Sexually transmitted diseases & women's health.When Karen Engle,* then 25, went for a Pap smear Pap smear or Papanicolaou smear Sample of cells from the vagina and cervix of the uterus for laboratory staining and examination to detect genital herpes and early-stage cancer, especially of the cervix. Developed by the Greek-born U.S. in 1999, it had been two years since she'd had the routine test. The Seattle woman figured she didn't need one, since she hadn't been sexually active during that time. Now, after meeting the man she would eventually marry, she was in her doctor's office for a routine exam and birth control pill birth control pill n. See oral contraceptive. birth control pill Oral contraceptive, see there prescription. But when the results of her Pap came back, she was shocked. Ms. Engle learned she had a highly advanced stage of cervical dysplasia Cervical dysplasia Dysplasia is the abnormal growth of the epithelial cells. This is what a Pap smear will detect in the cervix. Mentioned in: Pelvic Exam cervical dysplasia -- a precursor to cervical cancer Cervical Cancer Definition Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. . The cause: Human papillomavirus human papillomavirus (HPV), any of a family of more than 60 viruses that cause various growths, including plantar warts and genital warts, a sexually transmitted disease. Detectable warts can be or removed, usually by chemicals, freezing, or laser, but often recur. infection (HPV HPV human papillomavirus. HPV abbr. human papilloma virus Human papilloma virus (HPV) ), a sexually transmitted disease sexually transmitted disease (STD) or venereal disease, term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, . Karen had never heard of the virus -- let alone the fact that it could cause cancer. Her condition was so severe, she required laser surgery to the inside and outside of her vagina, labia and cervix. She wound up hospitalized for a week as a result of laser burns, and today, 12 years later, still has substantial scarring in the floor of her vagina, making intercourse between her and her husband nearly impossible. Even worse, she says, "I worry constantly that the virus will come back and I'll have to have yet another round of surgery. My Pap smears have yet to go back to normal after 12 years. Moreover, the stigma of having an STD (Subscriber Trunk Dialing) Long distance dialing outside of the U.S. that does not require operator intervention. STD prefix codes are required and billing is based on call units, which are a fixed amount of money in the currency of that country. has made it difficult for me to talk about it even with my friends." And it makes her angry that although HPV affects nearly one in four women on college campuses (and more than five million people each year), it is still not publicly discussed. Yet HPV is the one of the most common sexually transmitted diseases Sexually transmitted diseases Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely in the U.S., second only to herpes. It causes nearly all cases of cervical cancer and, therefore, is directly linked to the 4,400 women who die of the disease each year. (1) Even more alarming: a recent study found that HPV infection may occur during a woman's very first sexual experience. (2) The virus' very prevalence, and the difficulty in avoiding it (even condoms are not wholly effective in protecting against HPV), led researchers in that study to conclude that "perhaps cervical human papillomavirus infection should now be considered an inevitable consequence of sexual activity. Certainly, no stigma should be attached to its acquisition. " (2) That kind of thinking sends shivers down the spines of public health and other medical officials, who are dealing with what they call a hidden epidemic of sexually transmitted diseases--hidden because so many of the diseases, like HPV have no initial symptoms. Hidden also for another reason, says Stuart Berman, MD, who heads the U.S. Centers for Disease Control and Prevention's STD epidemiology and surveillance branch: "All these people are infected, but no one's talking to each other. Partners are not talking to partners, parents are not talking to kids, doctors are not talking to patients and patients are not talking to doctors." An STD Epidemic The STD epidemic is marked by more than 15 million new cases of STDs each year. These include the more common ones, such as HPV, chlamydia chlamydia (kləmĭd`ēə), genus of microorganisms that cause a variety of diseases in humans and other animals. Psittacosis, or parrot fever, caused by the species Chlamydia psittaci, , herpes, hepatitis B Hepatitis B Definition Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic and gonorrhea gonorrhea (gŏnərē`ə), common infectious disease caused by a bacterium (Neisseria gonorrhoeae), involving chiefly the mucous membranes of the genitourinary tract. , as well as syphilis, HLV HLV Heavy Lift Vehicle HLV Hessischen Leichtathletik-Verbandes (German) HLV Heavy Lift Vessel HLV Hasta La Vista HLV HTML Link Validator HLV Human Living Vampire HLV Hazard Limiting Value HLV Helensville and trichomoniasis trichomoniasis (trĭk'əmənī`əsĭs), sexually transmitted disease caused by the parasitic protozoan Trichomonas vaginalis. . (3) "There's a sense that a lot of women are playing Russian roulette with their sexual health," says Beth E. Cheney, RN, MSN (1) (MicroSoft Network) A family of Internet-based services from Microsoft, which includes a search engine, e-mail (Hotmail), instant messaging (Windows Live Messaging) and a general-purpose portal with news, information and shopping (MSN Directory). , CFNP CFNP Certified Family Nurse Practitioner CFNP Community Food and Nutrition Program CFNP Center for Food and Nutrition Policy , a nurse practitioner nurse practitioner n. Abbr. NP A registered nurse with special training for providing primary health care, including many tasks customarily performed by a physician. and the woman's health coordinator at Windham Hospital in Willimantic, CT. Ms Cheney directs the women's health Women's Health Definition Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues. clinic, which serves a high percentage of low-income and minority women. At any one time, one-third to one-half of Ms. Cheney's patients has a sexually transmitted disease. But STDs are by no means limited to any socioeconomic or racial group. Recall the old Time magazine cover that called the viral STD herpes the "VD of the Ivy League." (4) And if you thought AIDS was still a gay man's disease, think again. "About 30 percent of all new infections are among women," says David Landry, MS, senior research associate at The Alan Guttmacher Institute in New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of . Overall, women now account for more than 20 percent of all AIDS cases in the U.S., compared to just 14 percent in 1992. It's also the fifth leading cause of death for women age 25 to 44 and the third leading cause of death for African-American women in this age group. (5) In fact, African-American women have a tougher time with some STDs than Caucasian women. For instance, the rate of gonorrhea in African-American girls between the ages of 15 and 19 is 19 times higher than in Caucasian girls of the same age. (4) Beyond race, however, the group that's most at risk of catching an STD is young women, particularly teenagers. Two thirds of those who contract an STD are 25 or younger. One study found that one in five adolescent girls had an undiagnosed STD. (7) There are two reasons for the high numbers, says Dr. Berman: young girls' sexual habits and their biology. "Young women in general are probably at greater risk because of issues of serial monogamy," he says. That's when you stay with one sexual partner for awhile, then move onto another. Once you ye been with one person a few times, says Ms. Cheney, you begin to think they're "safe" and so may eschew precautions like the condoms you used during your first time with that person. And, as women put marriage further into their future, says Dr. Berman, the "age gap from when you begin menarche menarche /me·nar·che/ (me-nahr´ke) establishment or beginning of the menstrual function.menar´cheal me·nar·che n. The first menstrual period, usually during puberty. [menstruation menstruation, periodic flow of blood and cells from the lining of the uterus in humans and most other primates, occurring about every 28 days in women. Menstruation commences at puberty (usually between age 10 and 17). ] and may become sexually active, to when you get married and your risk of STDs dramatically declines, is the largest we've had in 100 years." Anatomically, says Dr. Berman, young girls have a greater risk of acquiring chlamydia--the second most common STD--because they haven't fully matured. "When women are young, the lining of the uterus is more exposed," he says, providing a bigger target for chlamydial chlamydial pertaining to members of the family Chlamydiaceae. chlamydial abortion abortion in cows, ewes, sows and goat does caused by Chlamydophila abortus and C. pecorum. See enzootic abortion of ewes. infections. As women age, the lining slides back into the uterus and exposure is reduced. Thus, it may take fewer exposures when you're young to actually catch the disease than when you're older, according to Dr. Berman. Long-term Effects of STDs But it's when you're older that chlamydia--and other STDs--can come back to haunt you. With HPV it's cervical cancer. "The issue is not so much getting it, but getting it and having it stay around for long periods of time," says Dr. Berman. Estimates are that more than 50 percent of all women are infected with the virus. The more partners a woman has, he says, the more likely the virus will "catch" and hang around longer after an initial infection. That's why regular Pap smears are so critical, says Thomas C. Wright, Jr., MD, director of GYN GYN abbr. gynecology GYN is short for gynecology–or a gynecologist Pathology, College of Physicians and Surgeons College of Physicians and Surgeons: see Columbia Univ. at Columbia University in New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. . "We reduce your risk of cervical cancer by well over 90 percent," with regular Paps, he says. "Can you imagine any other public health screening program that reduces risk by 90 percent?" Chlamydia, says Dr. Berman, "is a really nasty thing, because you may not know for 10 years that this infection did something bad to you." Ten to 20 percent of women with chlamydia or gonorrhea develop pelvic inflammatory disease pelvic inflammatory disease (PID), infection of the female reproductive organs, usually resulting from infection with the bacteria that cause chlamydia or gonorrhea. (PID (1) (Process IDentifier) A temporary number assigned by the operating system to a process or service. (2) (Proportional-Integral-Derivative) The most common control methodology in process control. ), which can lead to chronic pelvic pain Women and Pelvic pain Most women (and some men), at some time in their lives, experience pelvic pain. When the condition persists for longer than 3 months, it is called chronic pelvic pain (CPP). , infertility and potentially fatal ectopic pregnancy ectopic pregnancy or extrauterine pregnancy Condition in which a fertilized egg is imbedded outside the uterus (see fertilization). Early on, it may resemble a normal pregnancy, with hormonal changes, amenorrhea, and development of a placenta. . (8) "And," Dr. Berman says, "we're re starting to realize that it may be the infection that you get the second or third time that's most important and most responsible for causing damage to the reproductive system reproductive system, in animals, the anatomical organs concerned with production of offspring. In humans and other mammals the female reproductive system produces the female reproductive cells (the eggs, or ova) and contains an organ in which development of the fetus ." Yet because both chlamydia and gonorrhea are bacterial STDs, they are easily treated with antibiotics, he says, and young girls all too often become reinfected. In fact, the greatest risk factor for getting chlamydia is a previous chlamydia infection. "Young people don't come away appreciating that they ducked a bullet," he says. That bullet may be harder to avoid, at least with gonorrhea. A growing number of cases on the West coast, in Hawaii and in East Asian countries, are resistant to the most common class of antibiotics, fluoroquinolone fluoroquinolone /flu·o·ro·quin·o·lone/ (-kwin´o-lon) any of a subgroup of fluorine-substituted quinolones, having a broader spectrum of activity than nalidixic acid. fluor·o·quin·o·lone n. , used to treat the disease. That resistance is expected to continue spreading eastward across the U.S. STDs for Life Get herpes--a viral infection--and you've got it for life. Just ask Meg *, a 46-year-old mother of two who was infected sometime in her 20s. Twenty years TWENTY YEARS. The lapse of twenty years raises a presumption of certain facts, and after such a time, the party against whom the presumption has been raised, will be required to prove a negative to establish his rights. 2. later, she still gets painful outbreaks when she's stressed--usually on top of terrible PMS (Pantone Matching System) A color matching system that has a unique number assigned to more than 500 different colors and shades. This standard for the printing industry has been built into many graphics and desktop publishing programs to ensure color accuracy. . "You can just imagine how much fun that is," she says. At least Meg knows she has the disease and can avoid sex with her husband when she has an outbreak. Although at least 45 million people in the U.S. have genital herpes Genital Herpes Definition Genital herpes is a sexually transmitted disease caused by a herpes virus. The disease is characterized by the formation of fluid-filled, painful blisters in the genital area. , most haven't been diagnosed. In fact, most genital herpes infections are transmitted by people who don't know Don't know (DK, DKed) "Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party. they have the infection or who don't have symptoms when transmission occurs. (16) That was Meg's situation. "I just assumed the irritations were yeast infections or some other routine female thing," she says. "I have no idea how or from whom I contracted it--or how many people may have contracted it from me." The ultimate risk of HIV--death--is fairly well known. But that doesn't stop sexually active women from taking chances. "Despite the campaigns and efforts to educate people, we're just not getting through, especially to the teen population," says Ms. Cheney. "I think there's just this sense of 'It won't happen to me."' And yet it does. It's estimated that at least half of all new HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. infections in the U.S. are among those under 25. The majority of young people with the virus are infected sexually. (9) Ironically, the AIDS epidemic may, in part, be contributing to the STD epidemic. "Maybe in the wake of the AIDS epidemic people have not come to appreciate just how incredibly complicated these other diseases are," says Dr. Berman, "and that they run a far greater risk of getting them." And that, while STDs may not kill you, they will, by their very prevalence, negatively affect your life, he notes. Pondering Prevention Whenever Alvin F. Goldfarb, MD, professor of obstetrics and gynecology obstetrics and gynecology Medical and surgical specialty concerned with the management of pregnancy and childbirth and with the health of the female reproductive system. at Jefferson Medical College in Philadelphia, sees a teenage girl in his office, he asks her mother to wait outside. Then he quizzes the teenager: Do you have a boyfriend? Are you sexually active? What do you use for birth control? What about STD protection? Then, without question, he screens her for chlamydia and gonorrhea, and conducts a Pap to check for HPV. Then he has an incredibly blunt discussion with her about STDs. "I tell her, 'inspect the merchandise.' Look for pimples on the penis, any discharge." "I believe very strongly in education, and in everyone knowing that they must be respectful of themselves and of anyone they're going to share their body with," he says. Unfortunately, Dr. Goldfarb, who is also the President and CEO (1) (Chief Executive Officer) The highest individual in command of an organization. Typically the president of the company, the CEO reports to the Chairman of the Board. of the Adolescent Wellness and Reproductive Education Foundation (AWARE), which attracts more than 16,000 visitors a month (most of them teens), knows that too few teenagers have someone like him in their life and so have no clue as to how to protect themselves from STDs. Americans overall have misguided notions on how to protect themselves from STDs. In one study of 3,500 STD clinic visitors, nearly half believed douching douching Gynecology The rinsing of the vagina and cervix with water or other solutions; as a contraceptive method, it is essentially useless; because the vagina has a normal acidic environment which is protective, frequent douching is ill-advised protected against STDs, 20 percent thought birth control pills would do it and 16 percent thought washing their genitals after sex was effective. None of these approaches protects against STDs. In fact, irritation caused by douching may increase STD infection risk. (3) And testing for HIV does not prevent the disease, as more than 40 percent of women involved in a New York study believed. (10) Your best bet? Abstinence and properly used latex condoms. The diaphragm may also provide some protection against gonorrhea, chlamydia and trichomoniasis. (16) Within the next few years, however, there may be a host of new weapons to fight STD transmission, including vaccines against chlamydia, HPV, genital herpes, gonorrhea and HIV, (12) and virus- and bacteria-killing gels, foams, creams or films, known collectively as topical microbicides. (13)
STDs At-A-Glance
STD Type
Estimated Prevalence
& Incidence Symptoms
* HPV (viral) Human papillomavirus infection (HPV)
- 20 million people may cause genital warts, but
currently infected generally doesn't cause symptoms.
- 5.5 million new cases HPV infection can lead to cervical,
annually penile and anal cancer. (16)
* Hepatitis B (viral) Symptoms may not occur at first;
- 1.25 million people can cause loss of appetite, abdominal
currently infected discomfort, nausea and vomiting, often
- 140,000 to 320,000 progresses to jaundice. Eventually,
new cases annually may cause liver failure. (1)
* HIV/AIDS (viral) Within 3 to 6 weeks of becoming
- 800,000 to 900,000 infected: fever, joint pain, night
people currently infected sweats, white patches in the mouth and
- 40,000 (14) new cases throat, sore throat and skin rash; half
annually of those infecteds show no symptoms.
Other symptoms related to immune
deficiency may not appear for 10 years
or more
* Herpes Simplex Virus Small red blisters on the vulva, in
(viral) the vagina and cervix that may bleed;
- 45 million people flu-like symptoms. It can also make
currently infected those infected with HIV more
- 1 million new cases infectious. (8) Open lesions may
annually increase the risk of sexual
transmission of HIV.
* Gonorrhea (bacterial) Typically causes no symptoms; may
- estimated number of cause thick, pus-like discharge from
people infected N/A the vagina or urethra, frequent and
- 650,000 new cases painful urination and pelvic pain
annually during vaginal penetration. May
increase risk of sexual transmission
of HIV.
* Chlamydia (bacterial) Typically causes no symptoms; may
- 2 million people cause vaginal discharge, vague lower
currently infected abdominal discomfort and pelvic pain
- 3 million new cases during vaginal penetration May
annually increase risk of sexual transmission
of HIV.
* Syphilis (bacterial) Symptoms include sores that mainly
- estimated number of occur on the external genitals, vagina,
people infected N/A anus or in the rectum, and a skin rash.
- 70,000 new cases Sores also can occur on the lips and
annually in the mouth. Transmission occurs
during vaginal, anal or oral
sex. (2) May increase risk of sexual
transmission of HIV.
* Trichomoniasis (parasitic) Most infected women have an odorous,
- estimated number of yellow-green discharge and irritation
people infected N/A of the vaginal area. (15) May increase
- 5 million new cases risk of sexual transmission of HIV. (8)
annually
STD Type
Estimated Prevalence
& Incidence Treatment
* HPV (viral) External genital warts can
- 20 million people be treated with topical
currently infected medications, but infection
- 5.5 million new cases may not be completely
annually eliminated.
* Hepatitis B (viral) Antiviral medications such
- 1.25 million people as alpha-interferon or
currently infected lamivudine can treat chronic
- 140,000 to 320,000 hepatitis B. (16)
new cases annually
* HIV/AIDS (viral) Treatment can postpone or
- 800,000 to 900,000 prevent the onset of AIDS.
people currently infected Numerous antiretroviral
- 40,000 (14) new cases drugs, including protease
annually inhibitors. (16)
* Herpes Simplex Virus Antiviral medications such
(viral) as acyclovir, famciclovir,
- 45 million people valacyclovir, can treat and
currently infected prevent outbreaks, but
- 1 million new cases herpes cannot be cured. (8)
annually
* Gonorrhea (bacterial) Various antibiotics,
- estimated number of including ciprofloxin
people infected N/A and ofloxacin (16)
- 650,000 new cases
annually
* Chlamydia (bacterial) Antibiotics such as
- 2 million people azithromycin and
currently infected doxycycline (16)
- 3 million new cases
annually
* Syphilis (bacterial) Penicillin (16)
- estimated number of
people infected N/A
- 70,000 new cases
annually
* Trichomoniasis (parasitic) Oral metronidazole (flaggl)
- estimated number of is the recommended
people infected N/A treatment. (16)
- 5 million new cases
annually
STD Types
Estimated Prevalence
& Incidence Prevention
* HPV (viral) Difficult to prevent if
- 20 million people sexually active.
currently infected Abstinence or monogamy
- 5.5 million new cases with an uninfected
annually partner reduces risk. (16)
* Hepatitis B (viral) A vaccine is available and
- 1.25 million people recommended for those
currently infected with risk factors (includes
- 140,000 to 320,000 having several sexual
new cases annually partners). (8)
* HIV/AIDS (viral) Condoms (16)
- 800,000 to 900,000
people currently infected
- 40,000 (14) new cases
annually
* Herpes Simplex Virus Condoms; abstaining from
(viral) sex with infected person
- 45 million people when lesions are visible,
currently infected but infection can occur
- 1 million new cases when there are no
annually lesions. (16)
* Gonorrhea (bacterial) Condoms, diaphragm (15)
- estimated number of
people infected N/A
- 650,000 new cases
annually
* Chlamydia (bacterial) Condoms, diaphragm (15)
- 2 million people
currently infected
- 3 million new cases
annually
* Syphilis (bacterial) Condoms and avoiding
- estimated number of sexual activity with
people infected N/A someone with open
- 70,000 new cases sores." (18)
annually
* Trichomoniasis (parasitic) Condoms, diaphragm
- estimated number of
people infected N/A
- 5 million new cases
annually
Sources: U.S. Center for Disease Control and Prevention and American
Social Health Association, unless otherwise noted.
RESOURCES Adolescent Wellness and Reproductive Education (AWARE) Foundation 1015 Chestnut Street, Suite 1225 Philadelphia, PA 19107-4302 215-955-9847 http://www.awarefoundation.org Offers reproductive health education materials for teens, parents and educators. Advocates for Youth 1025 Vermont Avenue, NW, Suite 200 Washington, DC 20005 202-347-5700 http://www.advocatesforyouth.org Offers information to help teens make informed reproductive health decisions. American Social Health Association The American Social Health Association (ASHA) is an American non-profit organization established early 20th century, and currently active on issues concerning sexually transmitted diseases. History ASHA's roots stretch back to the Progressive-era social purity movement. P.O. Box 13827 Research Triangle Park Research Triangle Park, research, business, medical, and educational complex situated in central North Carolina. It has an area of 6,900 acres (2,795 hectares) and is 8 × 2 mi (13 × 3 km) in size. Named for the triangle formed by Duke Univ. , NC 27709 1-800-361-8400 http://www.ahastd.org CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation National STD Hotline: 1-800-227-8922 Provides basic STD information; coordinates CDC STD hotline. Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion 4770 Buford Hwy, NE Mail Stop K20 Atlanta, GA 30341-3717 770-488-5200 http://www.cdc.gov/nccdphp/drh/index.htm Publishes research-based reproductive health information on wide range of topics. Girls Inc. 120 Wall Street New York, NY 10005-3902 1-800-374-4475 http://www.girlsinc.org Develops educational programs to encourage girls to master physical, intellectual and emotional challenges. HIV Over Fifty http://www.hivoverfifty.org Promotes access to educational and health care programs for persons over age 50 affected by HIV. Sexuality Information and Education Council of the United States SIECUS, the Sexuality Information and Education Council of the United States is a United States organization dedicated to sexuality education, sexual health, and sexual rights. (SIECUS SIECUS Sexuality Information and Education Council of the United States ) 130 West 42nd Street, Suite 350 New York, NY 10036 212-819-9770 http://www.siecus.org Develops and distributes reproductive health information for teens, parents, educators and health care professionals. RELATED ARTICLE: The Basics of Birth Control and STDs Although abstinence is the only sure way to protect yourself against an STD, condoms come in a close second. If your partner resists condom use, consider the female condom female condom n. See condom. female condom Vaginal pouch An externally placed contraceptive device, which offers some protection against pregnancy and STDs. See Contraceptives. Cf Condom. . Although no clinical studies have been completed to evaluate the role of the female condom in providing protection from STDs, if used correctly, it may substantially reduce the risk. (16) Other birth control methods won't protect you from STDs, however. Vaginal spermicides containing nonoxynol-g (N-g) not only aren't effective in preventing gonorrhea, chlamydia or HIV, but frequent use has been associated with genital lesions, which may be associated with an increased risk of HIV transmission. While condoms can help prevent the spread of some STDs, they only work when they're used correctly: * Use a new condom with each sexual act (including oral sex). * Carefully handle the condom so you don't damage it with your fingernails, teeth or other sharp objects. * Put the condom on after the penis is erect and before any genital contact. * Use only water-based lubricants with latex condoms. * Ensure adequate lubrication lubrication, introduction of a substance between the contact surfaces of moving parts to reduce friction and to dissipate heat. A lubricant may be oil, grease, graphite, or any substance—gas, liquid, semisolid, or solid—that permits free action of during intercourse. * Hold the condom firmly against the base of the penis during withdrawal, and withdraw while the penis is still erect to prevent slippage. (16) References (1.) "HPV and Cervical Cancer Fact Sheet." Kaiser Family Foundation The Henry J. Kaiser Family Foundation (KFF), or just Kaiser Family Foundation, is a U.S.-based non-profit, private operating foundation headquartered in Menlo Park, California. , Nov. 2001. http://www.kff.org (2.) Collins, S. et al. "High incidence of Cervical Human Papillomavirus Infections in Women During Their First Sexual Relationship. BJOG BJOG British Journal of Obstetrics and Gynaecology , Jan. 2002, Vol. 109, 96-98. (3.) "Counseling Can Help Correct misconceptions about Sexually Transmitted Diseases. Center for the Advancement of Health. [Press release]. Sept. 27, 2000. (4.) Kaiser Family Foundation Reproductive Report, April 12, 2002. (5.) "HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Among U.S. Women: Minority and Young Women at Continuing Risk." Fact sheet. U.S. Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC). 2002. http://www.rdc.gov (6.) "African Americans Disproportionately Affected by STDs." CDC. Dec. 5, 2000. (7.) Wiesenfeld HC, Lowry DL, Heine RP, Krohn MA, Bittner H, Kellinger K, Shultz M, Sweet RL. "Self-collection of Vaginal Swabs for the Detection of Chlamydia, Gonorrhea and Trichomoniasis: Opportunity to Encourage Sexually Transmitted Disease Testing Among Adolescents." Sex Transm Dis. 2001 Jun; 28(6):321-5. (8.) "Tracking the Hidden Epidemics: Trends in STDs in the U.S. 2000." CDC. http://www.cdc.gov (9.) "New Resistant Gonorrhea Migrating to Mainland U.S." NY Times. May 7, 2002. (10.) Rosenberg PS, Biggar RJ, Goedert JJ. "Declining Age at HIV Infection in the United States." [Letter]. New Engl J Med 1994;330:789-90. (11.) "Women in a New York City Clinic Mistakenly Believe that HIV Testing is a Good Way to Prevent Infection." The Alan Guttmacher Institute. [Press release]. May 8, 2002. (12.) "An Introduction to Sexually Transmitted Disease" Fact sheet. National Institute of Allergy and Infectious Diseases (NIAID NIAID National Institute of Allergy and Infectious Diseases. ). 1999. http://www.niaid.nih.gov (13.) "NIAID Topical Microbicide Research Developing New Tools to Protect Women from HIV/AIDS and other STDs." Fact sheet. March 2000. http://www.niaid.nih.gov (14.) "Older Americans Make Up the New Face of HIV/AIDS, Experts Say." Associated Press. May 11, 2002. (15.) "The HIV/AIDS Epidemic in the United States." Fact sheet. Kaiser Family Foundation June 2001. http://www.kff.org (16.) "Sexually Transmitted Diseases Treatment Guidelines," 2002. MMWR MMWR Morbidity & Mortality Weekly Report Epidemiology A news bulletin published by the CDC, which provides epidemiologic data–eg, statistics on the incidence of AIDS, rabies, rubella, STDs and other communicable diseases, causes of mortality–eg, , May 10, 2002. CDC. (17.) "Viral Hepatitis viral hepatitis n. Any of various forms of hepatitis caused by a virus. viral hepatitis, n an inflammatory condition of the liver, caused by the hepatitis viruses: A, B, C, delta, E, F, G, or H. , Type B." Fact sheet. CDC. http://www.cdc.gov (18.) "Some Facts About Syphilis." CDC. March 16, 2000. http://www.cdc.gov (19.) "STDs and Pregnancy." Fact sheet. CDC. Oct. 1997. http://www.cdc.gov * Not her real name |
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