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or anal contact. The good news is that syphilis is easily cured with penicillin. The bad news is that this infection is on the rise.

       The number of reported syphilis cases rose over 70 percent from 2013 to 2017.

       Men, especially men who have sex with other men, are affected the most.

       Over 100,000 cases of syphilis were reported in 2017, with a rise in syphilis in heterosexual men and women.

       Syphilis can cause epididymitis in men and can be passed to an unborn child during pregnancy or at birth.

      Syphilis frequently starts as a painless sore on such areas as the mouth, genitals, or rectum. The sore is called a chancre, and this stage of syphilis is called primary syphilis. The sore may never be noticed and heals without intervention in 3–6 weeks. The next stage of syphilis is called secondary syphilis and is hallmarked by a rash that is frequently painless but can occupy the entire body including the palms of the hands and soles of the feet. This may continue for up to a year. The third stage of syphilis is called tertiary, and 15–30 percent of people infected with syphilis reach tertiary syphilis without treatment. Tertiary syphilis can lead to life-threatening problems with almost every system in the body and may not appear until years after the initial infection. Syphilis was a major cause of death until penicillin was available after World War II. In fact, it’s hit some pretty well-known people. Al Capone had tertiary syphilis, which destroyed his brain while he was incarcerated at Alcatraz. Capone was one of the first people to get penicillin, but it was too late. He eventually died at age 48 of heart disease believed to be related to his syphilis infection.

Babies born with syphilis contract the disease through the placenta or during birth. Usually the baby is initially without symptoms but eventually may develop deafness, teeth deformities, or saddle nose (loss of height of the nose.) Syphilis is diagnosed with blood or spinal fluid tests. The initial test is a screening test that does not miss many people who are infected. However, the screening test tells a number of people they do have syphilis when in fact they don’t. So, if the first test is positive, a second test is done which accurately identifies the people who truly are infected.

      Syphilis is easily treated if diagnosed early. A single injection of penicillin can cure syphilis if diagnosed within a year of exposure, but after that a more extensive treatment with penicillin is needed. Other antibiotics may be used. Contrary to folklore, syphilis can’t be caught from a toilet seat.

      

Early detection of syphilis is key, and it can be easily treated with penicillin (or another antibiotic if you are allergic to penicillin). Don’t be afraid, embarrassed, or otherwise deterred from talking to your doctor about STIs. Ignoring syphilis can be devastating to you, your partner, and your child.

      Genital herpes

      Genital herpes is caused by the herpes simplex type 2 virus (HSV). The cold sores some people are prone to on their lips are caused by the herpes simplex type 1 virus (although you can get genital herpes with type 1 and cold sores with type 2 — STIs don’t always play by the rules!). Currently, there is no vaccine against genital herpes in the works, but a few scientists are working on one for oral herpes. In the meantime, caution should be exercised when having a sexual relationship with an infected person as it is spread through body fluids. Here’s some other information on herpes:

       Fifty percent of Americans under age 50 are infected with oral herpes.

       One in eight people in the United States have genital herpes, with 500,000 new cases diagnosed each year.

       Unlike some of the other STIs, the incidence of genital herpes is decreasing.

       Once you are infected with the genital herpes virus, it stays in your body forever, even though initial symptoms of flu-like symptoms and chancres may disappear within two to three weeks. Occasional flare-ups can be managed with antiviral medications like acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex).

       There is no clear link between genital herpes and infertility; however, some researchers have suggested that the virus may cause implantation problems in women. The bigger issue is if you become infected late in your pregnancy, or you have an outbreak at delivery. Having genital herpes before a pregnancy has a very low risk of transmitting the infection to your baby.

        There is a 30–50 percent risk of infecting a fetus if the mother first contracts genital herpes late in her pregnancy.

       If you have an outbreak of genital herpes at the time your baby is ready to be delivered, you’ll need to have a cesarean section; if you deliver vaginally without treatment, your baby may suffer from neonatal herpes (leading to central nervous system damage, mental retardation, or even death).

       Antiviral medications are generally safe to take during pregnancy.

      HIV

      Human immunodeficiency virus (HIV) is a chronic infection that may or may not lead to the disease AIDS (acquired immune deficiency syndrome). At present, there is no cure for HIV or AIDS, although antiviral medications may keep HIV under control for some time. There are over one million people in the U.S. living with HIV, and approximately 15 percent of them are undiagnosed. Just under 40,000 new cases are reported per year.

      While some HIV-infected men may have sperm abnormalities (like a lower sperm count), many will see no impact on their ability to father a child. Further, special sperm preparation and IUI or IVF with ICSI can significantly reduce the likelihood of transmitting HIV to their partner or fetus. HIV-infected women do not have fertility issues simply due to their HIV. Pregnancy is another story.

      Check out the following facts about HIV and pregnancy:

       Women with HIV can become pregnant and carry the pregnancy to term, but they risk transmitting HIV to the baby or causing birth defects due to the medications they may be on.

       The risk of transmission is about 25 percent if you’re untreated but may be reduced dramatically if you receive antiviral drug regimens while you’re pregnant.

       You can reduce the chance of infecting a newborn to approximately 2 percent by using antiretroviral meds and not breastfeeding.

       You may reduce the risk of transmission of the disease to your baby if you have a cesarean section rather than a vaginal delivery.

       You must wait 3 to 18 months after delivery to find out whether your baby is HIV positive, because during pregnancy your antibodies are passed to the baby. This means that all babies of HIV-infected moms will test positive at birth. It can take as long as 18 months for all your antibodies to disappear from your baby’s blood. After your antibodies are all gone, if the baby tests positive, it means he or she is infected with the virus.

      

You can be tested for sexually transmitted diseases, including HIV, before trying to conceive. If you are using any third-party reproductive techniques, you will be required to have many of these tests (we talk more about this in Chapter 20). If you suspect that you may have an STD, or have been exposed to one, you need to rule out this potential danger to your fertility and your unborn child.

      Trichomoniasis

      Trichomoniasis (commonly known as “Trich”) is a sexually transmitted disease cause by the parasite Trichomonas vaginalis. Trich is the most common curable STI, and one estimate reports that 3 percent of all women in the reproductive age are infected. The disease is largely without symptoms in both men and women, with over 80 percent of those infected without symptoms. Symptoms, when they occur, include a vaginal discharge, itching of the perineum, odor, and irritation. There are tests that can be done in your doctor’s office from vaginal

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