University Health Services

• Sexually Transmitted Infections (STIs)
• Methods Of Contraception
• Sexual Health and Wellness Services

Only you know what's right for you!

The decision to have sex is a personal choice that only you can make. If you decide that having sex is right for you, talking with your partner about safer sex and pregnancy prevention before sex will allow you to be more comfortable and less worried about STIs and pregnancy. Remember though, abstinence is still the best protection against pregnancy and STIs.

SEXUALLY TRANSMITTED INFECTIONS (STIs)

The Naked Truth
 

• One in four American adults has an STI right now, though many don’t know it.
• The most common STIs on college campuses include genital warts, chlamydia, and herpes.
• Most bacterial STIs, like gonorrhea and chlamydia, are relatively easy to cure with antibiotics if caught early.

Chlamydia

Chlamydia is transmitted through contact of the mucous membranes with an infected person’s bodily fluids. Up to 80% of women and 40% of men do not show symptoms, but when signs do appear, women may experience pain or dull aching from the cervix, slight yellowish-green vaginal discharge, and pain during urination or intercourse. Men may suffer pain with urination, urethral discharge, and pain in the scrotum. Serious complications can occur if the bacteria infects a woman’s tubes, leading to scarring, infertility, and risk of an ectopic pregnancy (fetus begins to develop in fallopian tubes, rather than womb).

Patients can be treated for chlamydia with antibiotics. While receiving treatment, an infected person should avoid sex and make sure his/her partner is tested, and treated if necessary.

Genital Warts

Genital warts are caused by certain types of the human papillomavirus (HPV). More than 100 types of HPV have been identified, and are responsible for a wide range of expression in our bodies. The common warts found on hands and feet are caused by some of these viruses, as is its more dangerous relation, warts found on the cervix (the opening to the uterus). Some of these warts have been shown to be a risk factor for cervical cancer in females. Warts found in the male anogenital tract have also been linked with cancer, although such cancers are quite rare. Most external warts identified through a clinical exam are due to benign types of HPV. The pap smear test detects dangerous changes in HPV – changes that could lead to cancer.

Genital warts is the most common STI treated at Sexual Health and Wellness Services at UHS. The virus is passed through skin-to-skin contact, so intercourse is not necessary for transmission. Like herpes, and other viral infections, transmission of genital warts may not be fully prevented by using a condom because lesions can occur in areas not shielded by a condom.

There are often no noticeable symptoms because warts can blend in well with normal skin and do not necessarily cause itching or pain. In fact, lesions on the cervix can be seen only with the use of ascetic acid and magnification, a procedure called colposcopy. After transmission of the virus, it may take up to 18 months (or possibly longer) for warts to develop. Warts can develop in the mouth and throat of a person who has had oral/genital contact with an infected partner. About 2/3 of persons having sexual contact with a partner with genital HPV will contact the virus. Newer, growing lesions are probably the most infectious.

Warts can be removed by topical creams or gels prescribed by a doctor, cryotherapy (freezing them), or an acidic chemical. Cervical lesions may or may not require treatment, because the body’s immune system may contain the virus.

Gonorrhea

Gonorrhea, also known as “the clap,” “dose,” or “drip,” is caused by a bacterial infection transmitted through contact of the mucous membranes (cervix or urethra) with an infected person’s body fluids (blood, mucus, semen). The symptoms are very similar to those of chlamydia, and often do not appear at all.

Like chlamydia, gonorrhea can cause serious complications if the bacterial infection spreads to a woman’s fallopian tubes. Without treatment, the infection can spread to joints, tendons, and even the heart. In females, gonorrhea can cause pelvic inflammatory disease, a major threat to fertility. Fortunately, if the infection is diagnosed early enough, it can be fully treated with antibiotics.

Hepatitis

Hepatitis B is an infection of the liver caused by a virus, which is transmitted in the blood and body fluids (like HIV and AIDS). 100 times more infectious than HIV, hepatitis B infects 15,000-20,000 Americans each year. Most people recover, but a few become chronic carriers with increased risk of serious problems later, such as permanent liver disease and cancer of the liver. In fact, 5,000 Americans die each year from illnesses related to hepatitis B.

Symptoms typically appear within 2 to 6 weeks after sexual contact with an infected person. They can include poor appetite, nausea, vomiting, headaches, general malaise, jaundice (yellowing of the eyes and skin), dark urine, and light-colored stools. Even without symptoms you can pass the virus to others. Chronic carriers carry the hepatitis B virus for the rest of their lives and unknowingly pass it to their sex partners.

For acute hepatitis B, treatment includes rest and diet, and for chronic cases, new treatments include interferon and lamivudine. There is a highly effective vaccine that is now administered to most infants, but there is no cure for hepatitis B.

Herpes Simplex (HSV)

The herpes virus is transmitted by contact with an infected area, whether lesions are present or not. Both types 1 and 2 can be contracted on the mouth or genital area. Genital herpes is most contagious during outbreaks; however, up to 70% of transmission may result from sexual contact during periods of asymptomatic viral shedding, either with oral-genital contact or genital-genital contact. Once contracted, herpes blisters may appear as early as 2 days later. These single or multiple vesicles (fluid-filled blisters) appear anywhere on genital skin, and rupture three to five days after development, leaving extremely painful, shallow ulcers, which take about 12 days to heal. Patients may experience recurrent attacks. The most serious complications are for newborn babies who may contact the virus during vaginal delivery.

Although there are many treatments to limit the symptoms and pain an infected person suffers, there is no cure for herpes. First infections of oral and genital herpes and recurrent infections of genital herpes may be treated with an antiviral medication like acyclovir, prescribed by a health care provider. Other local treatment like Domeboro soaks and lidocaine-containing products may provide some symptom relief. Some individuals have found that they can abort or reduce the severity of a herpes simplex infection by using an amino acid, L-Lysine.

In order to avoid herpes, always use condoms to decrease chances of transmission due to asymptomatic genital viral shedding. Note that condoms reduce but do not eliminate your risk of contracting HSV. Abstinence (no skin to skin or skin to mucous membrane contact) is the only 100% effective means of HSV prevention. Avoid kissing others and sharing eating/drinking utensils when oral lesions are present. If you have already been diagnosed with herpes, protect yourself by avoiding trigger factors, when possible, like sun over-exposure or possible dietary precipitants, like chocolate and peanuts. (Individuals are likely to find that they have their own trigger factors, which are unique).

HIV

Human immunodeficiency virus (HIV) destroys the body’s immune system, leaving its victims unable to fight off disease, and attacks the central nervous system, causing mental and neurological problems. The virus cannot be passed through casual physical contact, such as kissing and hugging, but only when body fluids, such as semen and blood, pass from an infected person to another. There are several stages in the progression of HIV, but the first is characterized by fatigue, loss of appetite, chronic diarrhea, weight loss, persistent dry cough, fever, and swollen lymph nodes. HIV usually leads to AIDS, acquired immunodeficiency syndrome, which leaves patients vulnerable to many diseases, such as skin infections, tuberculosis, pneumonia, and cancer. Unfortunately there is no cure for HIV or AIDS, but some antivirals can help. Often medication focuses on the separate diseases that attack the body as a result of a weakened immune system.

HIV tests work by testing for antibodies to the HIV virus in the bloodstream. Testing can be confidential or anonymous. In confidential testing, the results of your blood test are confidential, but you must provide your name and identifying information (such as your date of birth). All test results are recorded in your medical chart. In New Jersey, the testing site is also required by law to report positive results to the Department of Health and Senior Services, but it is illegal for the state to disclose this information to any other person or agency without your consent.

Anonymous testing sites allow you to make up a name (like Jane Doe, Mickey Mouse, whatever...). Your blood sample will be assigned a random number and you will use this number to get the results of your test, so testing is guaranteed to be anonymous. It is recommended that you go to an anonymous test site if you seriously think that you are infected with HIV. Anonymous testing is currently not available at UHS - only confidential testing can be offered.

Molluscum Contagiosum

A type of pox virus, the name “molluscum” refers to the skin-colored bumps, called mollusca, that characterize the disorder. These small bumps can appear singly or in groups on the face, neck, chest, stomach, or groin area, but do not usually cause much discomfort. Mollusca are distinguished from herpes lesions because they are smooth, dry, and do not grow after first appearing. The virus is passed through contact with infected skin, so scratching the bumps will cause them to spread. If left alone, the bumps should disappear within a year to a year and a half, but for faster removal, you can talk to your doctor about cryotherapy, scraping or chemical treatment.

Pelvic Inflammatory Disease (PID)

PID only affects women, and young women are particularly at risk. Symptoms, if any, include abdominal pain and irregular or heavy menstrual periods. PID may be caused by other untreated STIs, in particular chlamydia and gonorrhea. PID can be cured with antibiotics, but can often lead to infertility if left untreated.

Pubic Lice ("crabs")

Pubic lice are tiny wingless insects that cause itching in the genital region. They are most commonly spread through sexual contact, but can also be transmitted by close body contact, clothing, bedding, towels, and other personal belongings. Pubic lice can be treated with prescription or over-the-counter delousing shampoos. The lice are not carriers of any other diseases.

Syphilis

Syphilis is a serious bacterial infection that can be debilitating and even result in death if left untreated. Fortunately, the incidence of syphilis is rare now due to the development and use of penicillin in treating the disease. However, the disease has by no means disappeared, for there are an estimated 70,000 new cases of syphilis in the United States each year, often because the carriers don’t know they are infected.

Syphilis has three stages. During the first stage, a painless sore may appear at the spot where the bacteria first entered the body (usually from 10-90 days after sexual contact with an infected person). This sore may appear around or in the vagina, on the penis, or inside the mouth or anus. Sores inside the vagina or anus are often unnoticed and may disappear on their own if not treated, but the bacterial infection remains. The second stage occurs from 3 weeks to 3 months after the primary stage and includes flu-like symptoms and possible hair loss. Some people experience a rash on the palms of the hands and soles of the feet, as well as over the entire body. Although extremely rare, tertiary syphilis can appear 3 to 10 years after the first and second stages. Symptoms of this stage may include skin lesions, mental deterioration, loss of balance and vision, loss of sensation, shooting pains in the legs, and heart disease.

A simple blood test can usually determine whether or not you have the disease. However, if you become infected 2 to 3 weeks prior to testing, the blood test might not be sensitive enough to pick it up. Fortunately, syphilis can be treated with proper antibiotics – most often injections of penicillin.

Trichomoniasis

“Trich” is a common sexually transmitted disease that attacks 2 to 3 million Americans every year. The infection is caused by a flagellated protozoan – a microscopic parasite called Trichomonas vaginalis.

Many people with trich experience no symptoms, but if signs do develop, they will appear within six months of being infected. Women may suffer itching, burning, vaginal or vulval redness, unusual vaginal discharge, frequent and/or painful urination, discomfort during intercourse, and abdominal pain. Symptoms tend to worsen after menstruation. Men are usually asymptomatic, but symptoms can include unusual penile discharge, painful urination, and tingling inside the penis. If you suspect you have trich, visit your health care provider who will collect samples from the vagina if you’re a woman, or from the urethra if you’re a man, and test for the presence of parasites. Trich is easily treated with antibiotics.

Coping with an STI

If you suspect you have an STI, go to Sexual Health and Wellness Services at University Health Services (UHS). When first diagnosed with an STI, every person has his or her own emotional response to the news. Most people have some difficult reactions to the diagnosis. Often it helps to talk to someone about these powerful feelings. Counseling and Psychological Services at UHS offers counseling to address those issues. These reactions may include:

• Shame
• Anger
• Guilt
• Fear
• Sadness
• Loss/Grief
• Blame
• Feeling Dirty

It is important to address these feelings so that they do not continue to have negative impact on your life.

Once you have coped with your emotional reactions to the diagnosis, it’s important to tell your partner before further sexual contact. The most important reason is to avoid spreading the virus and to protect someone who is intimate with you. There are many other reasons, including helping your relationship to be based on trust and openness and avoiding living with fear and secrecy.

Find a quiet time where you won't be interrupted. Be straightforward, calm, open, honest and non-threatening. If your partner sees you are relaxed, s/he will be more comfortable. Have a dialogue with your partner so that each of you may share feelings and ask questions. If you wish, you can meet before with a counselor to think about and practice what you want to say.

Give your partner time to adjust to the news. As you know, it may take a while to understand and accept. This news may cause stresses and strains on your relationship. Sometimes break-ups follow. However, most people will appreciate your honesty and your relationship can become stronger from such discussions. [top]

METHODS OF CONTRACEPTION

The Naked Truth
 

• 85 out of 100 sexually active women will become pregnant within a year if they do not use birth control.¹

Abstinence

Sexual abstinence is the only sure way to prevent pregnancy and sexually transmitted infections. Refraining from sexual activity is a normal and acceptable practice used by men and women of all ages who are not yet prepared to accept the risks of sexual activity.

People choose to abstain from sexual activity for many reasons, and some do so even after they've been sexually active. The reasons why people choose to be abstinent may change throughout their lives. Some may choose abstinence to wait until they have found the "right" partner, until they are ready for a sexual relationship and its possible consequences, to support personal beliefs, to help them through a rough period in their lives, to pursue other personal goals, to prevent pregnancy and STIs, or even to follow medical advice.

100 Percent Effective
Abstinence is 100 percent effective in preventing pregnancy. It also prevents sexually transmitted infection.

Condom

Considered the best form of protection against STIs and pregnancy, the condom is 90-98% effective if used correctly each and every time. It is made of latex or polyurethane and protects both partners by preventing contact with body fluids. The only worry you might have when using a condom correctly is if it does not cover certain skin infections, like herpes and genital warts, which are transmitted by skin-to-skin contact. There are two types of condoms, one for a man and one for a woman. The female condom is a loose-fitting, pre-lubricated polyurethane pouch, which can be put in the vagina up to eight hours before sex. When adding lubricant to either type of condom, make sure it is water-based (K-Y Jelly, Astroglide, or saliva) because oil will weaken the condom, increasing chances of breakage. You should apply lubricant to the external female genitalia to reduce friction.

Correct condom use is essential for safety. The condom must be put on before any genital contact with an erect penis. With a male condom, make sure you pinch the nipple end of the condom to keep air out and leave room for semen. To avoid spilling, remove the condom while still erect, and hold the rim of the condom so sperm won’t escape. Female condoms come with instructions, but make sure the inner ring slides into the vagina while the outer ring stays outside the body. Never re-use a condom.

Diaphragm

A diaphragm is a device that covers the cervix to prevent sperm from entering the uterus. Although it may be left in the vagina for up to 24 hours, a diaphragm must be covered with spermicide before each sexual encounter. Spermicide comes in several forms that are inserted into the vagina. A medical professional must fit the diaphragm to your body and show you how to put it in and remove it. When used with spermicide each time, these methods of birth control are 90-95% effective, but do protect against STIs in the vagina or external skin.

Hormonal Contraceptives: IUD, the Pill, the Patch, the Vaginal Ring, and Depo-Provera
 

IUD

These methods use synthetic imitations of naturally occurring hormones to stop a woman from becoming pregnant, but do not protect her from STIs. The intrauterine device, or IUD, is placed inside the uterus to prevent egg implantation in the uterine wall. Both copper and hormonal IUDs must be replaced every 5 to7 years.

The Pill

The “Birth Control Pill” prevents pregnancy by suppressing ovulation through the combined actions of the hormones estrogen and progestin. A woman takes a hormone pill daily for 21 days, then has a 7-day break from the hormones before a new package is started. Most pill packages provide inactive pills to be taken during those 7 days. In either case, the uterus sheds the lining and menstruation occurs during this 7-day break.

Birth control pills are a prescription medication, so you will need to make an appointment with a Sexual Health and Wellness Services clinician or your gynecologist before they can be prescribed for you. This visit may involve a pelvic exam and a discussion of which contraceptive method will best suit your lifestyle and medical history. If you and your clinician decide that oral contraceptives are the right choice for you, you can buy the pills from Sexual Health and Wellness Services at reduced cost. If you would like to speak with someone about the contraceptive choices available to you, you can make an appointment with a Sexual Health and Wellness Services clinician.

Advantages and Disadvantages

There are a variety of pros and cons associated with pill use. Most health care practitioners will agree that for a healthy, non-smoking woman, the advantages usually outweigh the disadvantages. The risks associated with taking birth control pills are extremely rare in healthy women under age 35 who do not smoke.

Benefits
 

• Effective contraception
• Can be used for several years
• Relief of menstrual cramps
• Lower risk of ovarian and uterine cancer
• Regular periods, often shorter and lighter
• Reduced pre-menstrual tension
• Decreased incidence of ovarian cysts
• Reduced risk of developing PID
• Decreased risk of iron deficiency anemia
• Protection against benign cystic breast disease
• Can be discontinued if desired

Risks
 

• Developing blood clots
• Increased risk of heart attack and stroke in smokers
• Benign liver tumors
• High blood pressure
• No protection against sexually transmitted diseases

Possible Side Effects

Approximately 40% of women who use oral contraceptives may experience one or more minor side effects. If you are experiencing uncomfortable side effects, please tell your clinician - often switching to another brand of birth control pill can relieve these problems. Other side effects may improve with time. Possible side effects include:

• Spotting during the first 3 months
• Missed periods
• Mood changes (rare)
• Nausea (in first two weeks)
• Effect on acne condition (usually positive) and skin pigment changes
• Breast enlargement and tenderness
• With some drugs, decreased absorption
• Vision problems or change in contact lens fit (with hard contact lenses)

However, there are a few serious problems all pill takers should watch for. The risk of these problems with the current generation of low dose pills is quite small, but it is important for you to be aware of the danger signs, which your clinician will discuss with you.

What should I do if I forget to take my pill?

If you miss one pill, take it as soon as you remember that you forgot it. If more than 12 hours have elapsed since you were supposed to take your pill, take it but use a back-up method like condoms for the next seven days. If you miss two pills in a row, take 2 pills on the day you remember and 2 pills the next day. Use a back-up birth control method like condoms for the next seven days. Finish your pack of pills.

The Contraceptive Patch

**NOTICE**

Recently Ortho McNeil, the makers of Ortho-Evra Patch updated the label for this product. The Label now includes a new warning and provides additional information on the differences between the Patch and the Pill. The new label states:

"Hormones from patches applied to the skin get into the blood stream and are removed from the body differently than hormones from birth control pills taken by mouth. You will be exposed to about 60% more estrogen if you use Ortho-Evra than if you use a typical birth control pill containing 35 micrograms of estrogen. In general, increased estrogen exposure may increase the risk of serious side effects (this includes blood clots, stroke and heart attacks). However, it is not known if there are differences in the risk of serious side effects based on the differences between Ortho-Evra and a birth control pill containing 35 micrograms of estrogen."

The Patch remains an effective method of birth control. Smoking increases the risk of serious side effects. If you smoke we encourage you to stop. If you want to discuss alternatives to the Patch, please contact Women's and Men's Health at (609) 258-5357.

The Ortho-Evra transdermal system is a once-a-week birth control option that is as effective as the pill. It is the first weekly, non-invasive form of reversible contraception that is 99 percent effective when used correctly. The Contraceptive Patch looks like a square band-aid. It is applied to the abdomen, buttocks, upper arm, or upper torso. The Contraceptive Patch works by slowly releasing a combination of estrogen and progestin hormones through the skin. These hormones prevent ovulation (release of an egg from the ovary) and thicken the cervical mucus, creating a barrier to prevent sperm from entering the uterus.

Some patients may express concern about losing the Patch, partial or complete detachment has been shown to occur in less than 5% of cases. If the Patch becomes loose or falls off, a new Patch should be applied immediately. The “Patch Change Day” will remain the same. The Patch is ideal for women who find it difficult to remember to take a pill everyday day at the same time.

The Vaginal Ring (NuvaRing)

The NuvaRing is a flexible transparent and thin polymer ring (2½ inches in diameter and an 1/8 of an inch thick) that provides a continuous low dose of etonogestrel and ethinyl estradiol (progestin and estrogen) to prevent pregnancy. The ring is inserted inside a woman's vagina and is kept in place for three consecutive weeks. At the beginning of the fourth week, the ring is removed for one week (withdrawal bleeding occurs during this week.) A new ring is then inserted.

Ring specific adverse effects include vaginal irritation, infections and discharge. Vaginal medications (such as antifungal creams) can be used while the ring is in place.

Depo-Provera

Depo-Provera is an injectable form of contraception that works for three months, containing a chemical similar to progesterone. Like the pill, Depo-Provera prevents egg cells from being released. Women who use this method may experience irregular periods, spotting between periods, and weight gain.

Spermicides

Spermicides are sold in many forms - as creams, foams, suppositories, jellies, and films – that a woman puts in her vagina to kill sperm. Although spermicide kills many germs that cause STIs, it should be used with a condom for best protection.

Emergency Contraceptives

Taken up to five days after unprotected intercourse, “the morning after pill” consists of two doses of hormone pills, with the first dose taken as soon as possible, and the second dose taken twelve hours later. You can also take both pills at the same time. The morning after pill is more effective if used within the first 12 hours after exposure. Depending on what stage you’re at in your menstrual cycle, the pill will prevent pregnancy in one of two ways. It either inhibits or delays ovulation, thus preventing fertilization, or changes the characteristics of the endometrium to deter implantation. Taking the pill does not disturb an already existing pregnancy.

Princeton students can get emergency contraceptives through UHS for $17. During regular clinic hours (Monday - Friday, 9 a.m. – 5 p.m.), you may “walk-in” to the UHS on the first floor of McCosh Health Center or call Sexual Health and Wellness Services for an “emergency slot” at (609) 258-3141. After regular clinic hours or on weekends, emergency contraceptives may be obtained from nurses on the second floor of McCosh Health Center.

For more information, visit the [top]

¹http://www.fda.gov/fdac/features/1997/babytabl.html, U.S. Food and Drug Administration “Birth Control Guide,” 7/31/03