Information on popular complementary and alternative medical topics

Many couples entering into new sexual relationships decide to be tested jointly for HIV. This is a good idea. If both partners are tested for HIV more than six months from their last sexual contact with other partners or exposure to any other risk factor, test negative, and are mum ally monogamous, then they can assume that they are negative for HIV However, if there is continued risk of infection—such as contact with other partners or injection drug use—then a couple cannot assume they are safe and should continue to use a barrier method to protect themselves against infection.

If you intend to be tested for HIV you should consider the issue of confidentiality. Insurance companies, if they know that you have sought testing for the infection, may label you as “high risk” and deny you insurance coverage or certain benefits in the future—even if you test negative. This consequence has prevented many people from being tested. Others who didn’t know about this practice, and who sought testing from a health care provider on their insurance plans, now have the test as part of their permanent records and may be denied insurance coverage in the future. Check in your area for a clinic that performs anonymous testing. To preserve your anonymity, such a testing center requires only your first name, or else you are assigned a number without having to give your name at all. Most public health clinics provide this service. There is also a home HIV test that is anonymous. People who do test positive must refer their partners for testing; health care providers can help with this.

The following five tests are available to test for HIV infection or to monitor the progress of an infected individual.

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Infected children who are not toilet trained and are around other children—for example, in a daycare center—can spread the infection to other children and adults. Family and household contacts of those who are infected frequently become infected themselves. In addition, institutional staffs, such as nursing home employees, may also be at higher risk.

Sexual transmission can also occur via the fecal-oral route. A person can become infected with hepatitis A through oral-anal contact (called analingus or rimming) or by stimulating a partner’s anus with the fingers and then not washing the hands before placing them in the mouth or preparing food. Occasionally outbreaks of hepatitis A occur among men who have sex with other men in urban settings. Other types of sexual contact are not thought to be a method of transmission. Studies of men who have sex with other men have shown that the more sexual partners a man has, the more likely he is to become infected with hepatitis A. This is true for any oral-anal contact with multiple partners.

At various times during infection, the saliva and blood of an infected person may also contain the virus, but it is very rare that transmission takes place through contact with saliva or blood. Although occasional outbreaks among persons who use intravenous drugs may be due to blood transmission, the more common method of transmission, via the fecal-oral route, may actually be the cause in these cases as well. Blood banks screen for all types of hepatitis, so transmission through blood transfusion is rare.

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Bloodborne infections, such as HIV and hepatitis, can also cause infection of the fetus in the womb. With HIV there are no developmental problems associated with the infection itself, but there is about a 25 percent risk of a child acquiring HIV if born to a mother who is HIV positive. Mothers who are HIV positive can reduce the transmission rate of the infection to their children by taking medications used to treat HIV infection during the pregnancy. (See the section on HIV infection and AIDS in Part II for more information.) Combination therapy (with more than one HIV medication) is also being offered in many settings. Children who are born to mothers with hepatitis B may be protected from acquiring the infection by being immunized at birth against the infection. If a child acquires hepatitis B at birth, there is a high risk that the child will become a lifelong carrier of the infection.

Children who are infected with herpes in the womb, at delivery, or after birth may experience problems that range in severity from a mild skin infection to mental retardation and death. Again, knowing your and your partner’s status for herpes prior to and during the pregnancy, and taking appropriate precautions, can nearly eliminate these risks. Most problems occur when a woman does not know she has herpes during the pregnancy and therefore takes no precautions, or when she becomes infected while she is pregnant, which poses a greater risk for transmission. This is why partners must also be tested. There is also a risk of infection after the delivery from well-meaning but uneducated friends and relatives, who may pass the virus to the baby by kissing the baby, especially if they have an active cold sore.

The human papillomavirus, which causes genital warts, may cause vocal cord infection in a newborn during passage through the infected birth canal. Considering how common genital infection with this virus is, this is a rare occurrence.

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1. If there is discharge, a small amount will be put on a swab, and tests can then be performed to test for various specific causes of urethral infection, such as gonorrhea and chlamydia. If there is no discharge, then a small swab will be inserted about 2 centimeters into the urethra and quickly removed; the swab is wiped on a slide, which is examined under a microscope for pus cells. The swab can cause pain, but the procedure is done quickly and the pain is usually brief. Another way of examining the urethra is to collect urine from the very first part of the stream and look for pus cells in this sample. New techniques also allow testing for gonorrhea and chlamydia from this first urine sample. (Whether or not a swab or urine sample is taken, it is very important that a man not urinate for four or more hours [and preferably overnight] before this part of the examination, since urination may wash out evidence of infection.) After this, a midstream urine sample may be tested to look for evidence of a bladder infection, a rare occurrence in men.

2. The anal area and buttocks will be examined for any rashes, bumps, or sores. Swabs may be taken from this area (to test for gonorrhea and chlamydia) if a man has been the recipient of anal sex or has STD symptoms in the anal area. If the man has diarrhea, a stool sample may be obtained to test for evidence of intestinal infections. Whatever a man’s sexual orientation, an anal examination is an important part of the screening. For example, genital warts and herpes lesions can occur in this area even if a man has never received anal sex. A procedure called an anoscopy may be performed if there are symptoms in the anal area or if the man has diarrhea. In an anoscopy, a small plastic speculum is inserted into the anal area to look for changes in the lining of the rectum or for skin lesions such as warts. If there are no symptoms in this area, this is not a routine part of the examination. 8. A prostate examination may be performed. (This is not routinely done during an STD screen unless symptoms indicate a need for it.) The health care provider will ask the man to bend over the table and then will insert a gloved, lubricated finger into the anal area. Not only can abnormalities of the wall of the rectum be felt, but the prostate gland can also be felt to determine whether it is swollen, tender, or irregular in shape. This part of the examination may cause brief discomfort. The man may be asked to provide a sample of urine after this part of the examination to test for evidence of prostate infection. This is best done after the earlier urine samples have been collected to evaluate for urethral infection and for bladder infection.

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The uterus is shaped like a small pear that sits upside down in the pelvic cavity, with the cervix as the “stem.” It is where a fertilized egg implants itself at the beginning of a pregnancy. (An ectopic pregnancy occurs when the fertilized egg implants itself somewhere outside the uterus, such as in the Fallopian tubes.) The uterus has a very rich blood supply and provides nourishment for the developing embryo. The uterus is very muscular and can grow to a very large size during pregnancy, but it shrinks back to just a little bit bigger than its prepregnancy size afterward. The lining of the uterus (called the endometrium) builds up each month in preparation for a pregnancy, and the lining is shed during menstruation (the period) if the woman does not become pregnant.

The lining of the uterus can also undergo cancerous changes, called endometrial cancer or uterine cancer. This is more common among older women. Fibroids are noncancerous growths in the muscle layer of the uterus that can cause pelvic pain and increased bleeding during and between periods.

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