A large, painless, ulcer-like sore known as a chancre occurs two to six weeks after infection and generally appears around the area of sexual contact. The chancre disappears within a few weeks.

Once syphilis reaches this stage, it may go unnoticed for years quietly damaging the heart, central nervous system, muscles and various other organs and tissues. The resulting effects are often fatal.

If you’ve been exposed to syphilis or have its symptoms, see a doctor or consult your county health department. For syphilis in its early stages, treatment consists of penicillin. If the disease has progressed further, you’ll require three consecutive weekly injections. (If you’re allergic to penicillin, you’ll receive an alternative antibiotic taken orally for two to four weeks.) You should have a blood test 3,6 and 12 months after treatment to be sure the disease is completely cured.

Once treatment is complete, you’re no longer contagious.

Questions to Ask

Do you have a large, painless ulcer-like sore (chancre) in the genital area, anus or mouth?
Did you have such a sore several weeks to months ago that healed, but not experience flu-like symptoms (fever, headache, general ill-feeling) and/or a skin rash of small, red, scaling bumps that do not itch?
Are you suspicious of having contracted syphilis or another sexually transmitted disease from someone you suspect may be infected?
Do you want to rule out the presence of syphilis or another sexually transmitted disease because you or your sex partner have had multiple sex partners and are considering a new sexual relationship, planning to get married or pregnant?
Self-Care Prevention Tips There’s only one way to guarantee you’ll never get a sexually transmitted disease: Never have sex. Limiting your sexual activity to one person your entire life is a close second, provided your partner is also monogamous and does not have a sexually transmitted disease. Avoid sexual contact with persons whose health status and practices are not known. Don’t have sex while under the influence of drugs or alcohol (except in a monogamous relationship in which neither partner is infected with an STD). Avoid sex if either partner has signs and symptoms of a genital tract infection. Discuss a new partner’s sexual history with him or her before beginning a sexual relationship. (Be aware, though, that persons are not always honest about their sexual history.) Latex condoms can reduce the spread of sexual diseases when used properly and carefully and for every sex act. They do not eliminate the risk entirely. Both women and men should carry latex condoms and insist that they be used every time they have sexual relations. Using spermicidal foams, jellies, creams (especially those that contain Nonoxynol-9) and a diaphragm can offer additional protection when used with a condom. Use water-based lubricants such as K-Y Brand Jelly. Don’t use oil-based or “petroleum” ones such as Vaseline. They can damage latex condoms. Wash the genitals with soap and water before and after sexual intercourse. Seek treatment for a sexually transmitted disease if you know your sex partner is infected. Ask your doctor to check for STDs every six months if you have multiple sex partners even if you don’t have any symptoms.

These are signs of gradual, age-related hearing loss called presbycusis. High pitched sounds are the ones to go first. Hearing loss from presbycusis cannot be restored, but hearing aids, along with the Self-Care Tips listed on page 61 can be helpful.

Hearing loss can also result from other things:

• Acoustic trauma – This may be caused by a blow to the ear or from excessive noise. Excessive noise includes that heard from low-flying airplanes when living near an airport, when flying in an airplane, or when working with heavy, loud machinery.
  
• Blood vessel disorders including high blood pressure.
  
• A blood clot that travels to nerves in the ear.
  
• Ear wax that blocks the ear canal.
  
• Chronic middle ear infections, or an infection of the inner ear.
  
• Meniere’s disease (a disease marked by excess fluid in canals of the inner ear which help maintain balance).
  
• Multiple sclerosis.
  
• Syphilis.
  
• Brain tumor.
  

• Ask people to speak clearly, distinctly, and in a normal tone.
  
• Look at people when they are talking to you. Watch their expressions to help you understand what they are saying. Ask them to face you.
  
• Try to limit background noise when having a conversation.
  
• In a church or theater, sit up front.
  
• To rely on sight instead of sound, install a buzzer, flasher, or amplifier on your telephone, door chime, and alarm clock. Also, an audiologist (hearing therapist) may be able to show you other techniques for “training” yourself to hear better.
  

• Lie on your side. Using a syringe or medicine dropper, carefully squeeze a few drops of lukewarm water into your ear (or have someone else do this). Let the water remain there for 10-15 minutes and then shake it out. Do this again, but use a few drops of hydrogen peroxide, mineral oil or an over-the-counter cleaner such as Murine Ear Drops or Debrox. Let the excess fluid flow out of the ear.
  
• After several minutes, follow the same procedure using warm water again, letting it remain there for 10-15 minutes. Tilt the head to allow it to drain out of the ear.
  

To prevent hearing loss:

• Don’t put cotton-tipped swabs, fingers, bobby pins, etc. in your ear.
  
• Don’t blow your nose with too much force. It is better to do so “gently” with a tissue or handkerchief held loosely over the nostrils.
  
• Avoid places that have loud noises (airports, construction sites, etc.). Protect your ears with earplugs.
  
• Keep the volume on “Walkmans”, car stereos, etc., on low. If someone else can hear the music when you have earphones on your head, the volume is too loud.
  
• Follow your doctor’s advice for disorders that can cause hearing loss (Example: High blood pressure, Meniere’s disease, etc.).
  
• Avoid prolonged use of medicines that cause hearing loss or overdosing on such medications. (Example: Heavy use of aspirin, streptomycin, quinine).
  

• Hearing aids (See your doctor).
  
• Devices made to assist in hearing sounds from the TV and radio.
  
• Special equipment that can be installed in your telephone by the telephone company.
  
• Portable devices made especially to amplify sounds. (These can be used for movies, classes, meetings, etc.).
  

In a child: Does the child not respond to any sound, even a whistle or loud clap? (Did the child’s mother have German measles when pregnant with the child)? Does the child not respond to sounds after experiencing any of these things? Recent earache or upper respiratory infection Airplane travel
In a child or adult: Do you have any of the following with the hearing loss? Discharge from the ear Earache Dizziness or feeling that things are spinning around you Recent ear or upper respiratory infection Feeling that the ears are blocked or filled with wax
Can you not hear a regular (non-digital) watch ticking when held next to the ear?
Do you hear a ringing sound in one or both ears all of the time?
Did you lose your hearing after being exposed to loud noises such as those associated with airplanes, work or hobby related loud noises (i.e., heavy machinery, power tools, firearms, etc.) and has this not gotten better?

Five common STDs in women are:

• Chlamydia.
  
• Genital Herpes.
  
• Gonorrhea.
  
• Syphilis.
  
• Trichomoniasis.
  
• Acquired immune deficiency syndrome (AIDS) is often classified as a sexually transmitted disease, but can be passed through means other than sexual contact. So, although mentioned at times, it is not defined here. (See page 34 for information on AIDS).

STDs are on the rise. This may be due to:

• Liberal sexual attitudes.
  
• Increased number of single adults who have casual sex.
  
• Having multiple sex partners.
  
• Less use of barrier methods of birth control, such as condoms and diaphragms in the past years, especially during the pre-AIDS era.
  
• Failure to test for STDs during regular physical exams.

Each STD has its own set of symptoms and treatment:

Chlamydia is caused by different strains of the bacterium chlamydia trachomatis. It is the most common STD.
In women, symptoms include slight yellowish-green vaginal discharge, vaginal irritation, a frequent need to urinate and pain when urinating. There can also be chronic abdominal pain and bleeding between menstrual periods. In men, symptoms include burning or discomfort when urinating, a whitish discharge from the tip of the penis and pain in the scrotum. These symptoms can, however, be so mild that they often go unnoticed. It is estimated that 75% of women and 25% of men who have chlamydia have no symptoms until complications set in. If they do appear, they usually do so two to four weeks after being infected. The only sure way to know whether or not you have chlamydia is to be tested for it.

Treatment for chlamydia includes oral antibiotics such as doxycycline or azithromycin. Erythromycin is used if a woman is pregnant or allergic to other antiobiotics. Doctors should treat the infected person’s sexual partner even if he or she doesn’t show any symptoms. Sex should be avoided until treatment is completed in both the person affected and in their sex partners. If left untreated, chlamydia can cause a variety of serious problems including pelvic inflammatory disease and infertility in women and infection and inflammation of the prostate and surrounding structures in men. Infants born to mothers who have chlamydia are likely to develop pneumonia or a serious eye infection in the first several months of life as well as permanent lung damage later on.

Genital herpes is caused by the herpes simplex virus II. The herpes simplex virus I is another form of the herpes virus, but it is usually limited to the oral area and shows up as fever blisters or cold sores. Engaging in oral sex can spread oral herpes to the genitals and genital herpes to the mouth, lips and throat. Both herpes simplex viruses are spread by direct skin to skin contact from the site of infection to the contact site. Once you are infected, these viruses remain with you forever.

Symptoms occur, though, only during flare-ups. Symptoms of herpes simplex virus II include sores with blisters on the genital area and anus and sometimes on the thighs and buttocks. After a few days, the blisters break open and leave painful, shallow ulcers which can last from five days to three weeks. If infected for the first time, you may experience flu-like symptoms such as swollen glands, fever and body aches, but subsequent attacks are almost always much milder. These attacks may be triggered by stress, emotional distress, fatigue, menstruation, other illnesses or even by vigorous sexual intercourse. Itching, irritation and tingling in the genital area may occur one to two days before the outbreak of the blisters or sores. This period is called the prodrome. Genital herpes is contagious during the prodrome, when blisters are present and up to a week or two after they have disappeared. If a pregnant woman has an outbreak of genital herpes when her baby is due, a Caesarean section should be performed so the baby does not get infected during delivery. No cure exists for genital herpes.

Treatment includes the prescription medication Zovirax, in oral and/or topical ointment forms, as well as self-care procedures to treat herpes symptoms. (See “Self-Care Procedures for Genital Herpes on page 58). Medical care is especially helpful during the first attack of genital herpes. Self-care procedures may be all that is necessary during recurrent episodes.

[Note: Sores and blisters that look like herpes can be a side effect of taking certain prescription medicine in some people. One example is sulpha drugs which are often used to treat urinary tract infections. Consult your doctor if you suspect this.]

Gonorrhea, often called the clap, dose, or drip, is one of the most common infectious diseases in the world. Gonorrhea can be symptom-free. In fact, about 60 – 80% of infected women have no symptoms. The signs of gonorrhea can, however, show up within two to ten days after sexual contact with an infected person. In women, symptoms include mild itching and burning around the vagina, a thick, yellowish-green vaginal discharge, burning when urinating and severe lower abdominal pain, usually within a week or so after their menstrual periods. In men, symptoms include pain at the tip of the penis, pain and burning during urination and a thick, yellow, cloudy, penile discharge that gradually increases.

If ignored, gonorrhea can cause widespread infection and/or infertility. But gonorrhea can be cured with injections of specific antibiotics such as Ceflasporin. If you’ve been infected with a type of gonorrhea that’s resistant to penicillin, your doctor will have to use another antibiotic.

To treat gonorrhea successfully:

• You and your sex partner should take prescription medicine in order to avoid re-infection.
  
• Have follow-up cultures to determine if the treatment was effective

Syphilis, sometimes called pox or bad blood is one of the worst STDs. It can lead to heart failure, blindness, insanity or death if left untreated. It is caused by a bacterium called Treponema pallidum. You get this STD through direct contact with a sore or lesion on an infected sexual partner. An unborn child can also contract syphilis from an infected mother.

Syphilis can progress slowly, through three stages, over a period of many years. When detected early, however, syphilis can be cured. Be alert for the following symptoms:

• Primary stage – A large, painless, ulcer-like sore known as a chancre occurs two to six weeks after infection and generally appears around the area of sexual contact. The chancre disappears within a few weeks.
  
• Secondary stage – Within a month after the end of the primary stage, a widespread skin rash appears, cropping up on the palms of the hands, soles of the feet and sometimes around the mouth and nose. The rash has small, red, scaling bumps that do not itch. Swollen lymph nodes, fever and flu-like symptoms may also occur and small patches of hair may fall out of the scalp, beard, eyelashes and eyebrows.
  
• Latent stage – Once syphilis reaches this stage, it may go unnoticed for years, quietly damaging the heart, central nervous system, muscles and various other organs and tissues. The resulting effects are often fatal.

If you’ve been exposed to syphilis or have its symptoms, see a doctor or consult your county health department. Treatment for syphilis in its early stages consists of a single injection of long-lasting penicillin. If the disease has progressed further, you’ll require three consecutive weekly injections. If you’re allergic to penicillin, you’ll receive an alternative antibiotic, to be taken orally for two to four weeks. After treatment, you should have a blood test at 3, 6 and 12 months to be sure the disease is completely cured. Once treatment is complete, you’re no longer contagious.

Unlike most sexually transmitted diseases, trichomoniasis is caused by a parasite rather than by bacteria or a virus. The trichomoniasis parasite can be present in the vagina for years without causing symptoms. If they do occur, typical symptoms for women include vaginal itching and burning, a greenish-yellow vaginal discharge, and burning or pain when urinating. Sexual Intercourse can be painful. In men, symptoms include mild itching and irritation of the penis, pain during intercourse and discomfort when urinating. Men who have trichomoniasis usually don’t experience any symptoms, though, and may unknowingly infect their sexual partners.

Trichomoniasis is diagnosed by examining a drop of vaginal fluid under a microscope. The oral medication metronidazole (brand name Flagyl), is used to treat trichomoniasis. If you’re a woman, don’t take this drug during the first three months of pregnancy. Avoid drinking alcohol for 24 hours before, during and 24 hours after taking the metronidazole. The combination causes vomiting, dizziness and headaches. Sexual partners of an infected person should also be treated to prevent getting infected again, or spreading the infection further.

Do you have a large, painless ulcer-like sore (chancre) in the genital area, anus or mouth? Did you have such a sore 2 to 6 weeks ago that healed, but now experience flu-like symptoms such as fever, headache, general ill-feeling and/or a skin rash of small, red, scaling bumps that do not itch?
Does your sex partner have any of these problems? A whitish discharge from the penis. Burning or discomfort when urinating. Pain and swelling in the scrotum. Pain during intercourse. Irritation and itching of the penis.
Do you have any of these problems? Itching and burning around the vagina. A vaginal discharge. This could be slight, cloudy or greenish-yellow in color with an offensive odor. Burning or pain when urinating. The need to urinate often. Discomfort in the lower abdomen. Abnormal bleeding from the vagina. Bleeding between menstrual periods.
Do you have sores and/or painful blisters on the genital area, anus or tongue and is this the first time you have had this? Do you have a low-grade fever, headache, general muscle ache and an over-all ill feeling? Have you had sexual relations with someone who had sores or blisters on their genital area, anus or tongue, or was experiencing genital itching, irritation and tingling?
For persons who have already been diagnosed with genital herpes: Are you experiencing severe pain and blistering and/or are you having frequent attacks? For pregant women only: Are those sores present and are you close to your delivery date?
Do genital sores appear only after taking a recently prescribed medicine?
Are you symptom-free, but worried about having contracted a sexually transmitted disease from someone you suspect may be infected? Do you want to rule out the presence of a sexually transmitted disease because you have had multiple sex partners and you are considering a new sexual relationship, planning to get married or pregnant?

• There’s only one way to guarantee you’ll never get a sexually transmitted disease: Never have sex.
  
• Limiting your sexual activity to one person your entire life is a close second provided your partner is also monogamous, and neither of you have an STD.
  
• Avoid sexual contact with persons whose health status and practices are not known.
  
• Discuss a new partner’s sexual history with him or her before beginning a sexual relationship. Be aware, though, that persons are not always honest about their sexual history.
  
• Latex condoms and the female Reality condom can reduce the spread of STDs when used properly and carefully. They do not eliminate the risk entirely.
  
• Plan ahead for safe sex. Practice what you’ll say. Learn to use condoms properly.
  
• Both women and men should carry condoms and insist that they be used every time they have sexual relations. Using spermicidal foams, jellies, creams (especially those that contain Nonoxynol 9) and a diaphragm, can offer additional protection when used with a condom. Use water-based lubricants such as K-Y Brand Jelly. Don’t use oil-based or “Petroleum” ones such as Vaseline. They can damage latex condoms.
  
• Wash the genitals with soap and water before and after sexual intercourse.
  
• Seek treatment for STDs if you know your sex partner is infected.
  
• Ask your doctor to check for STDs every six months if you have multiple sex partners even if you don’t have any symptoms.
  
• Don’t abuse drugs and limit alcohol consumption. These practices lower your inhibitions and can make you more prone to having unsafe sex

Self-Care Procedures for Genital Herpes

• Bathe the affected genital area twice a day with mild soap and water. Gently pat dry with a towel or use a hair dryer set on warm to dry lesions and kill surface viruses. Using Aveeno (colloidal oatmeal soap or bath treatments) may also be soothing.
  
• Take a hot bath if you can tolerate it. This may help to inactivate the virus and promote healing. Use sitz baths to soak the affected area. You can get a sitz bath device from medical supply stores or hospital pharmacies.
  
• Apply ice packs on the affected genital area for 5-10 minutes. This may help relieve itching and inflammation.
  
• Wear loose fitting pants or skirts. Avoid wearing pantyhose and tight fitting clothing. These could irritate the inflamed area. Wear cotton, not nylon underwear.
  
• Squirt tepid water over the genital area while urinating. This may help decrease the pain.
  
• Take a mild pain reliever such as aspirin, acetaminophen, ibuprofen or naproxen sodium.
  

  [Note: Do not give aspirin or any medication containing salicylates to anyone under 19 years of age or younger, unless directed by a physician, due to its association with Reye’s Syndrome, a potentially fatal condition.]
  

• A local anesthetic ointment such as Lidocaine can help during the most painful part of an attack. Check with your doctor before using it.
  
• Ask your doctor about using the antiviral drug acyclovir (brand name Zovirax). This is available as both a topical ointment and oral medicine.
  

  [Note: The oral form may help prevent outbreaks of herpes for persons who have multiple recurrences. This can be taken daily for many years.]
  

• To avoid spreading the virus to your eyes, don’t touch your eyes during an outbreak.
  
• Avoid sexual intercourse:
  
  • At the first sign of a herpes outbreak. This may be evident by the feeling of tingling and itching in the genital area which takes place before blisters are noticeable.
    
  • When active lesions are present.
    
  • One to two weeks after they have disappeared.
  
  
• Exercise regularly and eat a well balanced diet to reduce your risk of getting infections.
  
• Avoid stressful situations. Stress can trigger recurrences of herpes. Use relaxation exercises to deal with stress.