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ERROR: type should be string, got "https://www.thebody.com/article/president-trumps-opioid-response-could-reduce-ryan\nResource Center on HIV Stigma & Discrimination\nHIV Stigma and Discrimination\nPresident Trump's Opioid Response Could Reduce Ryan White HIV/AIDS Funds by $21 Million\nDrew Gibson\nwildpixel for iStock via Thinkstock\nIt might have appeared as if President Trump actually did something of heft and merit last week when he formally declared a public health emergency to tackle the burgeoning opioid epidemic in this country.\nUnfortunately, as is all too often the case with this administration, the casual observer who thought the president was taking positive action to curb the spread of opioid misuse would have been hoodwinked by a White House that has repeatedly shown that it does not prioritize the health and well-being of the American people.\nThe declaration of a public health emergency (PHE) seems plenty serious. But, just as a declaration of war means nothing without the resources to mobilize a powerful army, a PHE declaration means nothing without the requisite funding for a robust public health response to the emergency in question.\nNo New Money\nLet's be clear: President Trump's PHE declaration contained no new money for fighting the opioid epidemic. This was to be expected, given recent efforts to pass Affordable Care Act (ACA) repeal-and-replace plans that would cut Medicaid spending by 26% over the next 10 years and allow states to waive some ACA-mandated essential health benefits requiring insurers to cover substance use disorders.\nHowever, even the most cynical and jaded of HIV advocates might be shocked to learn that the Trump administration's PHE declaration would allow the Department of Health and Human Services (HHS) to take away federal HIV funding and reallocate it for use in fighting the opioid epidemic. This portion of the PHE declaration -- which Think Progress cleverly called \"robbing Peter to pay Peter\" -- would allow acting HHS Secretary Eric Hargan to shift up to 5% of unexpended funding for Part A and Part B of the Ryan White HIV/AIDS Program to programs aimed at fighting the opioid epidemic. That 5% of Ryan White Part A and Part B would amount to roughly $21 million -- a pittance when it comes to addressing the health care of 2.6 million Americans dealing with opioid addiction, but a small fortune for HIV/AIDS service organizations that are already underfunded.\nThe White House was vague about its plans for potentially redistributing Ryan White monies to help respond to the opioid crisis, and it is unclear whether such a redistribution is even possible, as the Ryan White grant money for the current fiscal year has already been allocated. In response to this unnecessary and damaging attack on HIV funding, five of the largest advocacy organizations in the country that focus on HIV and sexually transmitted infections released a statement expressing \"solidarity with all working to end the opioid epidemic\" and strongly opposing the Trump administration's divisive and insufficient plan to redirect funding from HIV programming.\nTo be fair, while the Trump administration's PHE declaration doesn't direct any new federal money toward combatting the opioid epidemic and could raid Ryan White's coffers to fund opioid programming, it did open up a new pot of money by allowing the federal government to access the federal Public Health Emergency Fund.\nThe only problem is that the fund currently has only $57,000 left in it.\nOr, to put it another way, the Public Health Emergency Fund has enough funding to give every person in America living with opioid addiction 2 cents to help with their treatment.\n\"Just Say No\" Looks Sophisticated by Comparison\nLieutenant Commander Diane Goldstein (Ret.) is a board member of Law Enforcement Action Partnership, a group of law enforcement officials working to promote the use of evidence-based, public health interventions by law enforcement in responding to the nation's drug problem. Goldstein told TheBody.com that she was appalled by President Trump's words:\nThe emphasis on tough law enforcement actions and a failed \"just say no\" ideology will simply result in more crime, death, disease and addiction. ... If this administration is serious about solving the opioid epidemic, they would fund harm-reduction programs that have resulted in positive health outcomes while enhancing public safety across countries that actually use science, evidence-based practices and compassion for drug users.\nBut instead, the Trump administration seems poised to take us back to the heyday of the Reagan '80s with drug misuse prevention messaging that makes \"Just Say No\" sound sophisticated by comparison. During his cringe-worthy speech prior to his signing of the PHE declaration, President Trump used his brother Fred's struggles with alcohol as a cautionary tale and doubled down on the sort of abstinence-only anti-drug prevention strategies that have failed miserably over the past few decades.\nIn fact, Trump not only endorsed Just Say No-ism. He also suggested that he was the one who invented it:\n\"This was an idea that I had, where ... we can teach young people not to take drugs -- just not to take them,\" Trump told an audience predominantly comprising administration officials, Republican politicians, law enforcement personnel and individuals who had lost loved ones to opioid use disorders. \"The fact is, if we can teach young people -- and people, generally -- not to start, it's really, really easy not to take them,\" he added.\nThis promotion of discredited and counterproductive abstinence-centric drug prevention strategies was not one of the president's impromptu tangents. Apparently, it's a major part of the Trump administration's approach to dealing with the opioid epidemic.\nEverything about Trump's speech, from his peddling of blatant falsehoods about the appeal of drugs --\"There is nothing desirable about drugs\" -- to his portrayal of prescription opioids as \"evil,\" reeks of the sort of moral absolutism and willful ignorance that can only serve to accelerate the progression of the opioid epidemic.\nMake no mistake about it. We are on the cusp of a full-fledged return to the War on Drugs.\nDuring the 10 months that he has been in office, President Trump has shown an aversion to proven public health interventions and a craving for a militaristic, authoritarian response to our nation's issues. There is no reason to believe these preferences will now change.\nThe Trump administration features Attorney General Jeff Sessions, who once remarked that \"good people don't smoke marijuana,\" and a president who recently encouraged police brutality and praised Philippines President Rodrigo Duterte's murderous attacks on his country's drug users. This declaration does nothing to assuage well-grounded fears of a worsening outlook for people who use drugs and the members of their communities.\n@SuppressThis\nDrew Gibson is a social worker and freelance writer based out of Cincinnati, Ohio. His blog, \"Virally Suppressed,\" covers a multitude of issues related to public health and social justice.\nTags:News, Substance Use, Ryan White CARE Act"

ERROR: type should be string, got "https://www.thebody.com/article/truth-st-ds\nNon-HIV Sexually Transmitted Infections\nThe Truth About STDs\nSexuality Information and Education Council of the United States\nBacterial STDs\nViral STDs\nThere are more than 25 diseases spread primarily by sexual activity. Together these infections -- called sexually transmitted diseases (STDs) -- have created a significant public health challenge in the United States. While many STDs are curable, others are not. Even those that are curable often have no symptoms and go unrecognized for long periods of time. If left untreated, even curable STDs can result in long-term health problems for both men and women.\nIn the United States, an estimated 15 million people become infected with one or more STDs each year. In addition, an estimated 65 million people live with an incurable STD. Still, less than half of adults 18 to 44 years of age have ever been tested for an STD other than HIV/AIDS.1 This fact sheet is designed to provide health care professionals, educators, and individuals with basic information. It focuses on eight of the most common STDs and contains information on how they are spread, what signs and symptoms individuals should look for, and what treatment options are available. Those interested in learning more about these or other STDs can go the web site of the Centers for Disease Control and Prevention at www.cdc.gov/nchstp/dstd/disease_info.htm.\nNote: Some professionals use the term sexually transmitted infection (STI) instead of sexually transmitted disease (STD). This fact sheet uses the term STD.\nTwo STD Categories: Viral and Bacterial\nSTDs are often divided into two categories -- viral and bacterial -- based on the type of microorganism that causes the specific disease.\nThose STDs caused by bacteria -- such as gonorrhea, syphilis, and chlamydia -- are curable with antibiotics. On the other hand, those STDs caused by viruses are not curable. These include human immunodeficiency virus (HIV), human papillomavirus (HPV), herpes, and hepatitis B. Medical treatment can, however, alleviate the symptoms of these STDs.\nSome STDs are also caused by protozoa (trichomoniasis) and other organisms (crabs/pubic lice and scabies). These STDs are curable with antibiotics or topical creams/lotions.\nTesting for STDs: What's Involved\nLess than half of adults 18 to 44 years of age in the United States have been tested for an STD other than HIV. Some people may not seek a test because they do not know they are at risk. Others may not seek a test because they are nervous, embarrassed, or unsure of what the tests involve.\nThere are many different ways health care providers screen for STDs. These can include visually examining sores or lesions, collecting fluid from the urethra or cervix with a cotton swab, testing urine or blood, or conducting a biopsy.\nIndividuals should seek an early diagnosis and treatment at the first sign of symptoms to avoid serious complications. They should also talk to their health care providers about having a routine STD screening as part of their annual physical or gynecological exam since many STDs have no symptoms. Women need to understand that STD screenings are not necessarily part of their annual gynecological exam and that Pap smears do not screen for STDs other than HPV.1\nwww.ashastd.org/news/112102.html.\nChlamydia, which is caused by the bacteria chlamydia trachomatis, targets the cells of mucous membranes including the surfaces of the urethra (male and female), vagina, cervix, and endometrium (the lining of the uterus) as well as the anus and rectum. Although possible, it rarely targets the mouth or throat. If left untreated in women, it can spread to the fallopian tubes and lead to Pelvic Inflammatory Disease (PID), a serious medical condition that can cause infertility.2\nChlamydia is transmitted through vaginal or cervical secretions and semen during unprotected anal, oral, or vaginal sex with an infected person. It can also be transmitted from mother to newborn during childbirth.3\nChlamydia is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.4\nSigns and Symptoms5\nSigns of infection usually appear within one to three weeks after contact. In some cases, infection is obvious only after several weeks or months. Approximately 75 percent of women and 50 percent of men do not have symptoms.\nWomen may experience such symptoms as itching, vaginal discharge, and burning during urination.\nSome women may experience pain of the lower abdomen or back, pain during intercourse, bleeding between menstrual periods, nausea, or fever if the infection has spread to the fallopian tubes. This may indicate that the infection has progressed to PID.\nMen may experience heaviness and discomfort in their testicles and inflammation of their scrotal skin. They may also notice pus in the form of a thick white fluid or watery or milky discharge from the penis. Men may also experience pain or burning during urination.\nChlamydia is diagnosed through cultures of secretions collected from the urethra, anus, throat, or cervix. It is also diagnosed through urine tests.\nChlamydia is curable with oral antibiotics prescribed by a health care provider. All partners should undergo treatment at the same time to avoid passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside.\nGonorrhea, once known as \"the clap,\" is caused by bacteria called Neisseria gonorrhoea that grow in the warm, moist areas of the reproductive tract, including the cervix, uterus, and fallopian tubes in women and the urethra in both women and men. The bacteria can also grow in the mouth, throat, and anus.7\nGonorrhea is transmitted through vaginal or cervical secretions and semen during unprotected anal, oral, or vaginal sex with an infected person. It can also be transmitted from mother to newborn during childbirth.\nGonorrhea is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.8\nMost men and women will experience no symptoms.\nMen may show signs of infection within two to five days after exposure. Women may show signs within 10 days. The signs are similar to those of chlamydia. Individuals should, therefore, receive tests for both STDs.\nMen may experience such symptoms as a yellowish discharge from the penis, burning or pain during urination, frequent urination, and pain or swelling of the testicles.\nWomen may experience such symptoms as a yellow or bloody discharge from the vagina and burning or pain during urination.\nSome women may experience pain of the lower abdomen or back, pain during intercourse, bleeding between menstrual periods, and nausea or fever if the disease has spread to the fallopian tubes. This is often an indication that the infection has progressed to PID.\nMen and women may have a sore or red throat if the infection has spread to that part of the body.\nGonorrhea is diagnosed through cultures of secretions collected from the throat, urethra, anus, or cervix. It is also diagnosed through urine tests.10\nGonorrhea is curable with oral antibiotics prescribed by a health care provider. All partners should undergo treatment at the same time to prevent passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside.\nSyphilis, which is caused by bacteria called spirochetes, causes sores (chancres) to appear mainly on the external genitals, vagina, anus, or in the rectum. They can also appear on the lips and in the mouth.\nThere are three stages of syphilis. During the primary stage, which usually occurs within 10 to 90 days after exposure, a sore may appear. During the secondary phase, which usually occurs within 17 days to six-and-a-half months after exposure, a rash may appear on various parts of the body. If left untreated, syphilis can proceed to the latent stage during which it may have no visible symptoms but can cause irreversible damage to internal organs.11\nSyphilis is transmitted through direct contact with sores during unprotected anal, oral, or vaginal sex with an infected person. Syphilis can also be transmitted from mother to newborn during childbirth.12\nSyphilis is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.13\nWomen and men may experience the same signs of syphilis.\nDuring the \"primary\" stage, a sore may appear on the genitals at or near the place where the bacteria entered the body. Usually firm, round, small, and painless, the sore will develop within 10 to 90 days after contact with the bacteria and will usually last from one to five weeks. A person can easily spread the disease during this stage. If adequate treatment is not received, the infection will progress to the \"secondary\" stage.14\nDuring the \"secondary\" stage, a rash may appear over the entire body or on the hands and soles of the feet. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. Symptoms may appear from 17 days to six-and-a-half months after infection has occurred. They can last up to six months. A person can easily spread the disease during this stage. If adequate treatment is not received, the infection will progress to the \"latent\" stage.15\nDuring the \"latent\" stage, the untreated bacteria will begin to damage internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Latent signs may include uncoordinated muscle movements, paralysis, numbness, gradual blindness, and dementia. A person is not usually contagious during this stage.16\nSyphilis is diagnosed through cultures of secretions from the sore or through blood tests.17\nSyphilis is curable with antibiotics prescribed by a health care provider. Damage to internal organs during the latent stage is irreversible. All partners should undergo treatment at the same time to prevent passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside.\nCDC'S National Syphilis Elimination Plan\nAs the result of a steady decline in syphilis rates in the United States, the CDC launched a National Plan to Eliminate Syphilis From the United States in 1998.\nThe CDC is using this window of opportunity to reduce the total number of primary and secondary syphilis cases to 1,000 or fewer -- 0.4 cases per 100,000 people -- and to increase the number of syphilis-free counties to 90 percent by 2005.\nThe National Plan has five strategies: (1) to increase surveillance, (2) to strengthen community involvement and partnerships, (3) to rapidly respond to outbreaks, (4) to improve and increase health promotion, and (5) to expand clinical and laboratory services.\nwww.cdc.gov/std/media/SyphElimKeyFacts.htm.\nTrichomonaisis\nTrichomoniasis, or \"trich,\" is a genital inflammation caused by the protozoa trichomonas vaginalis.\nTrichomoniasis is transmitted through skin-to-skin contact during unprotected anal, oral, or vaginal sex with an infected person.18\nSigns and Symptoms19\nSigns of infection in women usually appear within five to 28 days after exposure. Men usually show no signs of infection.\nWomen may have a frothy, yellow-green vaginal discharge with a strong odor. They may also experience burning during intercourse and urination as well as irritation and itching of the female genital area.\nPregnant women may experience a premature rupture of the membranes and a preterm delivery.\nMen may experience irritation inside the penis, a mild discharge, or a slight burning after urination or ejaculation.\nTrichomoniasis is diagnosed through cultures of vaginal and penile discharge.20\nTrichomoniasis is curable with antibiotics prescribed by a health care provider. Both partners must undergo treatment at the same time to prevent passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside.\nHerpes is a recurrent skin condition characterized by sores on the mouth or genitals. It is caused by the herpes simplex viruses called HSV-1 and HSV-2. Although HSV-1 most commonly causes \"cold sores\" or \"fever blisters\" on the mouth or face and HSV-2 most commonly causes sores on the penis or vulva, the viruses are identical under a microscope and either type can infect the mouth or genitals.21\nHerpes is transmitted through skin-to-skin contact during unprotected anal, oral, or vaginal sex with an infected person or through kissing. This is possible even when no sores are present.\nHerpes is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.22\nIndividuals are often not aware they are infected with herpes because there are either no symptoms, mild symptoms that are not noticed, or symptoms that are mistaken for other health problems such as yeast infections, insect bites, and hemorrhoids.\nSigns of herpes may first appear within days. They may, however, not appear for weeks, months, or years. Symptoms can last for three or four weeks though they usually heal within two to 12 days.23\nSymptoms may include one or more sores, blisters, cuts, pimples, bumps, or a rash. Other symptoms include an itching, burning, or tingling in either the genital area or the mouth, a fever, or swollen glands.24\nIndividuals usually have an average of four to five herpes outbreaks a year. The recurrences tend to lessen in severity and frequency with time.25\nHerpes is diagnosed through a visual examination of sores, an analysis of cultures from the sore(s), or blood tests.26\nThere is no cure for herpes. Antiviral medications can reduce the frequency of outbreaks and speed the healing of the outbreaks.\nHepatitis B is a virus that causes chronic infection, cirrhosis (scarring), and cancer of the liver. The virus is present in blood, semen, vaginal secretions, and breast milk.\nHepatitis B is transmitted through unprotected anal, vaginal, and oral sex with an infected person; through contaminated needles or syringes; or from an infected mother to her newborn during childbirth or breast-feeding.\nHepatitis B is the only STD for which a vaccine is available. Individuals must take all three doses of the vaccine to protect themselves against infection. They can obtain the vaccine from their health care provider.27\nHepatitis B is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.28\nIndividuals will usually experience mild flu-like symptoms including fever, aches, appetite loss, and fatigue. Many people will experience no symptoms.29\nMany people will develop a temporary jaundice (yellowing of the skin) as well as dark urine, nausea, and abdominal pain.30\nHepatitis B is diagnosed through blood tests.31\nThere is no cure for hepatitis B. Treatment varies depending on whether the infection is acute (newly acquired) or chronic (persistent).32\nThe human immunodeficiency virus (HIV) causes an individual's immune system to weaken and lose its ability to fight off infections and cancers. After developing a number of these infections or reaching a certain blood count level, an HIV-positive person is diagnosed with Acquired Immunodeficiency Syndrome (AIDS).33\nHIV is present in blood, semen, vaginal secretions, and breast milk. It is transmitted through unprotected anal, vaginal, and oral sex with an infected person; through contaminated needles or syringes used to inject drugs; or from an infected mother to her newborn during childbirth or breast-feeding.34\nHIV is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.35\nThere are no symptoms of HIV infection.\nThe average time between HIV infection and AIDS is eight to 11 years.\nOver time, HIV causes the body to develop opportunistic infections or cancers normally controlled by a healthy immune system.\nAIDS symptoms are usually those of the opportunistic infection or cancer. These include fever, chills and sweats, chronic fatigue, appetite or weight loss, muscle and joint pain, long-lasting sore throat, swollen lymph nodes, diarrhea, yeast infections, and skin sores.\nOpportunistic infections that most frequently affect someone with AIDS include Kaposi's sarcoma, Pneumocystis carinii pneumonia (PCP), tuberculosis, meningitis, and herpes simplex infections.\nHIV infection is diagnosed through blood tests. It can also be diagnosed through urine tests and an oral fluid test taken from the inside of the mouth.36 Individuals exposed to HIV may not test positive for three to six months. Individuals should test periodically for HIV if they feel they are at risk.\nThere is no cure or vaccine for HIV or AIDS. There are, however, new combinations of drugs (called \"cocktails\") that allow people to live with the infection or HIV/AIDS for longer periods of time.\nTests that determine HIV infection look for antibodies produced by the body to fight the virus. Most people will develop such antibodies between 25 days and six months after infection. Although it is possible to test earlier, the CDC recommends testing six months after the last possible exposure.\nMany places provide testing for HIV infection. These include local health departments, doctors' offices, hospitals, or specific HIV test sites.\nSites may provide pre- and post-test counseling for those who want it. They may also provide either anonymous (no name given) or confidential (name given only to doctor) testing. Some states require that doctors report positive results to state health departments. Individuals should check to determine procedures at individual sites.\nMost HIV tests involve drawing blood to determine if antibodies specific to HIV are present. Other options include urine tests and oral fluid tests that involve taking a sample of fluid from inside the mouth with a cotton swab.\nFor more information about HIV tests and test sites, individuals should contact the CDC National AIDS Hotline at 1-800-CDC-INFO (English) or 1-8888-232-6348 (TTY).\nwww.ashastd.org/nah/faqs.html.\nThere are over 100 strains of the human papillomavirus (HPV). Approximately a third of these strains cause warts that infect the genital tract. These warts can grow on the cervix, vagina, vulva, penis, scrotum, urethra, and anus. HPV can also cause other abnormal cells to grow on the cervix. Some strains of HPV can lead to cervical cancer.37\nHPV is transmitted by direct skin-to-skin contact with an infected individual. It can also transmitted when warts are not present.38 It is sometimes transmitted from mother to infant during childbirth.39\nPeople with HPV may experience no visible signs or symptoms or may have warts in places they cannot see (such as the cervix).\nGenital warts are raised or flat growths that are usually flesh colored or whitish in appearance.\nGenital warts usually do not cause itching or burning.\nIf left untreated, genital warts may disappear. However, HPV infection remains and warts can reappear.\nHPV is often diagnosed through a visual examination of genital warts. In some cases, a biopsy is necessary.\nThe presence of HPV on the cervix is detected through a Pap smear.41\nThere is no cure for HPV. There are, however, a number of methods to remove warts.\nCertain strains of HPV are considered the primary risk factor for cervical cancer. The majority of such cancers develop through a series of gradual precancerous lesions that are easily detected by a Pap smear, and can be removed.1\nA Pap smear is a routine gynecological test in which a health care provider uses a cotton swab or similar instrument to collect cells from the cervix. The test looks for abnormal or precancerous cells. These cells may be signs of cervical cancer.2\nRegular Pap smears reduce the risk of invasive cervical cancer by early detection of abnormal cells. In fact, over half of women with newly diagnosed cervical cancer had not had a Pap smear in five years.3\nResearchers are developing a vaccine that targets HPV-16, one of the HPV strains that lead to cervical cancer. In initial trials, none of the women who received the vaccine showed HPV-16 infections or precancerous tissue. The vaccine is awaiting approval by the Food and Drug Administration (FDA).4\nIt is important to note that not every HPV infection will become cervical cancer. The National Cancer Institute points out that while HPV infection is common, cervical cancer is not.5\nwww.ashastd.org/stdfaqs/paptest.\nwww.ashastd.org/hpvccrc/abcell.html#what.\nhttp://rex.nci.nih.gov/massmedia/backgrounders/cervical.html.\nP. Guthrie, \"Vaccine Could Wipe Out Cervical Cancer; Study: New Drug 100% Effective against Disease,\" The Atlanta Journal and Constitution, November 21, 2002.\nCondoms and STDs: Prevention Messages\nCondoms can provide different levels of risk reduction for different STDs. There is no definitive study about condom effectiveness for all STDs. Definitive data are lacking on the degree of risk reduction that latex condoms provide for some STDs; for others, the evidence is considered inconclusive.\nThe Centers for Disease Control and Prevention (CDC) states, \"It is important to note that the lack of data about the level of condom effectiveness indicates that more research is needed -- not that latex condoms do not work.\"1\nThese are prevention messages recently developed by the CDC:\nLatex condoms, when used consistently and correctly, are highly effective in preventing the transmission of HIV, the virus that causes AIDS. In addition, correct and consistent use of latex condoms can reduce the risk of other STDs.\nLatex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea, chlamydia, and trichomoniasis.\nLatex condoms, when used consistently and correctly, can reduce the risk of genital herpes, syphilis, and HPV only when the infected areas are covered or protected by the condom.2\nU.S. Centers for Disease Control and Prevention (CDC), Latex Condoms and Sexually Transmitted Diseases -- Prevention Messages (Atlanta, GA: CDC, 2001), p. 2.\nUpdate on Nonoxynol-9\nIn the past, public health experts recommended using condoms combined with Nonoxynol-9 (N-9), a spermicide, for increased protection against pregnancy, HIV, and STDs. Two recent studies, however, call into question the effectiveness and safety of N-9.\nA study published by UNAIDS found that N-9 used without condoms was ineffective against HIV transmission. This study actually showed some evidence that N-9 increased the risk of HIV infection.\nResearchers note that this study was conducted among commercial sex workers in Africa who are at increased risk and used an N-9 gel on a frequent basis. The adverse effects might not be seen at the same level among women who are using N-9 less frequently or in a different formulation.\nAs a result of this study, however, the CDC concluded that \"given that N-9 has been proven ineffective against HIV transmission, the possibility of risk, with no benefit, indicates that N-9 should not be recommended as an effective means of HIV prevention.\"1\nA similar study published in the Journal of the American Medical Association found that N-9, when used with condoms, did not protect women from the bacteria that cause gonorrhea and chlamydia any better than condoms used alone.2\nLetter to Colleagues from Helene D. Gayle, M.D., M.P.H., director, National Center for HIV, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, August 4, 2000.\nR. E. Roddy, L. Zekeng, K. A. Ryan, U. Tamoufé, and K. G. Tweedy, \"Effect of Nonoxynol-9 Gel on Urogenital Gonorrhea and Chlamydial Infection: A Randomized Controlled Trial,\" Journal of the American Medical Association, March 6, 2002, pp. 1117-22.\nPeople with STDs do not always seek testing or treatment, and health care providers do not always report all cases of diagnosed STDs. Therefore, in all likelihood, the number of STD cases included in the following statistics is less than the actual number of cases that occurred in the United States.\nOver 783,000 chlamydia infections were reported to the CDC in 2001.42\nThe reported rate of chlamydia among women (435.2 cases per 100,000 females) was approximately four times higher than the reported rate among men (113.9 per 100,000 males) in 2001.43\nFemale adolescents 15 to 19 years of age had the highest reported rates of chlamydia (2,536.1 per 100,000) in 2001.44\nChlamydia infections increased from 50.8 to 278.3 per 100,000 between 1987 and 2001.45\nGonorrhea46\nOver 361,000 cases of gonorrhea were reported to the CDC in 2001.\nThe reported rate of gonorrhea among women in 2001 (128.2 cases per 100,000 females) was similar to the rate in 2000 (126.7 per 100,000) and in 1999 (128.6 per 100,000).\nThe rate of gonorrhea among men declined from 135.5 cases per 100,000 males in 1999 to 130.9 in 2000 and 128.2 in 2001.\nAmong women, those 15 to 19 years of age had the highest reported rate of gonorrhea (703.2 per 100,000) in 2001.\nAmong men, those 20 to 24 years of age had the highest reported rate of gonorrhea (563.6 per 100,000) in 2001.\nSyphilis47\nOver 6,100 cases of primary and secondary syphilis cases were reported to the CDC in 2001.\nThe reported rate of primary and secondary syphilis increased 15.4 percent among men (from 2.6 cases to 3.0 cases per 100,000) between 2000 and 2001. During this time, the rate declined 17.7 percent among women (from 1.7 to 1.4 cases per 100,000).\nHerpes48\nApproximately 25 percent of adults have genital herpes.\nOver 45 million people 12 years of age and older (or one out of five) are infected with HSV-2, a herpes virus.\nInfection with HSV-2, a herpes virus, is more common in women (approximately one out of four) than in men (almost one out of five). This may be due to the fact that male-to-female transmission is more efficient than female-to-male transmission.\nThe number of new hepatitis B infections per year has declined from an average of 260,000 in the 1980s to approximately 78,000 in 2001.49\nOf an estimated 1.25 million Americans chronically infected with hepatitis B, 20 to 30 percent were infected during childhood.50\nHuman Immunodeficiency Virus (HIV)\nNearly 24,000 adult and adolescent males from the 39 areas of the country with confidential HIV-infection reporting were diagnosed as HIV positive in 2001.51\nOver 11,000 adult and adolescent females from the 39 areas of the country with confidential HIV-infection reporting were diagnosed as HIV positive in 2001.52\nNearly 32,000 adult and adolescent males were diagnosed with AIDS in 2001. In total, over 666,000 cases among adult and adolescent males were reported through December 2001.53\nOver 11,000 adult and adolescent females were diagnosed with AIDS in 2001. In total, over 141,000 cases among adult and adolescent females were reported through December 2001.54\nApproximately 5.5 million new cases of HPV infection are reported every year. At least 20 million Americans are already infected.55\nFifty to 75 percent of sexually active men and women will become infected with genital HPV at some point in their lives.56\nApproximately 14,000 women are diagnosed with cervical cancer each year; over 5,000 die from this disease each year.57\nSTDs Among Adolescents and Young Adults\nTeens are at high behavioral risk for acquiring most STDs. Teens and young adults are more likely than other age groups to have multiple sex partners and to engage in unprotected sex. In addition, young women are biologically more susceptible to chlamydia, gonorrhea, and HIV.\nChlamydia and gonorrhea are the most common curable STDs among teens. Curable STDs are typically caused by bacteria that can be killed with antibiotics. However, if these diseases remain undetected and untreated, they can result in severe health consequences later in life.\nThe rate of new infections for herpes and HPV -- both viral STDs -- is typically highest during the late teens and early twenties. Among women under the age of 25, studies have found that 28 to 46 percent are typically infected with HPV. Between 15 to 20 percent of young men and women have become infected with herpes by the time they reach adulthood.\nTracking the Hidden Epidemics: Trends in STDs in the United States, 2000 (Atlanta, GA: Centers for Disease Control and Prevention, 2001), p. 4.\nwww.ashastd.org/stdfaqs/chlamydia.html#what.\nwww.goaskalice.columbia.edu/2020.html.\nwww.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm.\nwww.ashastd.org/stdfaqs/gonorrhea.html#what.\nwww.ashastd.org/stdfaqs/syphilis.html#what.\nwww.cdc.gov/std/Syphilis/STDFact-Syphilis.htm.\nThe Boston Women's Health Book Collective, Our Bodies, Ourselves: For the New Century, (New York: Touchstone, 1998), p. 355.\nwww.ashastd.org/stdfaqs/syphilis.html.\nwww.cdc.gov/std/Trichomonas/STDFact-Trichomoniasis.htm.\nwww.ashastd.org/stdfaqs/herpes.html.\nwww.cdc.gov/std/Herpes/STDFact-Herpes.htm.\nwww.ashastd.org/stdfaqs/hepb.html.\nwww.ashastd.org/stdfaqs/hepb.html#get.\nwww.ashastd.org/stdfaqs/aidshiv.html.\nwww.cdc.gov/hiv/pubs/faq/faq31.htm.\nwww.plannedparenthood.org/library/STI/011120_hpv.html.\nwww.ashastd.org/hpvccrc/gw.html#symptoms.\nwww.ppnyc.org/facts/facts/stdservices.html.\nSexually Transmitted Disease Surveillance 2001 (Atlanta, GA: Division of STD Prevention, CDC, September 2002), p. 7.\nIbid, p. 8\nIbid, p. 15, 16\nIbid., p. 25, 26\nwww.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm.\nHIV Surveillance Report, vol. 13, no. 2 (Atlanta, GA: CDC, December 2001), p. 19, Table 10.\nIbid., p. 21, Table 12.\nIbid., p. 18, Table 9.\nwww.niaid.nih.gov/factsheets/stdhpv.htm.\nwww.ashastd.org/hpvccrc/quickfaq.html."