The Centers for Disease Control and Prevention estimates that in 2007, there were approximately 24,000 HIV-infected youth between 13 and 24 years of age in the US. Currently, HIV infection is the seventh leading cause of death in this age group. During 2001–2004, in the 33 states with confidential name-based HIV reporting, there were 17,824 persons 13–24 years of age with a diagnosis of HIV/AIDS, of whom 62% were males.
While HIV/AIDS remains incurable, early diagnosis and treatment has allowed those who are HIV-infected to lead longer, productive lives. However, there are many other sexually transmitted infections (STI’s) that most teenagers can also contract. Though fatalities are rare among other STIs, they can lead to infertility and ectopic pregnancies—the latter of which is life threatening.
In addition, other STIs such as —including chlamydia, gonorrhea, herpes and syphilis—also make those who are infected with these conditions more vulnerable to HIV infection.
Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)
AIDS is caused by the human immunodeficiency virus (HIV), which is spread through unprotected sexual intercourse with an infected person or through using a contaminated needle to inject drugs. It can also be spread through intravenous drug use and much less commonly, blood, blood products, needles, or other sharp instruments contaminated with infected body fluids or blood.
Upon entering the circulation, the HIV microorganisms abduct a type of white blood cell known as T-helper lymphocytes (also known as CD4 cells, T cells or helper-Ts). In a person with a healthy immune system, T-cells band together to help defend the body against diseases. But the hijacked T-cells are forced to mass-produce copies of HIV. Left untreated, helper T cells mass produce large numbers of HIV, this further depletes the number of normal helper-Ts in the blood stream, rendering the individual vulnerable to AIDS defining illness.
The five most common of these are:
- Pneumocystis carinii pneumonia
- HIV wasting syndrome
- Candidiasis of the esophagus
- Tuberculosis
- Kaposi’s sarcoma
Opportunistic illnesses pose minimal threat when the immune system is functioning properly, however when the body’s defenses are down, as in AIDS, they seize the opportunity to create havoc.
For the first ten years of the AIDS crisis, the disease was a virtual death sentence for most of its victims. Few survived more than two years, on average. However, today there are many different types of medications available for the control of HIV. While HIV remains incurable, good adherence to medications can allow those infected to lead long productive lives and never develop AIDS.
With introduction of highly active antiretroviral therapy, AIDS diagnoses and deaths declined substantially in the United States from 1995 to 1998 and remained stable from 1999 to 2008 at an average of 38,279 AIDS diagnoses and 17,489 deaths per year, respectively. Despite the decline in AIDS cases and deaths, at the end of 2008 an estimated 1,178,350 persons were living with HIV, including 236,400 (20.1%) whose infection remains undiagnosed. In particular, the undiagnosed HIV infections leave the sexual partners of these persons at high risk of infection.
Chlamydia
Chlamydia, the most prevalent bacterial STI in the United States, is the result of the Chlamydia trachomatis bacterium, which can infect the urethra (bladder opening) and cervix (uterus opening). It is common in youngsters aged fifteen to nineteen. The disease is easily treated, but like other sexually transmitted infections, chlamydia tends to be silent and therefore go undiagnosed until it becomes more serious than in its early stages. Three in four women and one in two men have no symptoms. In 40 percent of cases, by the time a girl seeks medical attention, the disease has progressed to pelvic inflammatory disease (PID, described below), a major cause of female infertility and pelvic pain.
Gonorrhea
Chlamydia infection is sometimes confused with gonorrhea, another bacterial infection transmitted through vaginal and anal intercourse, and oral sex. Not only do they share many of the same symptoms, the two diseases can occur together.
Gonorrhea usually begins in the urethra (bladder opening) or the cervix. However, the rapidly proliferating Neisseria gonorrhoea bacterium can migrate to the uterus and the fallopian tubes, giving rise to pelvic inflammatory disease (PID). The infection, like chlamydia, may also involve the rectum.
Pelvic Inflammatory Disease (PID)
A number of different microorganisms can cause pelvic inflammatory disease of the upper female reproductive tract. The two most common culprits are Chlamydia trachomatis and Neisseria gonorrhoea, which account for four in five cases.
Sexually active girls aged fifteen to nineteen are the most vulnerable population, partly because they are more likely than other age groups to have multiple sex partners.
PID from chlamydia infection typically produces mild symptoms or none at all, but should be treated promptly. Otherwise, like other forms of PID, it can inflame and scar the ovaries and the fallopian tubes. PID from gonorrhea, on the other hand, can produce what Dr. Meg Fisher of Philadelphia’s St. Christopher’s Hospital for Children characterizes as “the worst lower-abdominal pain a girl has ever had. That’s what brings most of them in to the doctor.”
Because PID affects the fallopian tubes, where conception takes place, if the scarring is severe enough, the male sperm may be prevented from reaching the female egg. In other words, sterility can be the final outcome of PID.
Genital Warts and Human Papillomavirus (HPV)
Scientists have identified more than one hundred types of this virus. A number of them are passed from one person to another during unprotected sex and cause benign genital warts (condylomata acuminata). Other human papillomaviruses are responsible for four in five cases of cervical cancer, in addition to several other genital malignancies.
HPV is another, often silent, STI. According to the National Institute of AIDS and Infectious Diseases, almost half the women harboring the virus exhibit no symptoms at all. Genital warts typically appear in clusters inside and outside the vagina, the cervix and/or the anus. Male venereal warts, which are far less common, form on the penis, the scrotum and/or around the anus. The pinkish or flesh-colored growths often vanish on their own.
The interventions for genital warts differ from those for other STIs. Most cases can be managed with topical treatment of the warts, though the lesions tend to return. Large warts may have to be removed using one of several surgical procedures: cryosurgery (freezing), electrocautery (burning) or laser surgery.
Genital Herpes (HSV-1, HSV-2)
There are two types of herpes simplex viruses, the highly contagious virus that causes genital herpes. “Herpes simplex 2 usually occurs on or around the vagina, the penis, the anus or on the buttocks and thighs,” says Dr. Fisher, “whereas herpes simplex type 1 generally causes cold sores around the outside of the mouth, or blisters on the gums or in the throat.” However, HSV-1 sometimes infects the genital-anal area, while both types can be transmitted to the mouth via oral sex.
Because the virus permanently inhabits sensory nerves at the base of the spinal cord, genital herpes is a chronic, lifelong condition. Most of the time, HSV lies dormant. But it is reactivated periodically and produces sores or vessicles—most notably, clusters of tiny ulcers that resemble cold sores. These outbreaks, which typically last about one week, should be taken as a warning that the disease is contagious. The virus travels up the nerves that lead to the surface of the skin, where it proliferates, giving rise to new sores. (Initial symptoms of genital herpes tend to be more severe and longer-lasting than subsequent episodes.) The disease can be infectious even if no sores or lesions are present.
Teenagers need to know that “at least half the time, active herpes produces no symptoms at all,” Dr. Fisher emphasizes. “So the virus can easily be transmitted sexually without either partner being aware that the carrier has active disease.” Recurrences flare up regularly in some people but can be unpredictable in others. Why they occur remains a mystery, although stress, menstruation, illness and sunlight exposure appear to be possible triggers.
Syphilis
Until the early 1940s, when the antibiotic penicillin entered into widespread commercial use, epidemics of syphilis had been reported for centuries. Even today the onetime scourge can be fatal if left untreated. The bacterium Treponema pallidum eventually slips into the bloodstream, which sends it to organs outside the reproductive tract.
Physicians divide the course of the disease into three stages: primary (stage 1), secondary (stage 2) and tertiary (stage 3). The first evidence of syphilis is a hard, round open sore known as a chancre (pronounced “shan-ker”) in the genital area. Young women often don’t realize that they are infected, says Dr. Fisher, “because the initial chancre typically may develop inside the vagina; whereas with boys, it forms on the outside of the penis and is noticed immediately.”
Since syphilis chancres aren’t painful and typically heal within four to six weeks, most boys don’t see a doctor. They assume the mysterious sore is gone for good, but one-third of men and women exposed to primary syphilis progress to a secondary infection. A few weeks after the chancre heals, they come down with a rash on the palms of their hands and the soles of their feet. The reddish-brown spots, about the size of a penny, can spread anywhere on the body. Other unwanted symptoms soon follow. Syphilis is still highly treatable at this point. However, a pregnant woman with primary or secondary syphilis will almost certainly transmit the bacterium to her fetus. Infection early in fetal life leads to death and abortion; infection later in pregnancy leads to a variety of problems including anemia, bleeding, swollen glands and infection of the various organs, such as the lungs, spleen and brain.
Symptoms That Suggest Sexually Transmitted Infections May Include:
HIV/AIDS
- Headaches
- Difficulty swallowing
- Fever
- Night sweats
- Fatigue/weakness
- Appetite loss
- Weight loss
- Chronic diarrhea
- Nausea/vomiting
- Itchy, rashy skin/skin lesions
- Chronic coughing
- Confusion/delirium
- Difficulty breathing
Chlamydial Infection
Symptoms typically occur one to three weeks after exposure.
Women:
- Abnormal vaginal discharge
- Mild pain when urinating
- Progression to pelvic inflammatory disease
Men:
- Penile discharge
- Mild pain when urinating
- Progression to epididymitis, an inflammation of the tubelike structure that stores and transports sperm
Gonorrhea
Symptoms typically occur two to ten days after exposure.
Men:
- Penile discharge
- Mild to severe burning sensation when urinating
- Can progress to epididymitis
Women:
- Painful or burning sensation when urinating and/or yellow or bloody vaginal discharge
- Abdominal pain
- Bleeding between menstrual periods
- Vomiting
- Fever
- Progression to pelvic inflammatory disease
Rectal Infection:
- Anal discharge
- Anal itching
- Painful bowel movements
Pelvic Inflammatory Disease (PID)
- Lower abdominal pain
- Abnormal vaginal discharge
- Fever
- Painful intercourse
- Irregular menstrual bleeding
Genital Warts/Human Papillomavirus (Hpv)
Symptoms typically occur three months after exposure.
Women:
Clusters of tiny warts outside and inside of the vagina, on the cervix or around the anus
Men:
Clusters of tiny warts on the penis, scrotum or anus
Genital Herpes
Symptoms typically occur two to ten days after exposure. Initial episode, typically lasting two to three weeks:
- Itching or burning sensation in the genitals or anus
- Pain in the genitals, buttocks, legs
- Vaginal discharge
- Feeling of pressure in the abdomen
- Tiny red bumps involving the vagina, cervix, penis and/or anal area; these turn into blisters and then become painful open sores
- Fever
- Headache
- Muscle aches
- Painful or difficult urination
- Swollen glands in the groin
Recurrences, typically lasting about one week:
- Itching or tingling sensation in the genitals, buttocks or legs
- Small blisters or open sores at the site of infection
Syphilis
Stage 1: Primary Syphilis
Initial symptoms typically occur two to six weeks after exposure and last four to six weeks.
- Painless chancre on the penis, vulva, vagina, cervix or around the mouth
- Inflamed lymph nodes
Stage 2: Secondary Syphilis
Symptoms typically occur one to six weeks after the chancre heals and last three to six months.
- Light rash with brown sores roughly the size of a penny, typically on the palms of the hands and soles of the feet; may also cover the rest of the body
- Sores in or around the genitals or anus
- Mild fever
- Fatigue
- Headaches
- Sore throat
- Patchy hair loss
- Appetite loss
- Weight loss
Stage 3: Tertiary Stage
Symptoms typically occur anywhere from two years to more than forty years after the onset of infection.
Syphilis in multiple systems, including the heart and blood vessels, skin, bones and brain.