JOE DELAN WAS FALLING IN LOVE. He had met Jessica four months earlier through an online personal ad. She was 27, tall, smart, and beautiful. She lived in Fredericksburg, and soon after Jessica met Joe face to face, she started driving up to Alexandria nearly every weekend to see him. Things were moving along so nicely that he started thinking she was the woman he'd spend the rest of his life with.
He was having these very thoughts as he stepped into the shower two weeks before Christmas in 1999. He was about to soap up when he felt
sharp pains where the water was hitting his genitals. He stepped out of the shower and looked down. Three bumps that looked like small ingrown hairs had developed on the shaft of his penis.
Delan suspected it might be herpes, a sexually transmitted disease. A doctor confirmed it. Jessica denied giving it to him.
"I was angry," says Joe, now 31. "A relationship is the last place you think something like this will happen. The fact that she didn't tell me she had it hurt."
But it's possible Jessica didn't have it--the incubation period for herpes is two days to a couple of years, meaning Delan could have contracted it before he and Jessica started dating. It's also possible she didn't know she had it. Of the 45 million Americans infected with herpes, only two-thirds have enough symptoms to make them aware they're infected.
After he was diagnosed, Delan and Jessica continued to have unprotected sex for a few more weeks; Jessica was taking oral contraception, so they hadn't used condoms since their first intimate encounter. But her comfort level in risking infection made Delan suspect she did have it--and knew it. Then Jessica broke up with him. She said it wasn't about the herpes.
Heartbroken and angry, Delan went to bars around his Alexandria apartment and started to meet other women. He had sex with two of them, telling neither he had herpes and using protection with only one.
"I was in denial that I had it and figured if I told them, no one would want to have sex with me ever again," says Delan, a contractor for the Navy. "After the second girl, I thought: What am I doing? I'm doing to them exactly what was done to me."
GETTING A SEXUALLY TRANSMITTED DISEASE IS NOTHING NEW. Humans have been swapping infections under the covers for centuries. Shakespeare refers to syphilis throughout his works, as does Geoffrey Chaucer, whose "summoner" and "pardoner" in the Canterbury Tales are implied to have sexually transmitted diseases.
What is new is the sheer number of people who have one. Roughly 70 million people are infected with a sexually transmitted disease, amounting to one in four people--the highest rate the United States has on record since the development of better reporting methods. There are at least 25 known STDs, which range from mild, itchy pubic lice to human immunodeficiency virus (HIV). Herpes, chlamydia, gonorrhea, and human papillomavirus (HPV), which causes genital warts, are the most common. Syphilis has nearly been eradicated, now affecting about 6,600 people, mostly in southern states. Richmond, Baltimore, and Norfolk have relatively high rates.
The impact these diseases have on people's lives depends on the STD. Herpes, HPV, and HIV are all viruses, meaning that while the symptoms can be treated, the disease will remain in the body and show recurrences throughout the person's life. Chlamydia and gonorrhea, whose discharge and abdominal pain can cause great discomfort, are easily cured.
According to the National Institute of Allergy and Infectious Diseases, the occurrence of STDs is rising because young people are having sex earlier and married couples are getting divorced, which means adults have more sexual partners than in the past. This year, 15 million people will be infected with an STD. Of those, nearly two-thirds will be under the age of 25.
"It's a pandemic," says Robin Sawyer, a professor of public and community health at the University of Maryland. His class, Human Sexuality, is the most popular course of the 5,000 offered on campus--one sign of the desire for sexual knowledge.
Off campus, diseases like herpes and HPV infect so many that area health clinics like Planned Parenthood extend their hours on evenings and weekends to accommodate students. People tend to get outbreaks of herpes and warts in time of stress.
Sawyer teaches his students that culturally, the pill revolutionized sexuality. "Once oral contraceptives were introduced, there was no real need to wear condoms until the '80s, when AIDS hit," says Sawyer. "Condom use has increased since then. Even so, students who have had it hammered into their brain that the worst thing they can do is have unprotected sex still do it."
The real concern for most who are sexually active, explains Holly Blanchard, a clinician at Planned Parenthood of Metropolitan Washington (PPMW), is preventing pregnancy and the transmission of HIV, not the spread of other STDs. "Everyone has the idea that it will never happen to them," she says.
WHEN DELAN REALIZED HE WAS INFECTED WITH AN STD, HE REacted the same way many do: He felt disgust for his own body. People who have contracted an infection through sex use words like "ashamed," "promiscuous," and "dirty" to describe how they feel about themselves. These thoughts are heightened in those who contract HPV or herpes because neither can be "cleansed" from the body.
Robin Sawyer equates the intensity of the negative self-imagery partly with the individual's own guilt. "You get an STD often from having unprotected sex, which right there is admitting you did something wrong," he says. Women, he says, especially feel as though they deserve it--a punishment for being "bad."
Lynn Marshall, a single 51-year-old woman recently infected with herpes, says the difficult thing about contracting an STD was not the physical repercussions but "facing the stigma of having it."
Joe Delan agrees. He says that before he contracted herpes he would hear of a woman having an STD and think she was "loose" or "damaged goods." The hard part for him was knowing that some people would now see him this way. Deep down, he felt this way about himself.
Mark Wasserman, an economist with the federal goverment who has had herpes for 20 years, says finding out you have an STD is like hearing news of a death in the family. "It's that type of emotional setback," he says. "They're not themselves for a bit. Half of them want to commit homicide, and the other half want to commit suicide. Then they adjust and learn to carry on."
Wasserman runs a support group for people with herpes. He sees only a small number of the afflicted--roughly 300 a year. Wasserman says that many are embarrassed to admit they have an STD. "They temporarily lose their ability to love themselves," he says. And it makes people feel as though no one else will ever love them again.
KATE WAS 19, A FRESHMAN AT A PENNSYLVANIA UNIVERSITY, WHEN she had sex with a good friend from high school. A few weeks later, she found warts on the labia of her vagina.
"I was shocked," she says. "You never think one wild night will change everything." After she was diagnosed with HPV, Kate had to make other partners aware that they too might have it. One told her, "You're sick," and walked away--a response, Kate says, that was devastating.
Kate doesn't remember if she used a condom that night, because she was drunk. According to a Kaiser Family Foundation study, 73 percent of 15- to 24-year-olds surveyed said their peers don't use condoms if they've consumed drugs or alcohol.
A condom doesn't offer 100-percent protection. Like herpes, HPV is transmitted through skin-to-skin contact. Holly Blanchard of PPMW says she has seen men come into the examining room with a perfect circle of warts around the upper part of their penis--a place the condom didn't cover. She's also seen individuals come in with warts in their throat, a result of giving oral sex to someone with HPV.
It's also possible to spread herpes of the mouth--80 percent of the population get these cold sores on their lips--to the genital area during oral sex. Herpes is most often spread during an outbreak and 72 hours before and after. It's possible--but unlikely--that the virus will be passed on at other times. Some people have outbreaks once a week, others once a year. Most people with herpes can feel an outbreak coming on--there is a tingling sensation on their genitals--and will refrain from sex. It's how Mark Wasserman and his wife, Sue, have been married 12 years without his having transmitted herpes to her.
Yet according to the American Social Health Association, 80 percent of all STDs are symptomless. HPV is thought to lie dormant in 75 percent of the reproductive-age population. Even gonorrhea and chlamydia don't show symptoms in 80 percent of women they infect (percentages for men are much lower)--but if a person is asymptomatic, he or she can still pass the disease on to a partner. Men are often less aware of having an infection because they aren't examined yearly, as most women are.
The problem is further complicated because people who learn they have an STD often don't tell past partners. Many health clinics offer to send an anonymous tip, something like, "We regret to inform you that one of your past partners has contracted chlamydia. We recommend you come in and get tested."
KATE'S DOCTOR USED LIQUID NITROGEN TO FREEZE OFF HER warts. She was told she wasn't contagious and sent on her way. Kate had a few more sexual partners in college, using protection with most of them. She graduated and was accepted as a graduate student at George Washington University.
When she moved to Washington, her new doctor told her that she'd been given misinformation. Researchers now know that HPV can be transmitted even when warts have been removed. Now Kate fears she may have passed it on to someone in the five years she didn't think she was contagious. Her guilt and regret soon turned to bitterness. After remaining celibate for several months, she found out another sexually transmitted disease had been lurking in her 26-year-old body. Herpes.
Having one sexually transmitted disease doesn't make you more suspectible to another. But if you have one STD, chances are greater that you've had multiple partners and may not always have used protection.
Kate spends many evenings crying to her aunt on the phone. She hasn't told anyone else she has both diseases. "I'd much rather wear a nametag that says my weight for the rest of my life than admit to strangers I have these two STDs," she says. "I made bad decisions."
She has shed her dreams of having a family because she feels no man would ever want her. She's gained 20 pounds. Her self-esteem has plummeted. She considers having sex with someone and not telling him. "No one is going to want to marry me," she says, blinking back tears. "As soon as I tell them I have HPV and herpes, they'll turn around and walk away."
IN AN EPISODE OF THE TELEVISION SHOW Friends, the character Joey is horrified when he finds out an ad he posed for is a public-service announcement for STDs. Because it's plastered everywhere in New York, Joey can't get any dates. It's all in jest, but there is some truth behind the skit.
Those infected with herpes and HPV say that men are more likely to accept a woman with an STD than a woman is to accept a man with one. Joe Delan says he is rejected one-third of the time. Many of the women interviewed for this article have never been rejected by men.
Anna, a senior at the University of Maryland, got genital warts in high school. As a teenager--and a virgin--she lay naked with a boyfriend and their genitals rubbed but, she says, there was no intercourse. It was enough to pass on the infection, and when she received irregular Pap-smear results the next year as a freshman in college, the doctor realized she had genital warts.
Sitting in her car at 5 AM, she told a former boyfriend, Jeff, that she had warts. They went inside his house. She fell asleep in his bed. The next morning they started kissing. When things started to heat up, Anna said: "You know what I have." He nodded. They had unprotected sex.
Later, Anna says, she worried about how many people he had done that with--forgone protection even when it was possible for him to get an STD.
A few months later, she met Paul. Anna says she delayed telling him by giving him oral sex for a week. But Paul wanted to make her feel good. "There is a reason I don't want you to be down there," she told him as they lay alongside each other in bed. She told him she has HPV and that it's contagious. Paul decided it was worth the risk.
They had intercourse three times over the next couple of weeks and used a condom only once. They broke up after a month. Afterward, she had another one-month relationship, with a man entering a master's program at Georgetown's School of Foreign Service. He also didn't insist on using protection.
Anna didn't either. Many individuals with an STD who were interviewed for this article are willing to take off the condom if their partner is. Anna says she'd feel guilty if one of the guys she has been with contracted HPV. But because she believes condoms get in the way of pleasure, she says she has her weak moments.
Her story--along with Delan's and Kate's--raises the question: What constitutes a monogamous relationship? The biggest misconception about getting an STD, says Stacey Little, vice president of community education at PPMW, is that you won't get it if you're in a committed relationship. "There is a so-called assumption of monogamy," she says. "But these relationships can last six weeks to six months." Then you break up, she says, and start a new "monogamous relationship," bringing into the bedroom all of the viruses from your previous partners.
It's why people often are shocked when they contract an STD. They are not out "sleeping around." Of the 15 individuals interviewed for this article, only one got an STD from a one-night stand. The rest were in relationships, including one woman who got herpes from her cheating husband. *
WHILE SOME FEAR THAT INTIMATE ENCOUNTERS are a thing of the past after being diagnosed with an STD, nearly all manage to piece together a sex life.
Take Angie of Falls Church. Angie, 39, got herpes while she was a student at Auburn University in Alabama. She graduated, got married at 28, and gave birth to a healthy baby girl.
Childbirth can be affected by an STD--early onset of labor, premature rupture of uterine membranes--but if your doctors know you have an STD, they can take precautions. If a woman has an outbreak of herpes at the time of delivery, the doctor will perform a caesarean section; a normal delivery could cause blindness in the baby. If a woman has her very first outbreak during pregnancy, the impact is much greater--it can cause nerve or brain damage in the fetus, or the baby's death.
If a woman has chlamydia or gonorrhea at the time of childbirth, it also can cause blindness or stillbirth. It's one reason why physicians screen pregnant women for STDs. According to the Centers for Disease Control and Prevention, 30 to 40 percent of premature births and infant deaths can be attributed to complications from sexually transmitted diseases. If untreated, sexually transmitted diseases can affect your health in other ways. Chlamydia and gonorrhea can decrease a woman's fertility or cause an ectopic pregnancy. The strains of HPV that don't cause genital warts--of the 30 known strains, only three cause warts--can lead to cervical cancer as well as penile and anal cancer. But it's rare. A yearly Pap smear screens women for precancerous cell changes, and before any woman became infertile from chlamydia, she'd suffer for years with a painful pelvic infection--something easily diagnosed.
When Angie got divorced a few years after having her daughter, she turned to Meet People With Herpes, or www.mpwh.net, a nationwide Web site that connects more than 25,000 people with the infection. There are photographs online, and individuals can instant-message one other. It's there that Angie met Luke, 55, a divorced father of three who is an investment consultant in Alexandria. He got herpes after he divorced. "Given my age, I thought my sex life was over," he says. "Then I realized there were all of these online clubs."
Angie and Luke, who have dated since December, say the fact that they knew right off the bat that the other has herpes has made the relationship easier and brought them closer faster. "All of those male-female sexual games aren't there," says Luke. Angie agrees: "There is a level of comfort that gives you a sense of sexual freedom." Even so, Luke says he's embarrassed to tell Angie when he has outbreaks. "It's still a personal part of your body," he says.
Contracting a sexually transmitted disease isn't as physically uncomfortable as it was 20 years ago. Once genital warts are burned, frozen, or lasered off, an individual won't have to treat the infection unless the warts reappear. Antibiotics cure chlamydia and gonorrhea in roughly ten days. Medications for those with HIV are lengthening life spans
Medications for herpes relieve the pain associated with lesions. Suppressive and episodic therapies such as Valtrex help stop outbreaks from occurring. Scientists are working on a vaccine to prevent the spread of herpes, but it's still in clinical trials. "I take a little blue pill every day," says Luke. "It makes me feel like everyone else. It makes me feel cleaner, healthier."
Both Luke and Angie were comfortable dating outside the herpes social circle. If things don't work out between them, both will resume searching for a soul mate the way they did before--on the herpes Web site or from a barstool. "The Web site is just another way to meet men," says Angie. "It's not the only way."
SOME PEOPLE ARE SO TRAUMATIZED AFTER CONtracting an STD that they vow to date only people who also have the disease. This is how Kimberlee, 33, an accounting assistant who works in Annapolis, reacted. She was 19, engaged, and having unprotected sex with her fiancé when she noticed a small red spot on his penis. He shrugged it off, claiming he caught it in his zipper.
A few weeks later, she called off the wedding because she felt she was too young to be married. Around that time, she started to feel a burning sensation when she urinated. Her doctor told her she had a urinary-tract infection and sent her home with pills. With many sexually transmitted diseases, the symptoms are similar to urinary infections--and people are often misdiagnosed on their first visit to the doctor. Medical tests can also mislead: Holly Blanchard of PPMW says in the screening of men for chlamydia, lab results are wrong 25 percent of the time.
Kimberlee realized she had herpes when a later boyfriend, who had been a virgin when they met, had an outbreak. He broke up with her. It hit Kimberlee hard. "I thought about suicide," she says. She tried to cheer herself up and dated a few guys--one said he didn't care that she had herpes; another got up and walked away--and then she was diagnosed with genital warts. "That's when I decided I didn't want to have that talk," she says. "I don't want to meet someone, fall in love, and then have them reject me. If they have the disease, it's just easier."
There's not necessarily a best time to have the talk. Joe Delan tells a woman within the first hour he's met her because he doesn't want to get smitten and then be rejected. Anna waits a few dates because she finds men are more accepting if they know her better.
Herpes-support-group leader Mark Wasserman recommends telling someone when you're comfortable. "There's no right time," he says. He adds that you should educate people--what are they putting themselves at risk for and how they can protect themselves.
Kimberlee spent the past decade finding dates through H20, a social group she helped start. The group brings together people with herpes for events at places like Dave & Buster's and Hard Times Cafe. Her picture is on the Meet People With Herpes Web site: "I'm a strong, independent, outgoing woman. I love to dance!"
This past New Year's Eve, she was dancing at Rumblefish, a Baltimore nightclub, when she met Andy. They started dancing, their bodies blending as they rolled their groins into each other. After a few hours, he pulled her aside. "What is it you have to tell me?" he yelled over the loud music. It had been years since Kimberlee had had to tell anyone who didn't have an STD that she had one. She gathered her courage. "I have HPV and herpes," she yelled back. His face looked shocked, she says, but he still asked for her number--and called the next morning.
They have spent nearly every day together since and feel as though they've known each other for years. Kimberlee says she's told him all of the risks. Andy says he's not worried. "Love is blind," he says.
Not everyone reacts so indifferently. Paige, a 31-year-old communications manager at a local nonprofit, has been with her boyfriend, Joseph, more than a year. He has accepted that she has herpes. But being on his side of the relationship can be hard. Worried about catching the virus, he insists they use condoms whether or not she's having an outbreak. He also won't perform oral sex. "It kind of bothers me," she says. "But I want him to remain healthy."
Paige says they are in love and are probably in it for the long haul, but she admits that Joseph's caution does cause tension. There are many conversations they haven't had--for instance, if he never takes the condom off, how will they have children?
FOR ALL OF THEIR SEXUAL PROWESS, THEfabulous four on HBO's hit show Sex and the City rarely talk about condoms, let alone STDs. The demure Charlotte got crabs, or pubic lice, last season but was quickly cured. And even after Miranda had chlamydia in the third season, Samantha grabbed a stranger at a party and had sex with him in a closet without any mention of protection. Carrie has also had her share of partners.
"The truth of the matter is if you're living in New York City and sleeping around the way they are," says University of Maryland's Robin Sawyer, "then you have herpes, chlamydia, gonorrhea, or something of the sort."
A true scene from sex in our city looks more like Kate lying on an examining table about to get a Q-Tip stuck up her urethra--one way to test for chlamydia.
"It's unglamorous to portray this on TV," says Sawyer. "But real life is not glamorous. It's not an MTV video. The reality is if you have unprotected sex, you get an STD."
The glossy images of sexuality we see in the mass media can be misleading, says Tara Torchia, a sexual-health counselor at the University of Maryland Health Center. She says she's surprised by how naive some students are.
"People don't associate an STD with someone who fits their ideal of beauty," she says. "But you can't see an STD. People think they can look at someone and tell if they have one."
While STDs affect people across ethnic, age, and class lines, women are infected in disproportionate numbers. According to the Centers for Disease Control, the number of women reporting chlamydia is four times the number of men. And although the total of men with gonorrhea is higher, among white Americans 34,000 women are infected versus 21,000 men. Herpes infects one in four women versus one in five men.
Some experts say the greater numbers of women with STDs has to do with testing; there are better screening tests for women. Others point to human physiology. Women have more mucus membranes in the genital area. This increases the chance of creating microscopic tears in the vagina, making an STD more easily transmittable.
AS CHALLENGING AS IT IS TO GET OVER THE INItial emotional punch of being diagnosed with an STD, Mark Wasserman says, "over time people learn to love themselves again." They become more accepting and thankful if they haven't contracted something life-threatening like HIV. "If herpes is the worst thing that's happened to you, then you can turn on the six-o'clock news and feel a lot better about yourself," says Joe Delan.
When Lynn Marshall, a senior program assistant for the National Education Association, found out she'd contracted herpes two years ago, she thought: Why is God putting this in my life?
She says she eventually decided, "This is God's way of telling me to slow down. I've had a lot of unprotected sex over the years. I'm thankful it wasn't something worse."
She says having herpes has made her more giving. Marshall is open about her disease--a conscious choice she made to help educate others. An acquaintance recently reached out to her and admitted she had herpes. Marshall feels she's helped the woman come to terms with the disease.
It's also made her appreciate just being alive. Her feelings were so intense that she was inspired to donate a kidney to her hairdresser, something that wouldn't have crossed her mind before.
Mark Wasserman says that contracting a sexually transmitted disease "has the capacity to help you re-evaluate how you live your life. It makes people realize: We are all simply struggling to be human and overcome our own adversities." *
"A relationship is the last place you think something like this will happen. The fact she didn't tell me hurt."
Photograph for The Washingtonian by CHRIS WHALEN
"Herpes was God's way of telling me to slow down. I'm thankful it wasn't something worse."
Photograph for The Washingtonian by CHRIS WHALEN
"I didn't have any education on STDs. I didn't know what I was risking."
Photograph for The Washingtonian by CHRIS WHALEN
"People diagnosed with herpes temporarily lose the ability to love themselves."
Photograph for The Washingtonian by CHRIS WHALEN
Women might be surprised by what Pap smears and pelvic exams test for, says Robin Sawyer, professor of sexual health at the University of Maryland.
A Pap smear looks only for abnormal cell changes, which might be a symptom of cervical cancer or of human papillomavirus (HPV). Because 80 percent of people who have an STD have no symptoms, it's unlikely your doctor would detect anything other than HPV unless you specifically ask to be tested for other diseases.
Holly Blanchard of Planned Parenthood of Metropolitan Washington (PPMW) suggests getting tested for all STDs each time you are close to being intimate with a new partner. At the very least, she says, men and women should get tested once a year.
Younger women who have multiple partners should be tested twice a year for chlamydia, says the American Social Health Association, because of its prevalence among 15- to 24-year-olds. Women are less likely to show symptoms than men.
While some viruses, such as herpes and HIV, can be revealed by a simple blood test, other tests can be uncomfortable. One test for chlamydia requires inserting a Q-Tip into the uretha.
"There is no such thing as safe sex," says Blanchard. "But there is safer sex."
The only way to protect yourself from an STD completely is to abstain from sex. But reducing the number of sexual partners helps.
Condoms help guard against herpes and HPV--viruses passed along through skin-to-skin contact. Condoms also help block infected fluids, providing protection against HIV, chlamydia, and gonorrhea.
Many people stop using condoms after they've been with someone a few weeks. "Don't," says Stacey Little, vice president of community education at PPMW. "You don't know how long that relationship is going to last."
The American Social Health Association recommends using a water-based spermicide in addition to a condom. It won't defend against viruses, but it does help kill chlamydia and gonorrhea bacteria.
Talk to your partner about his or her sexual history. Ask partners if they've been tested recently for STDs. If they haven't, encourage them.
If you like someone who has herpes, HPV, or HIV, you don't have to say goodbye to your health to be with them. Latex condoms protect against HIV 98 percent of the time. As long as you don't have sex with someone during a herpes outbreak, or 72 hours before and after, you most likely won't contract it. And once someone with HPV has the warts removed, the risk of your getting the disease is slim.
One out of four sexually active teenagers gets a sexually transmitted disease. Few teens are aware of how common these diseases are and of how to protect themselves.
"They think they know more than they do," says Sara Fiorini, a health-education teacher at Washington-Lee High School in Arlington. "They hear about HIV so much. But they don't hear about people dying from the other STDs, so they don't worry about them."
Part of the problem with teenagers, she says, is they don't equate oral and anal sex with "real" sex. They don't realize you can get all of the same diseases you could if having intercourse.
Stacey Little, vice president of community education at Planned Parenthood of Washington (PPMW), visits schools, churches, and youth organizations to teach young people about sexuality. When STDs come up, there are always lots of questions.
"It's always a friend of theirs that has a burning or an irritation; it's never them," she says. "Young people are afraid of being ostracized by their peers."
Little says that the lack of maturity among teenagers helps spread disease. In high school, having the wrong kind of sneakers makes you an outcast. Imagine telling someone you have an STD.
And the last thing many teens want to do is tell their parents they may have an STD. "That would be admitting they were sexually active," Little says.
That's assuming the teen knows he has a sexually transmitted disease. Teenagers can be uncomfortable with their bodies and may ignore or not recognize symptoms--or may not have any at all.
At Montgomery Blair High School in Silver Spring, students are given two weeks of sexual-health education in the tenth grade, including one week on STDs. Maryland and the District tend to be more liberal than Virginia when it comes to what health teachers can and can't teach.
Virginia is the only jurisdiction in the metro area that does not require sexual education. If it is taught, the state requires instruction on STDs but only in terms of abstinence.
Stacy Weibely teaches sexual education as a volunteer in the District's César Chávez School for Public Charter High School for Public Policy. She is also a senior public-policy associate at the Sexuality Information and Education Council of the United States (SIECUS). She says DC has one of the best sexual-education requirements in the country, but few DC schools have the resources to hire a sexual-health educator. Instead they call on volunteers like Weibely to give instruction.
Weibely says local private schools--with the exception of the Catholic schools--provide good sexual-health programs.
Susan Soulé, a health educator at Montgomery Blair, says everything she teaches about sexuality should be a supplement to what kids are learning at home. But she suspects many parents aren't talking to their kids.
"Parents get scared," she says. "And kids shut their door the moment a parent gives away their discomfort with a facial expression or through body language."
"If parents don't do anything outside of what they think their kids are getting in school," says Fiorini, "it goes in one ear and out the other."
FOR INFORMATION ON HOW TO TALK TO your children about sexuality and sexually transmitted diseases, visit www.siecus.org. Teenagers looking for easy-to-understand information about STDs can visit www.iwannaknow.org.
It infects 45 million Americans--one in four sexually active women, one in five men.
Symptoms: Small blisters or pimples in the genital area that may crust over and scab. You could also experience flulike symptoms--fever, swollen glands in lymph nodes near groin. Mild outbreaks can be mistaken for jock itch, ingrown hairs, razor burn, or a yeast infection.
Incubation period: First outbreak often occurs two weeks after infection, but it may be so mild you don't realize you have herpes until months or years later.
Treatment: Herpes cannot be cured. One of three medications--Zovirax, Famvir, and Valtrex--can be taken during outbreaks to relieve symptoms. These drugs can be taken more frequently to decrease the number of outbreaks.
Twenty million people are infected; more than 5 million new cases each year.
Symptoms: Of the 30 strains of HPV, most are asymptomatic. Three strains cause genital warts--small, flesh-colored bumps with a cauliflowerlike appearance. Some are so small you won't be able to see them. Men often have no symptoms.
Incubation period: Warts take several weeks to several months or years to appear--or not at all.
Treatment: HPV cannot be cured. Pap smears detect asymptomatic strains, helping doctors ensure that the virus doesn't lead to infertility or cervical cancer. Smaller warts can be treated with topical creams. Other warts have to be burned, frozen, or lasered off. In either case, warts often will reappear. Those with strong immune systems, especially young people, have been known to fight off the disease naturally.
Infects 3 million people a year.
Symptoms: 80 percent of women infected (40 percent of men) won't see symptoms. Some women experience unusual vaginal discharge or bleeding, burning during urination, or abdominal pain. Men should look for pain during urination, swelling in the testicles, or a burning or itchy discharge from the penis.
Incubation period: One to three weeks.
Treatment: The antibiotic Zithromax or several days of doxycycline. The infection will go away. You should also be treated for gonorrhea because of the tendency of these two infections to coexist.
Infects 650,000 a year.
Symptoms: In early stages of infection, 80 percent of women show no symptoms. Both men and women may experience frequency and pain associated with urination or an unusual discharge. Women may mistake it for a yeast infection.
Incubation period: 1 to 30 days.
Treatment: Rocephin or Cipro and several days of doxycycline. The infection will go away. You should also be treated for chlamydia because of the tendency of these two infections to coexist.
Infects 500,000 people in the United States; 20,000 new cases each year.
Symptoms: Most do not have any symptoms; some experience a week of mild to severe flulike symptoms soon after being infected. Otherwise, there are no signs until AIDS sets in--weakening the immune system so dramatically that a cold becomes life-threatening.
Testing: The most common way to detect HIV is a blood test. Another test examines a swab of cells from your mouth. Home tests that involve drawing your own blood can be purchased in drugstores.
Incubation period: Three months after infection.
Treatment: There is no cure. Breakthroughs in treatment have prolonged life for some patients by as much as 20 years. But the seven-pill "cocktail" taken daily can cause side effects that range from redistribution of body fat to long-term problems such as liver damage.