2); HSV-2 causes most genital herpes.
Symptoms: Minimal or none, but can appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. May include a second crop of sores and flu-like symptoms, including fever and swollen glands.
Treatment: No cure, but antiviral medications can shorten and prevent outbreaks. Daily suppressive therapy for symptomatic herpes can reduce transmission to partners.
Health Concerns: First episode can produce several (typically four or five) outbreaks (symptomatic recurrences) within a year, but the recurrences usually decrease in frequency over time. Can cause recurrent painful genital sores in many adults, and herpes infection can be severe in people with suppressed immune systems. Frequently causes psychological distress in those who know they are infected. Can lead to potentially fatal infections in babies. In rare cases, the herpes virus can enter the brain and cause encephalitis, an extremely rare but serious brain disease.
A very common infection caused by a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract.
Symptoms: No symptoms for most women and some men, but when they do appear: burning sensation during urination; penile discharge that is white, yellow, or green; swollen and painful testicles; increased vaginal discharge or vaginal bleeding between periods; rectal itching; rectal soreness; rectal bleeding; painful bowel movements; sore throat.
Treatment: Antibiotics
Health Concerns: If untreated in women, it may cause reproductive problems; in men, it can cause epididymitis, a painful condition of the ducts attached to the testicles that may lead to infertility. Can spread to the blood or joints, which can become life-threatening. Can be passed from an infected pregnant woman to her baby, where it can cause blindness, joint infection, or a life-threatening blood infection.
HIV damages a person’s body by destroying specific blood cells that are crucial to helping the body fight diseases. AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases, including certain cancers.
Symptoms: None, or flu-like symptoms within a few weeks of infection.
Treatment: Current combinations of medications can limit or slow down the destruction of the immune system and improve the health of people living with HIV, and may reduce their ability to transmit the virus. Most common HIV tests use blood to detect infection. Tests using saliva or urine are also available. Some tests take a few days for results, but there are also rapid HIV tests that can give results in about twenty minutes. Positive HIV tests must be followed up by a second test to confirm the positive result, a process that can take a few days to a few weeks.
Health Concerns: Early HIV infection is associated with many diseases, including cardiovascular disease, kidney disease, liver disease, and cancer.
The most common sexually transmitted infection.
Symptoms: None
Treatment: None for the virus itself, but there are treatments for the diseases that HPV can cause. Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer. The vaccines are given in three shots. For best protection, it’s important to take all three doses. The vaccines are most effective when received at eleven or twelve years of age. Talk to a doctor about the appropriate one.
Health Concerns: In 90 percent of cases, the body’s immune system clears HPV naturally within two years. If not cleared, can cause: genital warts, throat warts (respiratory papillomatosis), cervical cancer, or other less common cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat, including base of tongue and tonsils).
Refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus), and other reproductive organs.
Symptoms: Subtle or none; or lower abdominal pain, fever, bleeding, and pain in the right upper abdomen (rare).
Treatment: Antibiotics
Women who douche may have a higher risk of developing PID, compared with women who do not. Douching changes the vaginal flora (organisms that live in the vagina) in harmful ways, and can force bacteria from the vagina into the upper reproductive organs. Women who have an intrauterine device (IUD) may have a slightly increased risk of PID near the time of insertion, compared with women using other contraceptives or no contraceptive at all. Risk is greatly reduced if a woman is tested and, if necessary, treated for STIs before an IUD is inserted.
Health Concerns: Can damage the fallopian tubes and tissues in and near the uterus and ovaries and lead to serious consequences, including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and chronic pelvic pain.
Bacterial infection that is often called “the great imitator” because so many of its signs and symptoms are indistinguishable from those of other diseases.
Symptoms: Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. May present no symptoms for years, yet sufferers remain at risk for late complications if they are not treated. Also may include paralysis, numbness, gradual blindness, dementia, difficulty coordinating muscle movements, or death.
The primary stage is usually marked by the appearance of a single sore (called a “chancre”), but there may be multiple sores. The time between infection and the start of the first symptom can range from ten to ninety days (average twenty-one days).
Skin rash and mucous membrane lesions characterize the secondary stage, which typically starts with the development of a rash on one or more areas of the body. The typical secondary syphilis rash appears as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. But rashes with a different appearance may occur on other parts of the body. Other symptoms include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment the infection will progress to the latent (hidden) and possibly late stages of the disease.
Treatment: A single intramuscular injection of penicillin, an antibiotic, if infection is less than a year. Additional doses are needed for someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available for treatment.
Health Concerns: In the late stages, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.
Common infection caused by a protozoan parasite.
Symptoms: None; itching or irritation inside the penis, burning after urination or ejaculation, discharge from penis; itching, burning, redness, or soreness of female genitals, discomfort with urination, thin discharge with unusual smell, uncomfortable sex.
Treatment: Laboratory test needed for diagnosis; can sometimes be cured with a single dose of prescription antibiotics.
Health Concerns: Preterm delivery in pregnant women.
Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.+cdc.+gov/+std
Order Publication Online at www.+cdc.+gov/+std/+pubs
CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
Email: cdcinfo@cdc.gov
Source: The Centers for Disease Control and Prevention’s Division of STD Prevention