Dr. Rose Recommends for Healthy & Safe Travel
Health Guide Chapter 14
HIV/AIDS and Sexually Transmitted Diseases (STDs)
AIDS and HIV infections occur worldwide and the true number of cases is likely far greater than officially reported. Acute retroviral syndrome (onset of newly-acquired HIV infection) is a flu-like illness, easily confused with mononucleosis.
The risk for a traveler of acquiring HIV, however, is statistically very low.
The chances for acquiring HIV is determined primarily by a traveler's lifestyle.
Unprotected sex with a high-risk partner and injecting drug use account for most cases of AIDS.
Unscreened blood transfusions and medical injections with nonsterile equipment can also transmit HIV, but these are largely avoidable.
Mosquitoes cannot transmit HIV.
Some countries require an HIV test for entry, but these tests are usually reserved for long-stay travelers and immigrants.
India, Russia, eastern Europe, and the Caribbean have the fastest growing incidences of AIDS and HIV.
According to the Joint United Nations Program on HIV/AIDS (UNAIDS), there are now an estimated 33 million people living with HIV worldwide, of whom 2.7 million became infected in 2007; 2.0 million people (range, 1.8 million to 2.3 million) died from AIDS in 2007.
For the first time, both fewer children (who account for about 15% of the totals) and fewer adults are becoming infected, and fewer people are dying than in previous years. In sub-Saharan Africa, most national epidemics have stabilized or — in Zimbabwe, for example — have begun to diminish, as measured by annual determinations of HIV prevalence among women receiving prenatal care.
However, in Kenya, infections are on the rise, as they are in Russia and Ukraine, which have the largest epidemics in Eastern Europe and Central Asia. In Russia, injection-drug users lack access to methadone and to large-scale programs providing clean needles and syringes. Source: NEJM August 2008
The World Health Organization's Department of HIV/AIDS announced in June 2008 that there will be no generalized epidemic of AIDS in the heterosexual population outside sub-Saharan Africa. They state that: "Whereas once it was seen as a risk to populations everywhere, it is now recognized that, outside sub-Saharan Africa, HIV/AIDS is primarily confined to high-risk groups including men who have sex with men, injecting drug users, and sex workers and their clients."
According to The Independent (London, June 9, 2008): "Critics of the global AIDS strategy complain that vast sums are being spent educating people about the disease who are not at risk, when a far bigger impact could be achieved by targeting high-risk groups and focusing on interventions known to work, such as circumcision, which cuts the risk of infection by 60 per cent, and reducing the number of sexual partners.
The article goes on to say: Why is the situation so bad in sub-Saharan Africa? It is a combination of factors – more commercial sex workers, more ulcerative sexually transmitted diseases, a young population and concurrent sexual partnerships.
"Sexual behaviour is obviously important but it doesn't seem to explain [all] the differences between populations. Even if the total number of sexual partners [in sub-Saharan Africa] is no greater than in the UK, there seems to be a higher frequency of overlapping sexual partnerships creating sexual networks that, from an epidemiological point of view, are more efficient at spreading infection."
"Low rates of circumcision, which is protective, and high rates of genital herpes, which causes ulcers on the genitals through which the virus can enter the body, also contributed to Africa's heterosexual epidemic."
But the factors driving HIV were still not fully understood, the article states.
"The impact of HIV is so heterogeneous. In the US , the rate of infection among men in Washington DC is well over 100 times than in North Dakota, the region with the lowest rate. That is in one country. How do you explain such differences?"
Until 2008, ceftriaxone, 125 mg/250 mg intramuscularly, in a single dose, was the only available drug, practically speaking, recommended by the CDC for treating gonorrhea (GC).
As of June 2008, 400 mg cefixime tablets became available to use for single-dose treatment of gonorrhea. Previously, cefixime was available only in liquid form in the U.S.
In April 2007, the fluoroquinolone drugs, including ciprofloxacin, ofloxacin, and levofloxacin, lost their "recommended" status for treating gonorrhea due to resistant strains of GC in the United States and overseas.
Overview of HIV and AIDS
The development of AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person's body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
What are HIV and AIDS?
The acquired immunodeficiency syndrome (AIDS) was first recognized in 1981 and has since become a major worldwide epidemic. AIDS is caused by infection with HIV—the human immunodeficiency virus. This virus causes the destruction and/or impairment of the body's immune system. It takes months to years before HIV impairs the immune system sufficiently to cause the symptoms of AIDS.*
The HIV virus is commonly transmitted by:
- Having unprotected vaginal or anal sex with an infected person. (There is less risk from oral sex.) The virus can enter the body through the breakage of any mucous membrane of the vagina, vulva, penis, rectum, or mouth. This is the most common pathway through which at-risk travelers acquire HIV, and they may not be aware of the risk.
- Sharing needles or syringes for injecting drugs with an infected person
- Accidental contact with infected blood. This is often an occupational exposure, such as an accidental needle stick.†
- Transfusion of contaminated blood or blood products. Some blood banks in less developed countries do not screen blood for the AIDS virus.
- An unsafe medical injection or surgical/dental procedure using nonsterile equipment. Many less developed countries recycle needles and syringes, which may be contaminated with HIV (as well as hepatitis viruses).
- Acupuncture, tattoos, or body piercing with nonsterile needles
An Overview of HIV/AIDS Worldwide
HIV/AIDS in the United States, Canada, Western Europe, Australia, and New Zealand
In these countries, AIDS is still largely a disease of men who have sex with men (MSM) and urban drug users, with the rates of HIV and AIDS increasing in the female partners of bisexuals and injecting drug users. In the United States, the epidemic is growing most rapidly among minority populations and has become a serious problem among heterosexual African Americans; the Latino population is increasingly affected too. AIDS is a leading killer of African-American males.
HIV/AIDS in the Caribbean and Latin America
AIDS is spreading rapidly in the Caribbean and Latin America. HIV is spilling over to female sexual partners of infected bisexuals and intravenous drug abusers, and through drug-related commercial sex. The Caribbean has a well-established HIV epidemic and the incidence of HIV/AIDS in the region is now second only to sub-Saharan Africa, making the region the second most affected in the world. The predominant route of HIV transmission in the Caribbean is heterosexual contact. Much of this transmission is associated with commercial sex, but the virus is also spreading in the general population. The contribution by men having sex with men is significant but not well documented, due to a general atmosphere of homophobia making data gathering difficult. At one extreme, Haiti has the highest HIV prevalence in the entire western hemisphere (3.8%); at the other, Cuba has one of the lowest (0.1%). The Bahamas (3.3%), Trinidad and Tobago (2.6%) and Guyana (2.4%) are all heavily affected, while Puerto Rico is the only Caribbean country apart from Cuba where it is thought that less than 1% of the population is living with HIV. (Source: www.Avert.org)
More than half of Latin Americans living with HIV reside in the four largest countries in the region: Brazil, Columbia, Mexico and Argentina. The most severe epidemics are found in smaller countries such as Honduras and Belize, which have HIV prevalence rates of 1.5% and 2.5% respectively. The majority of countries in the region have prevalence rates of less than 1%, but the prevalence among specific groups, such as men who have sex with men (MSM) and commercial sex workers, is often very high.
HIV/AIDS in the Middle East and North Africa
Only small numbers of cases are reported in the Middle East, and these are mostly in people returning from areas with higher infection rates. In these countries, the generally conservative social and political attitudes tend to make it difficult to address risk behavior directly, or discuss it.
The countries most affected are the Russian Federation, Ukraine, and the Baltic states (Estonia, Latvia, and Lithuania), but HIV continues to spread in Belarus, Moldova, and Kazakhstan, whereas more recent epidemics are now evident in Kyrgyzstan and Uzbekistan. Driving these epidemics is a widespread change in behaviors—increasing injecting drug use and unsafe sex—especially among young people. Drug abuse is rampant, especially in Russia, and is still the main route of HIV transmission, but the spread of the disease has now reached a critical point: the virus is moving from high-risk groups such as drug users, sex workers, and prisoners to a bridge population—the wives of convicts and the partners of drug abusers, and into the general population. The forecast is that the epidemic will then progress by the same pattern as in Africa, where HIV is contracted primarily through heterosexual sex.
In sub-Saharan Africa, AIDS is a devastating problem. In the “AIDS-belt”—countries of central and east Africa—the infection is spread primarily through heterosexual intercourse, and men and women are infected almost equally. In many urban areas, 30% or more of sexually active people carry HIV and up to 90% of commercial sex workers are infected. Four out of five HIV-positive women in the world live in Africa. The factors behind the epidemic in Africa include:
Multiple sexual partners—There is widespread, culturally tolerated male promiscuity in many countries. (It is not uncommon for people to have two or more regular sex partners at the same time. Someone is most likely to transmit HIV during the period shortly after they are infected, when they have very high levels of virus in their body. Therefore someone who has two or more concurrent partners is more likely to transfer HIV between their partners than someone who has a series of monogamous relationships. Source: Avert.org.)
Commercial sex—As many as 90% of commercial sex workers in the larger cities in sub-Saharan Africa are HIV infected.
Widespread incidence of sexually transmitted diseases—These diseases greatly enhance the transmission of the HIV virus.
Social resistance to the use of condoms and lack of effective public health programs directed against HIV/AIDS and other sexually transmitted diseases thwart containment.
Contaminated needles and syringes—Few countries can afford sterile, disposable supplies for safe injections. Needles and syringes are often reused, a problem common to almost all less developed countries.
Blood transfusions—Some countries do not have the means to screen blood for HIV (as well as hepatitis B and C viruses).
The social implications of the AIDS epidemic in Africa are profound and affect other countries as well. The shrinkage of the adult population in sub-Saharan Africa presents increasing social and security problems. The absence of adults in communities, including the parents, police, teachers, laborers, doctors, nurses, and many others of the middle class, invites economic chaos, social disorder, the rise of demagogues, and increased regional instability. Many of these conditions already exist in some pockets in Africa. AIDS orphans, or children without their parents who have died from AIDS, are a growing problem in these areas.
The AIDS epidemic in India is expanding rapidly. It is estimated that more than four million people are living with HIV, which makes India the country with the largest number of HIV-infected people in the world. HIV has spread beyond high-risk groups and is now firmly embedded in the Indian population and is fast spreading into rural areas. Between 30% and 60% of commercial sex workers and 15% of truck drivers are infected with HIV or have AIDS. Sex workers continue to play a critical part in the heterosexual spread of HIV, which is the dominant mode of transmission in India, except in two regions (Nagaland and Manipur) where intravenous drug use is widespread. Another mode of transmission is through contaminated blood and blood products and nonsterile needles and syringes. Children sold into prostitution are yet another avenue for the transmission of the HIV virus.
No AIDS cases were reported in China until 1988, when an outbreak was reported among the tribesmen of the Yunnan Province in the western part of the country, bordering the “Golden Triangle.” The government of China estimated that at the end of 1996 as many as 200,000 people were living with HIV/AIDS. It is estimated that this figure had doubled by the beginning of 1998. The increase in injecting drug use, particularly in the Southwest, and the increase in commercial sex on the eastern seaboard are primarily responsible.
In Thailand infection rates among drug users increased from 1% to 43% between 1987 and 1998. Up to 70% of rural commercial sex workers in Thailand are now infected, and spillover into the heterosexual population is occurring, causing a serious public health problem. The Thai government has begun to formally address these issues in ways in which it has not been addressed in many other countries.
*AIDS is the end result of HIV infection. It generally occurs when the concentration of immune T cells (CD4+ T cells) falls below 200 per cubic milliliter of blood, and is characterized by the appearance of unusual infections and certain cancers. These include: Pneumocystis jiroveci pneumonia; toxoplasmosis; tuberculosis; extreme weight loss and wasting, often exacerbated by diarrhea; fungal infections, including meningitis; syphilis; malignancies such as lymphoma, cervical cancer, and Kaposi's sarcoma, which affects the skin and mouth, and may spread elsewhere—it can occur in earlier stages of HIV as well.
†Compared with the hepatitis B and C viruses, the human immunodeficiency virus is much less infectious. For example, the chance of getting hepatitis B from a contaminated needle stick is about 1 in 3, from hepatitis C, 1 in 10, and from HIV, 1 in 200 to 300.
*According to the U.S. Department of State “Travelers to the United States who are HIV positive are not eligible, under current United States visa law, to travel visa free under the Visa Waiver Program. They are required to apply for a visa and a waiver of the ineligibility before traveling.”
HIV/AIDS in the Philippines, Korea, Indonesia, Japan, and Oceania
At present, the incidence of AIDS in these regions is still low, although spread into the heterosexual population is a threat wherever commercial sex is widespread.
Preventing HIV Transmission
Travelers can virtually eliminate the possibility of becoming infected with HIV if they are not sexually active, or are in a monogamous relationship with an uninfected partner or spouse, and are not injecting drug users. Many travelers, however, do have sex with new acquaintances, even strangers. What is their risk of acquiring HIV? As shown earlier, some countries have a much higher incidence of HIV/AIDS than others; so being in certain geographic areas may automatically put them at a higher risk. But what other factors are involved? Just how risky is sex?
As a starting point, one may ask: What is the estimated risk in the United States for acquiring HIV by vaginal intercourse? The actual risk throughout the general population is statistically low. Researchers estimate that the odds are 5 million to 1 against acquiring HIV after a single act of unprotected vaginal sex with a “low-risk” partner. The per-event, male-to-female HIV transmission rate is about 1 in 1,000 with a “high-risk partner” and 1 in 500 if the partner is HIV-positive. Condoms will reduce transmission tenfold. These statistics are reassuring because they demonstrate that it is relatively difficult to acquire HIV from random sex with people in populations deemed to be “low-risk.” But there is a significant flaw in these numbers—statistics can mislead. It is still possible to transmit HIV from a single act of unprotected intercourse. And the traveler may be among a “high-risk” population. Indeed, studies have shown that frequent travelers do represent a higher risk group. In some cases, travelers had rates of HIV that were 50 to 500 times the rate in their home countries. Travelers may engage in behaviors while traveling that they would not engage in at home. In addition, although travelers may not engage in casual and unprotected sex with a commercial sex worker, they may do so with a new acquaintance who they deem is from a similar socioeconomic and educational background. Unfortunately, this is poor judgment. Therefore, the only way to really protect oneself is to take preventive measures, which include:
Avoid sex with high-risk partners.
Use a condom, or insist on condom use.
What is a high-risk partner? In general, it is someone who is sexually active with many people (i.e., promiscuous), or is an injecting drug user, or is someone who is, or has been, a partner of a high-risk individual. In addition, anyone with an STD (later) should be considered high risk, as well as uncircumcised males; they have a greater chance of being infected with HIV. Also, some people with HIV may be much more infectious than others with this disease. For example, if your partner has a newly- acquired HIV infection, there is much more HIV virus in his/her blood and body fluids than during a later phase of infection; and if you happen to have an open sore in your mouth or on your genitals, you are much more susceptible to getting infected.
If you do have unprotected sex, having a low-risk partner is safer, but it is rare that you can feel certain about the safety of a casual acquaintance. When you met, were you under the influence of alcohol? Or drugs? Many people, whether heterosexual, homosexual, or bisexual, don't practice safe sex, may not tell the truth about it, and don't reveal their sexual orientation. Your intuitive sense about the safety of the relationship may be misleading. Asking a new acquaintance about his or her past sexual habits or drug use may not be adequate. In fact, the Archives of Internal Medicine (1998) reports that of 203 consecutive HIV-positive patients at two U.S. hospitals, 40% had not told their partners, and nearly two thirds of them had not always used a condom. People with multiple partners, homosexual and heterosexual, were three times less likely to reveal their HIV status than those with one partner.
Condoms You should always use a condom, or insist one be used, for anal, oral, and vaginal intercourse. But how effective are they? Simply put, very effective, but not 100% effective. A study published in 1994 in The New England Journal of Medicine looked at 256 heterosexual HIV-discordant couples (i.e., one partner is HIV negative and the other is HIV positive). Of the 124 couples that consistently used condoms, none of the HIV-negative partners in the study became infected. Among the 121 couples that did not consistently use condoms, 12 (about 10 percent) of the HIV-negative partners became infected. This is not to say that a condom cannot break or slip off, but considering that semen (and pre-ejaculatory fluid) has the greatest concentration of HIV of any body fluid, the use of condoms is highly logical.
Spermicides and Diaphragms A female should also use a diaphragm along with a spermicidal jelly; this further protects the cervix and uterus from HIV (but not the vaginal walls). Condoms, diaphragms (or cervical caps), and spermicidal jellies, used together, also help prevent other sexually transmitted diseases, as well as pregnancy. Note: Used by themselves, contraceptive jellies may not prevent pregnancy and probably are not effective in preventing HIV transmission. Diaphragms and spermicidal jelly, used together, somewhat reduce the risk of a sexually transmitted infection, but not as effectively as condoms.
Note: Women taking oral contraceptives have a lower risk of HIV transmission. Women who have unprotected sex, who are using IUDs, have a higher risk of HIV transmission. Men who are circumcised have a lower risk of acquiring HIV.
Post exposure Prophylaxis for HIV People exposed to the AIDS virus through a lapse in safe sex or drug-use behavior, or are exposed through sexual assault or accidents, or who experience condom slippage with a partner who is HIV positive can receive emergency prophylaxis with a combination of three antiretroviral drugs. This complex “morning-after pill” regimen must be started within 72 hours of exposure and taken for 28 days. It should not be considered a substitute for abstinence, safe sex, mutual monogamy, consistent condom use, or sterile needles. Choices of drugs include the three-drug combinations of antiretroviral medications recommended by the U.S. Department of Health and Human Services, except those containing nevirapine, which has been associated with severe reactions and liver damage. Medical attention should be sought immediately should post exposure prevention be required.
NOTE: All people seeking care after HIV exposure should be tested for the presence of HIV antibodies at baseline and at 46 weeks, 3 months, and 6 months after exposure to determine whether HIV infection has occurred.
What separates high risk from low risk exposure?
Low, or negligible, risk= Exposure of: vagina, rectum, eye, mouth, or other mucus membrane intact or non-intact skin, or percutaneous contact with: urine, nasal secretions, sweat or tears if not visibly contaminated with blood regardless: of the source's HIV status.
High, or substantial risk = exposure of: vagina, rectum, eye, mouth, or other mucus membrane, intact or nomn-intact skin, or percutaneous contact with: blood, semen, vaginal secretions rectal secretions, breast milk, or any body fluid possibly contaminated with blood when: the source is known to be HIV-infected
HIV Testing and Foreign Travel
In most countries, tourists staying less than 1 month do not need to show evidence of an HIV test. But dozens of countries—including the United States—do require an HIV test for those coming to study, work, reside for long periods, or apply for immigrant status.* Under these rules, those who test HIV positive usually are denied entry, although sometimes a waiver may be issued. Countries that screen immigrants for HIV include Argentina, China, Colombia, Costa Rica, Cuba, Hungary, Iraq, Israel, Mongolia, Myanmar (Burma), the Philippines, Russia, South Africa, South Korea, Syria, Thailand, and the United Kingdom. Furthermore, several countries have policies of rejecting or expelling all foreigners with AIDS. Among those countries are Indonesia, Malaysia, Sri Lanka, and Thailand. Policies tend to change; seeking information from the United States Department of State website (see later) is useful.
Sometimes visa forms ask whether a visitor has any infectious or communicable diseases, so if you are HIV positive, be prepared for this question—and rejection of the application if you answer truthfully. The World Health Organization regards HIV screening as discriminatory and unnecessary from a public health perspective.
For the most current HIV testing requirements for foreign travel, go to the Bureau of Consular Affairs website. This information may also be found at www.thebody.com/state_dept/entry.html. To confirm requirements, telephone the country's consulate in the United States because these requirements may change. Some of the countries requiring testing will accept a test done in the United States. If you need a test, contact the country's nearest consulate to find out which laboratories in the United States can perform the test and how the results are authenticated and certified. You want to avoid, if possible, having your blood drawn overseas. Consider carrying sterile, disposable needles and syringes with you if you anticipate overseas testing. If you will be tested overseas, call the U.S. embassy in the country of your destination to inquire about the safety of a test done locally and if sterile needles are used.
Be aware that a country's announced policy and what actually happens may differ. Random testing may also be performed. Also, travelers found carrying an anti-HIV drug, such as AZT, may be turned away.
Sexually Transmitted Diseases (STDs)
In addition to HIV, other STDs may be acquired from unsafe sex. Risky behavior relates to the number of sexual exposures, number of different partners and/or anonymous partners (e.g., commercial sex workers), anal intercourse (especially MSM—men having sex with men), and use (or nonuse) of condoms. Having another sexually transmitted disease greatly increases the risk of HIV transmission.
Causes of STDs
Sexually transmitted diseases can be caused by bacteria, fungi, parasites, and viruses. Some STDs can be spread by kissing and mouth-to-genital contact (e.g., herpes and genital warts).
Gonorrhea; syphilis; chancroid
Chlamydia infections (urethritis, lymphogranuloma venereum)
Shigella, Salmonella, or other bacteria transmitted, often transmitted by MSM Virus-Caused STDs
AIDS; hepatitis B; hepatitis C
Hepatitis A (oral-anal contact)
Genital herpes; genital warts
Parasite (protozoa)-Caused STDs
Giardia, Isospora, Cryptosporidium, Entamoeba histolytica, or other parasites, especially in MSM
Vaginal or urethral infections caused by Trichomonas
Symptoms of STDs
The most common STDs in the United States are caused by gonococcus and chlamydia, and by the herpes virus, but statistics are lacking about the extent and type of STDs occurring in travelers. In those with gonorrhea or genital herpes, symptoms usually occur 4 to 10 days after exposure, and the association with travel would be obvious. Diseases that have much longer incubation periods, such as hepatitis, may not be recognized as being travel related because their symptoms may occur well after the traveler has returned home.
Genital Lesions If you notice any ulcers or sores on your genitals—herpes, syphilis, or chancroid may be the cause. A painless ulcer may indicate syphilis, whereas herpetic ulcers are usually shallow and quite painful. These lesions require a specific diagnosis for appropriate treatment. Be sure to seek qualified medical care.
Pelvic Inflammatory Disease (PID) Women who develop lower abdominal pain, vaginal discharge, and fever should be examined for the possibility of pelvic inflammatory disease (PID, salpingitis), which is an infection of the uterus and/or fallopian tubes. This is often a mixed infection, usually caused by gonococci and/or chlamydia, along with a mixture of aerobic and anaerobic bacteria. Depending on the severity of symptoms, treatment may require a 3-drug regimen, including intravenous administration of antibiotics. (Oral therapy can be considered for women with mild-to-moderately severe acute PID, as the clinical outcomes among women treated with oral therapy are similar to those treated with parenteral therapy.) Bear in mind that appendicitis; an ovarian cyst; endometriosis; and even an ectopic pregnancy can mimic PID, so a precise diagnosis is important. An ultrasound exam, or CT of the abdomen/pelvis, if available, may be useful.
Several regimens are available for the outpatient treatment of uncomplicated PID:
A 250-mg injection of ceftriaxone (Rocephin) plus a 14-day course of doxycycline, 100 mg twice daily (or tetracycline, 500 mg four times daily), for 14 days. Add metronidazole (Flagyl), 500 mg twice daily for 14 days, for additional anaerobic coverage, e.g., if you suspect tubo-ovarian abscess. You can substitute doxycycline with a 1-g dose of azithromycin, once weekly x 2 doses.
A single 2-gm dose of azithromycin. This has the advantage of simplicity, and is useful when competent medical care is not readilyonce weekly x 2 doses. available, but may cause significant GI upset.
Note: Cefixime, 400 mg orally x 1 dose, is now approved by the CDC to be used in place of ceftriaxone for treating gonorrhea.
Note: Fluorquinolones remain effective for chlamydia, a cause of PID, and are also first-line treatment for urinary tract infections (UTI), which can mimic PID. Fluoroquinolones should no longer be used to treat gonorrhea.
Note: Any sexual partner(s) must also be treated. The use of condoms (or abstinence) during treatment is essential.
Urethritis in Men A man with a STD may complain of a discharge from his penis and a burning sensation on urination. This is called urethritis. Gonorrhea causes a copious purulent, greenish/yellow discharge, whereas chlamydia urethritis is characterized by a thinner, milky discharge. When a person has symptoms of gonorrhea, co-infection with chlamydia must be considered.
Treatment of Gonococcal Urethritis
Several treatment options are available:
A single 125 mg/250 mg injection of ceftrixone (Rocephin).
A single 400 mg oral dose of cefixime
Note: When treating gonorrhea, also give either a single 1-g dose of azithromycin, or a 7-day course of doxycline, to treat a possible chlamydia co-infection.
A single 400 mg dose of cefixime plus single 1-g dose of azithromycin is virtually 100% effective against a mixed gonorrhea/chamydia infection.
In April 2007, the fluoroquinolone drugs, including ciprofloxacin, ofloxacin, and levofloxacin, lost their "recommended" status due to resistant strains of GC in the United States and overseas.
Cefixime 400-mg tablets are now available in the U.S. Previously, intramuscular ceftriaxone was the only drug, practically speaking, recommended by the CDC for treating gonorrhea.
Single-dose azithromycin (1 gm orally), or
Doxycycline 100 mg twice daily for 7 days, or
Levofloxacin, 500 mg daily for 7 days
The above treatments can also be used for women who are diagnosed with nongonococcal cervicitis.
Treatment During Pregnancy If you are pregnant, you can safely be treated with ceftriaxone or cefixime, plus azithromycin. Don't take doxycycline or tetracycline. Use a fluorquinolone only if alternative drugs are not available.
Post-Treatment Follow-Up If you were treated for gonorrhea or PID while traveling, you should contact your physician when you return home. Women should have follow-up cultures of the cervix to see if they are still carrying gonorrhea and/or chlamydia. Both men and women should have blood tests to check for syphilis and should be screened for HIV infection (as well as hepatitis B and perhaps other infections as well). HIV screening tests may not be positive for 12 weeks or longer after exposure. Early diagnosis of HIV infection is important because early, aggressive anti-HIV therapy with antiretroviral drugs may preserve crucial components of the immune system. Note: There is also an FDA-approved home HIV test, made by Home Access, which is similar to the test done in hospitals. It is sold in most drug stores and can be ordered by phone (800-HIV-TEST) or online (www.homeaccess.com).
Prevention of STDs
Follow the same prevention guidelines as for HIV
There are many ways in which HIV can be spread, but first you should realize that HIV is not spread by
Casual contact at work or school
Touching or hugging
Coughs or sneezes
Insect or mosquito bites
Food or water
Eating utensils, cups, plates
Swimming pools or baths
With HIV, a single act of unprotected vaginal or rectal intercourse may be sufficient for transmission. It is believed, however, that in the majority of cases, repeated exposure to the virus through multiple acts of intercourse is necessary for transmission to take place.