Introduction to Human Sexuality Part II Chapter 14 Sexually Transmitted Infections

CHAPTER 14 Chapter 14 Sexually Transmitted Infections , AND EMERSON WOLFE , LEARNING OUTCOMES Develop a plan to implement safer sex practices with partners and ways to discuss sexual health with healthcare providers . Compare and contrast treatment options for sexually transmitted infections and ways to outreach to diverse community members about STI prevention and intervention utilizing health psychology and educational techniques . Analyze and address the unethical and inhumane research regarding paid for by the United States government . INTRODUCTION Topics addressed this week will include safer sex practices , history of sexually transmitted infections ( sexually transmitted diseases or ) symptoms , treatments , and statistics . Tips on how to talk with healthcare providers and partners about will be provided . The harmful past ( and still ongoing ) wrongs committed by researchers will be analyzed and called out as they intersect with race , poverty , nationality , and gender . Distrust of medical research and regarding the development of treatment options remains among many minority groups due to the unethical research that was done . In moving forward , what are the best ways to outreach to reluctant participants who have reason to question motives based on these historical experiences ?

Talking with Partners about Safer Sex Practices Preventing starts with developing skills to talk with partners about safer sex practices . Here is a video from Planned Parenthood ( 2017 ) on how to talk with partners about Safer Sex 192 CHAPTER 14 SEXUALLY 193 One or more interactive elements has been excluded from this version of the text . You can view them online here . 44 How to Prevent Sexually Transmitted Infections Safer Sex Techniques Abstaining from sexual behaviors , such as anal , vaginal , or oral sex in which you physically come into direct contact with another person bodily fluids and skin , is the only way to prevent the transmission ofan STI ( Centers for Disease Control and Prevention , 2020 ) Some sexual behaviors in which you are not directly in contact with others bodily fluids or skin , such as masturbating in front of each other , touching body parts through clothing , and more , can be done safely as well . Keep in mind , are transmitted through contact with skin anywhere on the body that might have an active viral load and others are spread through the exchange of bodily fluids . As direct , naked , and penetrative contact increases , so do the risks of STI transmission . Vaccination against certain viral , such as hepatitis A and and human ( are important prevention measures ( 2020 ) Vaccinations for are recommended beginning as early as age through age 26 , and individuals 27 and older have less benefit from a vaccine due to likely already being exposed ( 2020 ) Ask your healthcare provider about being vaccinated for ifyou are 27 years and older as it is possible to have not been exposed prior depending on previous sexual activity history . Hepatitis vaccines are recommended at any age if not previously inoculated . Most children in the United States receive hepatitis vaccinations as requirements to attend public school with very limited mandates regarding vaccination throughout the United States ( North , 2016 ) As of 2014 , vaccination rates were at about 60 for girls and about 42 for boys in the United States ( North , 2016 ) Condoms should be used every time when engaging in penetrative sexual behavior with a new partner in which a penis is entering a vagina , anus , or mouth . Often referred to as a male condom , external condom , or just this type is meant to be rolled down over the penis ( Check out these provided by the on he Right Way to Use a Male Commonly referred to as a female condom or internal condom , this type of condom is placed within the vagina until it rests against the cervix with the outer ring remaining outside the body . They can also be used anally by using the fingers to place the internal condom . It is especially important that the outer ring remains outside the body in order to not get lodged internally . Check out another from the on The Right Way to Use a Female Next time you are at the store , try to find and compare different types of condoms . According to Planned Parenthood ( 2021 a ) internal condoms are harder to find and may require a prescription to purchase at some drug stores . Dental dams can be used during oral sex ( using the mouth to pleasure the penis or vulva ) or ( more commonly known as rimming or providing pleasure to the anus with the mouth ) as a protective barrier . Check out the on How To Use A Dental Dam As A Barrier For Oral Sex , which also provides guidance on how to create a dental dam out of a condom . Safe sex with sex toys is important to reduce the likelihood of spreading by using mild soap and water in between uses and before sharing the toy with a partner ( Planned Parenthood , 2021 ) Condoms can also be used on some types of toys , such as dildos , as long as the condom is changed to a clean one in between uses as well ( Planned Parenthood , 2021 ) Mutual monogamy is when two people within a relationship agree to be exclusive or only sexually active with one another ( 2020 ) After being tested for , engaging in sexual behaviors is safe as long as no new partners are engaged with sexually . A common issue with this is that an individual within an

194 EMERSON WOLFE , monogamous relationship may cheat and expose the partner to since using safe sex practices may alert the partner that something has changed requiring protection ( 2015 ) Safer sex in consensually monogamous relationships , such as using condoms with primary and additional partners and getting tested more frequently for , was practiced more frequently than in monogamous relationships ( 2015 ) In the study by ( 2015 ) about 25 of the monogamous participants reported having sex outside their primary relationship with a majority of these individuals stating their primary partners did not know about this . Getting tested and knowing your STI status is vital to preventing the spread of . Individuals who are engaging in unprotected sexual behaviors with new partners or have partners who are engaging in sexual behaviors with other people should be tested at least once a year ( 2014 ) Pregnant individuals should be tested early in pregnancy and testing should be repeated if necessary depending on sexual behavior and risks ( 2014 ) Check out Your Safer Sex Toolkit by the American Sexual Health Association that includes questions for you to decide your own safer sex boundaries based on what is most important to you as well as additional information on safer sex techniques . This Safer Sex Guide by ( 2020 ) is another helpful resource , which also includes information regarding ways to be safer while engaging in , hand sex , and more . For ways to better outreach to men who are African American , straight , and years old about safer sex practices , the American Sexual Health Association ( 2015 ) developed the Health is Power Toolkit to be used by their partner agencies . This toolkit provides guidance to sexual health organizations on ways to better outreach to and educate community members with these particular intersecting identities . History of the Most Common The following timelines will provide background concerning how the understanding of has changed over time . The information summarized in this section is taken from ( 2020 ) Gonorrhea and Syphilis Gonorrhea named by an ancient Greek physician , Galen Gonorrhea was present in ancient Egypt and China as well An epidemic of Syphilis was reported in Europe in the 14905 In the 19305 , effective medications ( sulfa drugs and penicillin ) were used to treat both syphilis and gonorrhea Eradication was expected but the lack of people using safer sex practices and the development of strains caused infections to rise by the 19505 Gonorrhea and syphilis were thought to be the same until the early century Gonorrhea and syphilis remain global health concerns today Herpes Herpes became prevalent in the 605 and 705 No cure but symptoms can be reduced ( remission ) through the development medications HIV clearly identified in 1981 and AIDS , which develops from untreated HIV Gay men in the US and western Europe and straight individuals in tropical Africa were at the

CHAPTER 14 SEXUALLY TRANSMITTED INFECTIONS 195 greatest risk of infection due to lack of access to education and resources regarding safer sex practices Communities were devastated as many people died Symptoms , Classifications , and Treatments General symptoms will be addressed and will be broken down by whether they are caused by a bacteria , virus , etc . because treatments may be similar for many of the that fall under each of these categories . General Symptoms to Look Out For According to the National Institutes of Health ( some people may have an STI and experience no symptoms which is why getting tested is best . Others may experience an immune response in which they feel Common symptoms of include ( Unusual discharge from the penis or vagina this can sometimes be discolored as well ( yellowish , greenish , etc . Blisters , sores , or warts on the genital area Painful or frequent urination Itching and redness on or around the genitals Blisters or sores in or around the mouth odor Anal itching , soreness , or bleeding Abdominal pain Fever or chills Check out this from the ( 201 ) on 10 Ways Women Differently from Men . Bacteria Types of bacterial infections Chlamydia Gonorrhea Syphilis ' Urinary tract infections This Caused by bacteria entering the urethra specifically by a parasite but is i 35 Pelvic Inflammatory Disease is a possible complication bacterial infection goes untreated , which may impact future fertility in women specifically . Check out the Pelvic Disease PID Fact Sheet for more Bacterial i ( American Sexual Health Association , 2021 ) Treatment Antibiotics (

196 EMERSON WOLFE , Viral Infections Types of viral infections Human ( Genital warts and some types of cancers ( cervical ) are side effects Vaccines have been developed Herpes Cause sores on parts of the body can still be contagious without a sore present if the viral load is high enough No cure , but outbreaks can be reduced or prevented with antiviral medications Human Immunodeficiency Virus ( HIV ) Acquired Immune Deficiency Syndrome ( AIDS ) develops from untreated HIV The virus interferes with the functioning ofthe immune system and weakens the body ability to fight off diseases and infections Hepatitis ( Infects the liver and can lead to chronic liver disease if untreated Vaccines have been developed Hepatitis A ( HAV ) and Hepatitis ( Infects the liver , causing damage Less common than Treatments Antiviral medications Vaccines that increase the immune system ability to fight off the virus and prevent the illness Drugs that prevent transmission that are taken by an individual before they are potentially exposed to a virus by an infected person ( PrEP for HIV ) medications , such as for HIV , work by preventing the life cycle of the virus from continuing to the next stage ( Here is another resource from the regarding HIV Treatment . Parasites Types of infections due to parasites Trichomoniasis Parasite in fluids Treated with an antibacterial medication

CHAPTER 14 SEXUALLY 197 Pubic lice Commonly known as crabs Scabies Treatments Insecticide cream Insecticide oral medication Fungus ( yeast infections ) Treatment Antifungal medicine Statistics and Education versus Stigma and Shame Due to the way that our society discusses , they are often associated with words like dirty . This leads to discomfort or worry when discussing them with healthcare providers and partners . Let take a look at the statistics in order to educate about the prevalence and risks of contracting various . Various organizations are also actively trying to undo the stigma and shame by creating community education campaigns around ways to talk with healthcare providers and partners about . Statistics The following statistics are from the American Sexual Health Association ( ASHA , 2020 ) in people who are engaging in sexual behaviors will get an STI by the age of 25 Human ( 80 of sexually active people have vaccine has been very helpful ( 64 reduction in younger individuals ) Herpes in people have oral herpes in have genital herpes 90 do know they have either type Chlamydia , Gonorrhea , and Syphilis Most commonly reported Young people most at risk

198 EMERSON WOLFE , Annual screening recommended but rarely followed diagnosis for all on the rise PID results when untreated from gonorrhea and chlamydia leading to infertility in in women Hepatitis Hepatitis drastically decreased by 82 since 1991 due to routine vaccination of children Hepatitis most common among baby boomers ( born ) they are times more likely to have this HIV In the US , million people are living with HIV in do know PrEP reduces HIV infection risk up to 92 Undoing Stigma and Shame Moving Forward Check out this campaign by ASHA that is seeking to reduce stigma around in order to encourage people to get tested called , Yes Means Test . How to Talk with Healthcare Providers and Partners about Getting Tested How to Talk about Having an STI with Partners

CHAPTER 14 SEXUALLY TRANSMITTED INFECTIONS 199 THE TIMELINE This following content is currently under review by to ensure the content is accurate and verifiable . The Study Begins In 1932 , the Public Health Service , working with the Institute , began a study to record the natural history of syphilis in hopes treatment programs for blacks . It was called the Study of Untreated Syphilis in the Negro . The study initially involved 600 black men 399 with syphilis , 201 who did not have the disease . The study was conducted without the benefit of patients informed consent . Researchers told the men they were being treated for bad blood , a local term used to describe several ailments , including syphilis , anemia , and fatigue . In truth , they did not receive the proper treatment needed to cure their illness . In exchange for taking part in the study , the men received free medical exams , free meals , and burial insurance . Although originally projected to last months , the study actually went on for 40 years . What Went Wrong ?

In July 1972 , an Associated Press story about the Study caused a public outcry that led the Assistant Secretary for Health and Scientific Affairs to appoint an Ad Hoc Advisory Panel to review the study . The panel had nine members from the fields of medicine , law , religion , labor , education , health administration , and public affairs . The panel found that the men had agreed freely to be examined and treated . However , there was no evidence that researchers had informed them of the study or its real purpose . In fact , the men had been misled and had not been given all the facts required to provide informed consent . The men were never given adequate treatment for their disease . Even when penicillin became the drug of choice for syphilis in 1947 , researchers did not offer it to the subjects . The advisory panel found nothing to show that subjects were ever given the choice of quitting the study , even when this new , highly effective treatment became widely used . The Study Ends and Reparation Begins The advisory panel concluded that the Study was unjustified knowledge gained was sparse when compared with the risks the study posed for its subjects . In October 1972 , the panel advised stopping the study at once . A month later , the Assistant Secretary for Health and Scientific Affairs announced the end of the Study . In the summer of 1973 , a lawsuit was filed on behalf of the study participants and their families . In 1974 , a 10 million settlement was reached . As part of the settlement , the government promised to give lifetime medical benefits and burial services to all living participants . The Health Benefit Program ( was established to provide these services . In 1975 , wives , widows and offspring were added to the program . In 1995 , the program was expanded to include health as well as medical benefits . The Centers for Disease Control and Prevention was given responsibility for the program , where it remains today in the National Center for Viral Hepatitis and Prevention . The last study participant died in January 2004 . The last widow receiving benefits died in January 2009 . There are 11 offspring currently receiving medical and health benefits .

200 EMERSON WOLFE , Important Timeline 1895 Booker Washington at the Atlanta Cotton Exposition , outlines his dream for black economic development and gains support of northern philanthropists , including Julius ( President of Sears , Roebuck and Company ) 1900 educational experiment gains widespread support . Fund provides monies to develop schools , factories , businesses , and agriculture . 1915 Booker Washington dies Robert continues work . 1926 Health is seen as inhibiting development and a major health initiative is started . Syphilis is seen as a major health problem . Prevalence percent observed in the reproductive age population . 1929 Aggressive treatment approach initiated with mercury and bismuth . Cure rate is less than 30 percent treatment requires months and side effects are toxic , sometimes fatal . Wall Street Crash depression begins . 1931 Fund cuts support to development projects . Clark and decide to follow men left untreated due to lack of funds in order to show the need for treatment programs . 1932 effort organized into study of 399 men with syphilis and 201 without . The men would be given periodic physical assessments and told they were being treated . agrees to support study if Institute gets its full share of the credit and black professionals are involved ( Dibble and Nurse Rivers are assigned to study ) 1934 First papers suggest health effects of untreated syphilis . 1936 Major paper published . Study criticized because it is not known if men are being treated . Local physicians asked to assist with study and not to treat men . Decision was made to follow the men until death . 1940 Efforts made to hinder men from getting treatment ordered under the military draft effort . 1945 Penicillin becomes accepted as treatment of choice for syphilis . 1947 establishes Rapid Treatment Centers to treat syphilis men in study are not treated , but syphilis declines . 1962 Beginning in 1947 , 127 black medical students are rotated through units doing the study . 1968 Concern raised about ethics of study by Peter and others . 1969 reaffirms need for study and gains local medical societies support ( AMA and chapters officially support continuation of study ) First news articles condemn studies . Study ends . 1973 Congress holds hearings and a lawsuit is filed on behalf of the study participants . 1974 A 10 million settlement is reached . The government also promised to give lifetime medical benefits and burial services to all living participants the Health Benefit Program ( was established to provide these services . 1975 Wives , widows and offspring were added to the program . 1995 The program was expanded to include health as well as medical benefits . 1997 On May President Clinton apologizes on behalf of the United States . 1999 University National Center for in Research and Health Care hosts Annual Commemoration ofthe Presidential Apology . 2001 President Council on icon was established . 2004 funds 10 million dollar cooperative agreement to continue work at University National Center for in Research and Health Care . 2004 The last Public Health Service Syphilis Study at participant dies on January 16 . 2006 University holds formal opening of Center .

CHAPTER 14 SEXUALLY 201 2007 hosts Commemorating and Transforming the Legacy of the United States Public Health Service ( Syphilis Study at . 2009 The last widow receiving benefits dies on January 27 . The content here can be syndicated ( added to your web site ) Watch this interview with the reporter , jean Heller , who served as a whistleblower alerting the public about what was going on One or more interactive elements has been excluded from this version of the text . You can view them online here ?

The United States Experiments in Beginning in 1946 , the National Institutes of Health , which is part of the United States government , funded research in in which 5128 vulnerable people , including children , orphans , child and adult prostitutes , Indians , leprosy patients , mental patients , prisoners , and soldiers were used for inhumane medical experimentation without their informed consent ( Rodriguez Garcia , 2013 , 2122 ) By 1948 , over 1300 individuals were purposefully infected with syphilis , gonorrhea , and chancroid while others were subjected to diagnostic tests on their blood serum ( Rodriguez Garcia , 2013 ) Additionally , the experiments conducted were not done in sterile environments causing additional infections , individuals were injected and with multiple types of , and were withheld treatment ( Rodriguez Garcia , 2013 ) john Cutler , the main researcher , and his colleagues purposefully withheld information from the public and did not publish anything about the experiments they were conducting because they knew many would find it unethical ( Lombard , 2019 ) Cutler donated his records to the University of Pittsburgh School of Public Health , and it until 2003 that the historian , Susan , discovered the documents ( Lombard , 2019 ) After years of trying to uncover the truth of what happened , presented and alerted the , and President Obama instructed the Presidential Commission for the Study of Issues ( to conduct a thorough review of what had occurred ( Lombard , 2019 ) As of February repeated calls for governmental , organizational , or institutional responses have focused on identifying or making reparations to subjects of the experiments or their relatives . The only direct advocacy on behalf of the subjects came from the private lawsuits that , nine years after public revelation and sixty years after the studies occurred , have yet to provide a remedy to the subjects or their families ( Lombard , 33 ) Disclaimer This video is not required to View due to the upsetting nature of the content .

202 EMERSON WOLFE , One or more interactive elements has been excluded from this version of the text . You can view them online here on . Research and Community Outreach Moving Forward Instead of ignoring the painful history of STI research , healing is not possible without first addressing the harms done by researchers . Fear and distrust remain among communities that have been abused and disenfranchised , and the United States government holds the blame in many cases along with individuals who knowingly supported these inhumane projects . At the same time , and advocacy have also been documented as Jean Heller , the researcher breaking the news to the public about what was happening in , and Susan , the historian who uncovered the truth about the experiments being conducted in , worked to bring the truth to the public attention . In moving forward , how can we make sure that communities who are most vulnerable are represented and supported by treatment and educational outreach programs ?

What are the specific needs and concerns for those who are , adolescents , young adults , and older ?

How can we make sure people with these various intersecting identities can receive the best preventative education , care , and treatment possible ?

Licenses Centers for Disease Control and Prevention Creative Commons Attribution License . Journeyman Pictures ( 2011 , 11 ) The Frightening Legacy of US Syphilis Experiments in Video . License All Rights Reserved . License Terms Standard YouTube license . Newsy ( 2016 , August 25 ) The unknowns about the syphilis study Video . watch ?

License All Rights Reserved . License Terms Standard YouTube license . Planned Parenthood ( 2017 , April ) How to Talk About Having Safer Sex Video . watch ?

License All Rights Reserved . License Terms Standard YouTube license . Planned Parenthood ( 2017 , April ) How to Talk About and Screening Video . watch ?

License All Rights Reserved . License Terms Standard YouTube license . Planned Parenthood ( 2017 , April ) How to Tell Someone You Have an Video . watch ?

License All Rights Reserved . License Terms Standard YouTube license . REFERENCES American Sexual Health Association ( ASHA ) 2021 ) The STI you ( probably ) never heard of . American Sexual Health Association ( ASHA ) 2020 ) Statistics . Editors of Encyclopaedia ( 2020 , February 20 ) Sexually transmitted disease . Encyclopedia .

CHAPTER 14 SEXUALLY TRANSMITTED INFECTIONS 203 Centers for Disease Control and Prevention ( 201 ) fact sheets . Division of Prevention , National Center for , Viral Hepatitis , and Prevention . Centers for Disease Control and Prevention ( How to use condoms and other barriers . National Center for , Viral Hepatitis , and Prevention . Centers for Disease Control and Prevention ( 2020 ) How you can prevent sexually transmitted diseases . Division of Prevention , National Center for , Viral Hepatitis , and Prevention . Centers for Disease Control and Prevention ( 2014 ) Which tests should I get ?

Division of Prevention , National Center for , Viral Hepatitis , and Prevention . 2015 ) A comparison of sexual health history and practices among monogamous and consensually nonmonogamous sexual partners . The Journal of Sexual Medicine , 12 ( 10 ) National Institutes of Health ( Treatments for specific of transmitted diseases and transmitted infections ( National Institutes of Health ( What are the symptoms of sexually transmitted diseases ( or sexually transmitted infections ( North , 2016 ) Human vaccination requirements in US schools Recommendations for moving forward . American journal of Public Health , 106 ( 10 ) Planned Parenthood . How do I buy internal condoms ?

Planned Parenthood . 2021 ) Sex toys . Rodriguez , Garcia , 2013 ) First , do no harm the US sexually transmitted disease experiments in . of Public Health , 103 ( 12 ) Lombard , 2019 ) Public Health Service experiments in ( and their aftermath . Ethics Human Research , 41 (