In life, we continuously run the risk of getting sick. Even in love this can happen, and sometimes, it happens with those we would least expect it from. Loving someone can be wonderful, as long as there are no risks or anxieties of an unwanted pregnancy, or of Sexually Transmitted Diseases. This is easy to say, but it's important to want it and remember it under all circumstances, even those that seem the safest. Unfortunately, the signs that help us recognize danger are not always so clear and, in some cases, the sexual attraction we feel towards another person, and the sincerity of our intentions, blind us to such an extent that we don't see the hidden dangers. To avoid getting into trouble, it's important to listen to your own instincts and emotions, as well as to the advice of the people who love and care about you. What are the most risky situations? Having unprotected sex often with strangers or with multiple partners at the same time, or with those who have relationships with other people (multi-partner relationships). Risky sex also involves having unprotected sex with those affected by contagious diseases or AIDS (seropositive or with the disease), drug addicts and prostitutes. Also pay attention to poor hygiene and promiscuous situations in general.

Sexually Transmitted Diseases (STDs) are infections that can be contracted through unprotected sex (risky sex). These used to be referred to as venereal diseases, named after Venus, the ancient Roman goddess of love. These are among the most common and frequent infections. Some are trivial, others are much more serious, so it is imperative to know about them to be able to protect yourself adequately under any circumstances. Anyone can be infected, even without knowing it. Contagion occurs through sexual intercourse, but for some diseases (HPV, for example), even simple contact is enough to cause an infection. The infection may be caused by bacteria, such as with syphilis and gonorrhea, by parasites such as Trichomonas, by fungi such as Candida, or by viruses such as Papillomavirus (there are more than 120 types, of which about 40 are associated with infections of the genital area), Herpes (genital or labial) and HIV, the virus that causes AIDS.

These are mostly transmitted through risky sex with an infected partner. Some STDs are also transmitted through blood (ex. AIDS and hepatitis B) or saliva (hepatitis B). Some infections can also be spread through contact with infected sheets or toilets.

Girls are the most sensitive, but boys are also affected in a more subtle way.

Often, these infections are invisible. In other words, they do not show any apparent symptoms when contracted, making it more difficult to recognize them. If they are not treated immediately, some STDs can cause serious complications.

This is the so-called "ping-pong effect," and is a danger that should not be underestimated for couples who are a little careless or absent-minded. He gets infected by her but has no symptoms, so he doesn't get treatment. She gets treatment, but continues to have sex and inevitably gets infected again. How can this vicious circle get interrupted? By both partners getting treatment even in the absence of symptoms. During treatment, it's best to abstain from sexual intercourse, and to wash all sheets and bathroom articles (which in any case should never be shared) at high temperatures. Once healed, it is always advisable to use a condom to protect yourself from STDs, although it is good to be aware that this does not guarantee complete protection against Papillomavirus since it does not cover the entire genital area. The risk of acquiring a new infection is at most 10-15 years after you begin to engage in sexual activity. During delivery, it is possible for the mother to transmit an infection to the infant.

There are diverse precautions you can take that are easy to follow. First of all, always carry (or make your boyfriend carry) at least two or more condoms with you, and use one each time you have sex (including oral or anal). Remember that frequently changing sex partners or having frequent multi-partner sexual relationships favors sexually transmitted diseases (STDs). If you change partners, check for STDs – this is a gesture of responsibility towards yourself and others, and helps to reduce the spread of STDs. Limit alcohol consumption and don't use drugs. Both of these things can make you lose clarity of mind and self-control, favoring promiscuous and unprotected sex.

• Learn how to observe your external genitals, and get in touch with your body. For your boyfriend this is easier. He must look at and touch his penis carefully. When he touches it, he shouldn't feel pain or the presence of nodules, and there should be no spots on the glans or discharge from the urethra (the channel through which urine passes).

To observe your intimate parts, you can use a mirror. Touch your vulva and the inner and outer labia. You shouldn't see any stains or blisters, feel pain or the presence of nodules, or have any urine leakage.

• Take care of your intimate hygiene every day. Use specific products that are delicate, and have a neutral pH. Always wash yourself before and after sexual intercourse.
• Avoid lingerie, as well as pants or jeans that are too tight. Always choose natural fibers such as cotton, linen and silk. Synthetic underwear doesn't breathe, which causes sweating and maceration of the intimate parts, favoring the proliferation of germs.
• Never sit on toilet seats in public restrooms, and don't even touch the walls around them. Always wash your hands for your sake when you go inside, and for the sake of others when you leave. To turn the knob on the door of the public restroom, use your elbow and not your hand. This is one of the areas that is most infested with germs and bacteria, especially considering the continuous flow of people (and many do not wash their hands!!). If you have the slightest suspicion that you've contracted an infection, go see the doctor. Do not take it lightly!

Only barrier methods of contraception, such as condoms, can effectively protect against sexually transmitted diseases (STDs). Condom use is recommended whenever you have casual sex with occasional partners, or with partners you don't know well. There are condoms available for all style preferences, sensibilities and sizes. There still exists an unjustified, negative perception of the condom, whose use is seen as a lack of trust in a partner, as representative of dirty sex or as something that acts as a barrier to free and spontaneous sexuality. The thrill of sexuality "without limits" should not, however, be so intriguing because the price to pay is too high in terms of future sexual well-being. Without thinking of serious infections such as AIDS, which unfortunately is still ever-present in Italy, contracting a viral infection such as genital herpes or papilloma virus (HPV) can strongly interfere with your sex life and negatively mark your first sexual experiences. It may even become a burden that is difficult to break free of in your later years of maturity.

The IUD (Intra Uterine Device) is not a barrier method and does not protect against sexually transmitted diseases. In fact, in some women, it may favor them, compromising future fertility. The IUD is an intrauterine device that must be inserted by a gynecologist into the uterine cavity (a thread is left in the vagina for easy recovery). It should be changed every 3-5 years. The IUD is a contraceptive that prevents implantation of a fertilized egg using multiple mechanisms. However, it constitutes a possible pathway for germs in the vaginal cavity to enter the uterine cavity, and is therefore not recommended for women who have not had children, especially if they have multiple sexual partners.

Yes, this is possible. Expectant women have the same risks of contagion as other women. Pregnancy does not provide any protection against sexually transmitted diseases (STDs) for the future mother, the fetus or the newborn. In fact, under these conditions, the consequences of a sexually transmitted disease can be much more serious. In a pregnant woman, an STD can also cause premature delivery.

A sexually transmitted disease (STD) can be transmitted from the mother to her baby before, during and after childbirth. Some STDs (for example, syphilis bacteria) can cross the placenta and infect the baby when it is still in the mother's womb. Other sexually transmitted diseases (such as gonorrhea, chlamydia, hepatitis B and genital herpes) may be transmitted by the mother to the baby during childbirth, when the infant passes through the delivery channel. HIV (the AIDS virus) can cross the placenta during pregnancy, infect the baby during birth or, unlike other STDs, infect it during maternal breastfeeding.

If you suspect an infection, contact your gynecologist or a women's health center immediately. If the examination reveals a sexually transmitted disease, it is important that you alert your partner (or all your partners if there are more than one) immediately so that he can also go for a check up, and if necessary, undergo the necessary medical treatment prescribed. Because it works, it’s important that you both follow the treatment meticulously, and for as long as the doctors say. It’s better to abstain from sexual intercourse throughout the entire course of treatment, even if you don't have any symptoms. Sexually transmitted diseases (STDs) are sneaky, and often develop for some time asymptomatically without causing any problems.

This is, in fact, true. Sexually transmitted diseases (STDs) are more common among teenagers, especially for girls and for young people under the age of 25. Why? The reasons are different. First, there is increased sexual promiscuity among young people, little use of protection, and, unfortunately, according to research, a lack of information about the risks of unprotected sex, both in regards to a possible unwanted pregnancy as well as in regards to sexually transmitted diseases (STDs). According to a recent report from Censis (a socio-economic research institute), 90% of boys identify sexually transmitted diseases with AIDS; only 15% know about Papillomavirus or HPV, 13% about gonorrhea, 11% about hepatitis and 6% about chlamydia.

Most boys do not use a condom, or do so only occasionally. It only takes a single sexual encounter with an infected person - who may not even have any apparent symptoms - to be infected with one or more diseases. Some may only be mild, but this is not always the case! Above all, those who have already had an infection have a greater chance of being reinfected, and have to pay more attention. Various germs have different incubation periods, and therefore even if everything seems fine and you have no symptoms, after the doctor's diagnosis and undergoing the indicated therapy, it is important to get checked out to make sure that all infections have been effectively resolved so you can avoid any surprises.  

Young girls are more vulnerable, in part because of the anatomy of the female genitals, which are more susceptible than the male ones. This is partly because the tissue surrounding the cervix in a teenager is not yet fully mature; it is more delicate than that present in an adult woman, and therefore more fragile when faced with aggressive and resistant bacteria. Among these is Chlamydia, which prefers young women between the ages of 15 and 24, and the bacteria that causes gonorrhea, which can affect all ages and often associates with Chlamydia. According to World Health Organization (WHO), gonorrhea is increasingly widespread and very contagious. It is reported that about 78 million people a year contract this infection through sexual intercourse, and it is becoming more resistant to antibiotics.

It’s true. It can often happen that these infections occur asymptomatically (without disturbances or obvious signs), at least in the beginning, without causing any problems, and this partly explains the ease of contagion and its dangerous spread. Let's give some examples: Only 1 in 20 people know they have hepatitis just as over 50-60% of HIV-infected people do not know they have contracted it because they did not get AIDS. The same applies to Chlamydia - the healthy carriers are numerous, especially among men who are not aware of having it. Such people may appear healthy, but they are highly infectious, and they are not even aware of it. Unprotected sex in these cases can become very dangerous.

Here's some basic indications. They are not meant to make a diagnosis, but they can help you recognize the main symptoms of sexually transmitted diseases (STDs). This is a discussion that involves being attentive toward intimate, personal and sexual hygiene. Three main elements should be kept under control: 1) problems with urination, 2) genital hygiene and care, 3) the appearance of abnormal discharge.

Let's look at each of these in a little more in detail.

• Problems with urination (this applies to you as well as your partner)
  If you ever feel a burning sensation when peeing or have an abnormal secretion, possibly accompanied by small cramps, you should learn to recognize these symptoms and contact your gynecologist or a women's health center immediately. All that's necessary is a few simple tests, like a urine test or a secretion test, and you will know what it is in a few days, and have the right medicines to cure it. Therapy usually works very quickly.

• Taking care of your genitals (this applies to you as well as your partner)
  When you wash your intimate parts, remember to check the entire genital area and the surrounding area, as far as the anus. Use a mirror to help with this. If you notice any slight alterations, red areas, swelling, small blisters or other external manifestations, pay close attention. Of course it's easier for boys to examine their genitals and the surrounding area, which are all external, but it's also important for girls to learn to examine their inner and outer labia. It's easy once you get in the habit of it. You can also use one of those round magnifying mirrors to make viewing easier. This should become a customary practice, thereby making it easier to notice any anomaly early on, even if it's something small, and take care of it quickly. If you notice something strange, contact your gynecologist or a women's health center. If an infection is not diagnosed, the slight alteration will be treated immediately without any consequences.

• The appearance of abnormal discharge
  For girls, as you may already know, one of the signs of the condition of uterine and vaginal activity is the so-called white discharge. When looking at your panties, if you notice that the discharge has a consistency, color or smell that is different from the usual, pay particular attention – it could be a sign of some slight irritation or inflammation. If it continues, report it to your gynecologist or someone from a women's health center. With a very simple exam, which involves taking a small sample of mucous with a swab, you will be able to get a diagnosis and treatment within a few days, whether it be a sexually transmitted disease or a reassuring answer of "you have nothing to worry about."

Even boys may sometimes experience discharge from the urethra, for example in the case of Chlamydia, Gonorrhea and Trichomoniasis. Exams are quick for them too. They can consult a women's health center or a urologist/andrologist.

Many sexually transmitted diseases go away when they are treated early and in a timely manner. Some, such as genital herpes, can recur. This means that a person, after contracting the virus the first time, gets better. However, after a variable period of time (from several months to many years), under conditions of stress, tiredness or fatigue, the viral infection may return. People suffering from recurrent herpes learn right away to keep the treatment for this disease at home so that they can begin treatment again at the first sign of symptoms.

Yes this is true, and they can cause the so-called pediculosis pubis. The agents responsible are small parasites - pubic lice - that are equipped with hooked legs that attach to hair. They feed by piercing the skin with their mouths and sucking blood. They attach their eggs (nits) very firmly to the root of the pubic hair, or hair of other areas of the body, and deposit a liquid that causes intense itching. Boils or pustules may also occur.

The pubic lice settle at the base of the pubic hair, in the genital area, under the armpits, between the eyelashes and in the eyebrows. This infection is transmitted through sexual intercourse but can also be transmitted through direct contact with underwear or swimwear, using toilets or other hygienic objects that are infested by these small parasites, or by sleeping in unclean sheets. Thus, if you are with strangers, it's best not to exchange clothing, soaps or wipes. After casual sex, if you feel a lot of itching around the genital area, check yourself carefully and consult a gynecologist. The treatment of choice, which must be followed by all partners at same time, is an antiparasitic for local use that is recommended by the doctor.

Scabies is a contagious parasitic infection caused by a mite. The female mites, following reproduction, penetrate the skin, dig a tunnel and deposit their eggs, after which they die. It spreads quickly, especially in very crowded environments such as hospitals, schools, barracks etc. Contagion can be caused by prolonged direct contact with people who are already infected, by sexual intercourse, by exchange of underwear, garments or contaminated objects, or by sleeping on sheets that were infested previously by an infected person. 

Scabies causes intense itching, usually at night or when you are hot. Itching causes scratching injuries in the navel and genitals areas, on the breasts, in the front folds of the armpits, on the hands, in the spaces between one finger and another, on the front of the wrists and on elbows. They do not usually appear on the face. The infection manifests with pearl-shaped blisters at the end of a stretch of thickened skin that indicates the subcutaneous "tunnels" dug by the female mite in the stratum corneum.

A condom will not prevent contagion. If you find small, shiny blisters that are very itchy following casual sex, go to the gynecologist or women's health center. The therapy of choice will be an antiparisitic drug, which must be prescribed by a gynecologist. Healing is quick and complete if treatment is timely.

Yes, in the case of diagnosis of Trichomonas vaginalis, treatment should be followed by all partners. This is the only way to heal properly, without the risk of recurrence. The vagina is the most frequent site of infection in a woman, while in a man it is the urethra. If the infection is neglected, the Trichomonas can travel up the genital tract, infecting the urinary tract. It is one of the most common sexually transmitted diseases contracted through unprotected sex. An infant can be infected during childbirth. 

Infection can often be asymptomatic, especially in boys. In girls, however, infection occurs with intense itching, local burning, redness of the vulva and vagina and yellowish-green discharge that is frothy and bad-smelling. It is also associated with pain during sexual intercourse (dyspareunia) and burning during urination.

Healing can be quick if the treatment is done right away. There is a specific drug that needs to be taken orally for treatment. The treatment should be followed by all partners at the same time to avoid any reinfection. During treatment, consumption of alcohol is not advisable, as it may greatly increase instances of nausea or vomiting.

A yeast infection is a vaginal infection that is common among adolescents. It is caused by Candida Albicans, a fungus that normally lives in balance with other microorganisms in certain areas of the body (vagina, mouth, digestive system). In specific situations, Candida begins to overdevelop, causing an infection. This can happen under conditions of stress, illness, prolonged intake of antibiotics or cortisone drugs, alcohol or drug abuse, poor intimate hygiene, excessive use of harsh intimate detergents or repeated vaginal irrigations that tend to disrupt the vaginal ecosystem, AIDS or other sexually transmitted diseases.

Aside from contagion through sex, girls can also be infected - albeit less frequently - through contact with infected lingerie or through exchanging underwear or bathing suits with friends. 

The most common symptom is an intense burning in the vagina or the penis, along with whitish discharge that has the appearance of curdled milk, local irritation, and difficulty and burning during sexual intercourse.

The intense vaginal itching for girls, or in the glans (the tip of the penis) accompanied by red spots for boys, would suggest an infection of this type. If you notice any of these symptoms, contact your gynecologist or a women's health center immediately.

To prevent a yeast infection, you must use a condom and have good intimate hygiene, using a delicate detergent that maintains the balance of the vaginal ecosystem. You should also follow a healthy diet with few yeast-containing foods (bread, pizza, snacks, etc), which are a breeding ground for the growth of Candida (especially before and during the menstrual cycle), and engage in physical exercise. It is also important not to share your lingerie with friends or sisters, and always wear underwear made of natural fibers. Synthetic fabrics do not breathe well, and create a moist environment that is ideal for Candida growth.

Treatment requires specific medications that must be prescribed by the gynecologist.

Healing can be slow and characterized by frequent recurrences.

Gonorrhea is one of the most commonly sexually transmitted diseases (STDs), also among adolescents. It is caused by a bacterium, the gonococcus (Neisseria gonorrhoeae), which has the typical coffee bean shape and grows well in wet areas. This is why it nests in the mucous membranes. It can be transmitted during childbirth and through unprotected sex. Ejaculation is not necessary for contagion, which can also result from simple contact with the skin or with infected linens. Gonorrhea is often associated with other STDs, such as Chlamydia.

It can be asymptomatic in both girls and adult women, or it may cause: abdominal pain and during sexual intercourse, infections of the urethra and fallopian tubes, pus-filled and foul-smelling discharge, sometimes even bloody discharge between menstruation and burning during urination.

In males it can cause discharge with pus from the genitals ('drainage'), burning, pain and difficulty with urination, swelling and itching in the genitals. In the case of oral or anal sex, an infection in the throat or anus is not always symptomatic.

A diagnosis can only be made after careful medical examination. To prevent gonorrhea, always use a condom, avoid occasional unprotected sex, limit the number of partners and avoid the use of drugs and alcohol because it reduces the reactive capacity of the immune system.

Therapy involves antibiotic treatment, which must be followed by all partners at the same time. Due to the antibiotic resistance that this bacterium is demonstrating, older and less expensive antibiotics have lost their effectiveness in treating the infection, which is becoming more difficult to get rid of.

If treatment is done right away and adequately followed by all partners, healing is generally quick. If the infection is not treated, serious complications can occur, and not only in the genital areas.

Chlamydia (Chlamydia trachomatis) is one of the most widespread sexually transmitted diseases, especially among adolescents. There are numerous healthy male carriers. Adolescents are particularly at risk of contagion due to the immaturity of the cervix, which is more fragile and delicate than that of an adult woman.

The infection is caused by bacteria of the genus Chlamydia. It can be recognized using a swab or blood test. It can be easily treated and cured with antibiotics, provided that all partners do the treatment properly, abstaining from sexual intercourse throughout the duration of the treatment. it's good to go for a check up 3-4 months after you have completed the antibiotic treatment to make sure everything is fine.
If not treated appropriately and right away, Chlamydia can cause serious complications, including infertility. 

Chlamydia can be asymptomatic in the beginning, but within a few weeks it can spread from the vagina to the cervix, the urethra, and progressively trace down Fallopian tubes, causing abnormal whitish/yellowish discharge or bleeding in between menstrual cycles. It also causes burning during urination, nausea and fever, as well as back and lower abdomen pain that increases during sexual intercourse. After oral sex, pain and burning may occur in the throat.  

Fallopian tube infections are common in young girls. They may not have many symptoms and may not seem worrisome, but they are particularly dangerous. These may in fact be a cause of ectopic pregnancies, where the embryo is implanted in one of the two tubes and not in the uterus as it should be, with the risk of severe acute bleeding that may also be fatal.

Chlamydia may reoccur within two years of the first infection in 35% of girls, causing tube lesions, pelvic peritoneal infections and intense pain upon penetration. The most feared consequence is pelvic inflammatory disease (PID), a serious disease that can cause permanent damage and is one of the major causes of female infertility.

Unfortunately, experts say that even after a first infection, adolescents don't learn to use condoms. In the case of Chlamydia, this is very risky behavior for a woman's future health, not only from a reproductive point of view.

It can happen. Even though these are two different types of viruses, they are from the same family. Genital herpes is an infection caused by Herpes simplex virus type 2 (HSV-2) in 90% of cases. Type 1 (HSV-1) is responsible for cold sores, but may also cause genital infection (1% of cases).

Genital Herpes is one of the most common sexually transmitted diseases, also among young people. It is more common in women than men.

Contagion occurs mainly through sexual intercourse with infected partners who may not even know they have it because the infection can start without symptoms and without visible skin lesions.

Once contracted, the infection can last for a lifetime through recurrent episodes, as is the case with cold sores. Genital herpes is very contagious during recurrence, when the virus is active, and much less during so during dormant periods (it hides in nerve cells).

It can develop without causing symptoms (asymptomatic), or it can occur with a characteristic "outbreak" of small blisters filled with transparent liquid, typically gathered in "clusters," which are mainly located in the vulvo-vaginal area, and less frequently in other areas (anus, buttocks, thighs, penis). The blisters may be painful and burst, leaving 1-2 mm erosions that form a crust and heal spontaneously within 2-4 weeks.

In this stage, the virus is very contagious. Sometimes the symptoms are similar to those of influenza (swelling of the glands, fever, bone pain, general weakness).

Therapy involves specific antiviral drugs, which act selectively on infected cells. Recurrences may be frequent (recurrent genital herpes), as they are for cold sores under stressful conditions, emotional tensions, during menstruation, or if you consume a lot of hard liquor or drugs.

If a genital herpes infection is not treated, it can cause serious complications, including kidney infections with very irritating disorders and pus formation. Like the symptoms, these too may initially be subtle and silent, especially in young women.

True, this is the first symptom and the most recognizable of bacterial vaginosis, which manifests itself with foul odors that smell like spoiled fish. Not by chance, one of the tests used to detect it is called a fish-test or sniff-test.

This bacterial infection occurs when normal vaginal bacterial flora (the "good" bacteria that defend us from the "bad" ones, and which are predominantly the Lactobacilli, such as Döderlein bacillus, that usually live in the vagina of the woman, where they play a beneficial role) is replaced by other bacteria, which find favorable conditions for growth, and can grow in large numbers and become dangerous. Among these, one of the main ones is Gardnerella vaginalis.

Contagion occurs primarily through sex with infected partners. In about half of the cases, the infection is asymptomatic. In the other half, symptoms generally manifest that include:

• grayish vaginal discharge with an unpleasant fishy smell, irritation and inflammation of the vagina and surrounding area, burning during or after sexual intercourse or during urination.

Specific therapy involves antibiotics, which must be prescribed by a gynecologist. Resolution can be quick if the treatment is done right away. In most cases, this is not a serious infection, but it is annoying and can be transmitted to your partner, who should in any case be informed. 

To prevent re-infection, it is important to maintain the vaginal acidity around pH = 4, which helps protect the equilibrium of the beneficial resident flora (acidophilus lactobacillus). These constitute the first defense against invading pathogenic strains, which can also come from the intestine (through the anus). In this regard, it is always important to wash the intimate parts from the front to the back, and not vice versa, in order to prevent germs in the anal area from infecting the vulvo-vaginal parts. 

The soft chancre, or chancroid, is caused by rod-shaped bacteria (Haemophilus ducreyi) that more commonly infects and manifests in a more painful form in males (it can be asymptomatic in women). In Western countries, this infection is rare, while in Africa and the Caribbean, infections are especially frequent.

Contagion always occurs directly from unprotected sex.

Within 3-7 days of unprotected sex with an infected person, the bacterium causes typical ulcerous lesions that are swollen around the edges, painful and have a soft center (hence the name of the infection). These mainly affect the area of ​​the glands, the frenulum (thin flap of skin joining the gland at the foreskin), the perineum and the area around the anus.

There is usually an enlarged lymph node (lymphadenopathy) on one side, with a tendency towards suppuration and fistula formation.

The ulcers caused by the bacteria can spread by autoinfection (if you touch ulcers, in fact, the bacteria can get onto the fingers and be transferred to the mouth or other areas). Sexual promiscuity and poor hygiene increase the chance of contagion. The presence of ulcers may predispose you to other sexually transmitted diseases.

Diagnosis involves looking for Haemophilus ducreyi in the material collected from the ulcer or lymph node. In severe cases, it may be necessary to drain the pus with a needle from inside the ulcers. Treatment is based on the intake of antibiotics, either orally or by intramuscular injection. At the end of treatment, it is very important to go for a checkup. Complete healing is achieved in about 10-15 days. Relapses are uncommon unless treatment was not followed properly.

Despite its romantic image, powered by several films and screenplays of the past, syphilis is one of the most dangerous sexually transmitted diseases. It has spread all over the world, and unfortunately, is still growing. In just the United States alone there are about 36,000 cases of syphilis every year, in both men and women. Recently, syphilis has reappeared in European countries as well. In Italy, it has gone from 150-200 cases to over 1500 per year!

Syphilis is caused by Treponema pallidum, a very invasive spiral-shaped bacterium (spirochete). The infection is contracted through sexual intercourse with an infected person, and the spirochete penetrates the body through the skin (especially if there are micro-abrasions) or through the oral mucosa, the vagina, the penis or the rectum. At the point where the bacterium has penetrated, a small, painless nodule forms first, followed a few days later by a small wound that, after releasing a large amount of spirochetes, heals by itself. It is very contagious at this stage, and if the infection is not treated properly, it can evolve into the subsequent states. After a couple of months, non-itchy red spots appear on the skin, accompanied by joint pain, muscle pain, fever and swelling of all the glands in the body. After another three to four months, the disease seems to be healed, but remains contagious for at least two years. If it continues to be untreated, the infection evolves in a subtle and silent way, creating serious complications that may even become fatal: aortic rupture, heart attack, liver and bone damage, blindness, paralysis and brain damage with severe psychiatric symptoms.

Syphilis can exist without symptoms for years, and be transmitted from one partner to another during unprotected sex, without either being aware of it. Condoms protect against contagion. Syphilis is diagnosed through a very careful medical examination and numerous laboratory tests.

It's fairly easy to cure in the early stages, but more complex when the disease is advanced. The treatment of choice is penicillin and its derivatives, under a doctor's supervision. Other antibiotics can also be used to eliminate the bacteria and prevent future damage, but it's not possible to repair damage that has already occurred, which is irreversible. During the entire treatment, it is essential to avoid contact and unprotected sex in order to minimize the risk of reinfection.

Granuloma inguinale is a very rare infection in temperate climates like ours, but is more common in tropical and subtropical areas. It is caused by the Klebsiella granulomatis bacterium. It manifests initially as painless, red-colored nodular lesions that turn into rounded, raised, bad-smelling, bleeding ulcers with a velvet-like texture. In men, the infection is located on the penis, scrotum, groin and thighs. In women, it nests in the vulva, vagina and perineum. In homosexual males, it is in the anus and in the buttocks area. There is no enlargement of the lymph nodes (lymphadenopathy). Diagnosis is made by analyzing a small sample of material taken from the lesion. Therapy involves the use of antibiotics.

Condylomas, also called genital warts (due to their similar appearance to skin warts, and the fact that both are caused by the same virus), first form small pink lesions, then grow irregularly and become small benign skin growths with bumpy edges, commonly referred to as genital warts. They are located mainly in the penis and the female genitals, and tend to become chronic. In general, they do not cause pain, but you can feel them and sometimes they cause itching. A doctor can easily recognize them. If you feel small, hard growths around your genital area, it is best to get your doctor's opinion immediately. 

Genital warts are caused by some human Papillomaviruses (HPV type 6 and type 11 are responsible for 90% of cases). HPV is a very common virus that can affect both sexes. There are 45 different types of Papillomavirus that have been identified, which can be found on the skin and mucous membranes. Some types, such as those that cause warts, are considered to have low risk for genital and cervical cancer. Persistent infections, related to types of HPV from the α-papillomavirus genus, are instead associated with high-risk types, and thus pose a greater risk of developing cervical cancer and other types of HPV-related cancer. (For more information about Papillomavirus and related vaccines, go to the dedicated section).

Contagion of warts occurs by direct contact during unprotected sex, although indirect transmission can also be a cause, occurring through repeated contact with contaminated surfaces, clothing, or underwear. All conditions that cause suppression of the immune system, such as excessive consumption of hard liquor, drugs, smoking, as well as a large number of casual sex partners, can be factors that favor an infection by papilloma virus.

However, the presence of lesions caused by papilloma virus should not be considered an indicator of irregular sexual habits. Rather, it is simply an expression of a very common infection to which the overwhelming majority of male and female populations are subjected. In reality, the majority of these infections heal over a span of time that varies from 6 months to 2 years. They can, however, under particular conditions or in the case of factors that favor infection, reactivate or form a new infection due to the lack of specific antibodies that provide definitive immunity. Cervical cancer in particular, while being a serious illness, is considered a rare event in a very common infection. However, it is not possible to know beforehand which of the frequent at-risk lesions will actually evolve into cancer. Thus, it is best to visit a gynecologist, who will be able to recognize and eliminate them while avoiding any risk of aggravation. Condylomas, on the other hand, while unpleasant to look at and even embarrassing where your partner is involved (not to mention infectious), do not constitute a precursor to a possible tumor since they are benign manifestations, just like common skin warts.

Treatment is personalized on a case by case basis, and indicated by your doctor. It may include medications associated with various non-pharmacological treatments (electrocoagulation, diathermocoagulation, laser therapy, cryotherapy, surgical removal).

Cytomegalovirus (CMV) is a viral infection caused by the virus of the same name, which is part of herpes virus family. These viruses are able to remain dormant for long periods (even throughout life) in the host organism. The virus can spread to all body fluids, in both men and women, and can therefore infect urine, saliva, tears, sperm, vaginal secretions and even breast milk.

CMV infection is usually contracted in early childhood. For many people there are no consequences. In others there are symptoms such as persistent fever, weakness and hepatitis. The most serious forms are those affecting immunosuppressed subjects (patients on dialysis, transplant patients, patients infected by AIDS or cancer patients), where CMV infection is one of the major causes of serious illness (retinitis, pneumonia, gastrointestinal disease, etc.) and mortality.

Adolescents and adults can transmit CMV primarily through kissing and sexual intercourse, but also through blood transfusions or by handling infected fluids. The virus can be transmitted to the fetus during all 9 months of pregnancy or the infant during childbirth. In these cases, this represents a serious infection that can cause serious harm especially during the first months of gestation. For those planning a pregnancy, it is important to take into account that the initial CMV infection can occur only once in life. Therefore, if you have already contracted it in the past, the antibodies are already present in the blood of the future mother, and thus she is protected in case of further contact with the virus. However, in the case that the infection has not been contracted prior to becoming pregnant, the gynecologist will repeat the CMV test several times throughout the pregnancy in order to monitor its possible presence from the earliest stages. This makes it possible to treat an infection with specific treatment, thus protecting the future mother, the fetus and the newborn.

There is currently no treatment for CMV infection in healthy people. Immunosuppressed patients are treated with specific antiviral-based treatments. Scientists are still trying to create a vaccine.

Molluscum contagiosum virus (also known as MCV) is a viral skin infection that is common among children, ranging from 1-4 years old, who are predisposed to allergic diseases (atopy) and therefore have a more fragile immune system. In adolescents and adults, especially those who are immunocompromised (patients with AIDS, transplants, on dialysis, with tumors or undergoing prolonged treatment with corticosteroid drugs), transmission occurs primarily through sexual intercourse if the partner has lesions on the genital mucosa (differential diagnosis with genital herpes) or through direct contact with infected skin (always wash your hands thoroughly!). It can also be transmitted through the promiscuous use of infected sheets, towels, or underwear, and the sharing of bathtubs or showers with people infected with molluscum contagiosum. It is an extremely contagious, but fortunately benign, infection. Hot climates and humidity facilitate contagion.

The strange name "molluscum" that identifies the infection comes from the Latin word molluscus, which means soft. In fact, the lesions caused by this virus have a soft, rather spongy appearance. They are small raised lesions with a dimple in the center, which appear after a variable incubation period of 2 to 7 weeks. They can vary by number (from a couple to over a hundred), by size (2-15 mm) and by color (white, yellow, gray, skin-colored). The lesions can spread across the body's surface (without damage to the internal organs), although in most affected subjects they appear on the face, armpits, arms, hands and groin. The infection does not affect either the palm of the hands or the soles of the feet.

Generally, they do not cause any symptoms. Particularly sensitive subjects complain of itching, inflammation, secondary infections and conjunctivitis. In subjects with severe immunological impairment, lesions assume atypical aspects in terms of number, morphology, and localization. 

The diagnosis is clinical, and is done through careful, direct observation of the papular lesions. Eventually, if the diagnosis is uncertain, it can be confirmed by a skin biopsy.

In healthy subjects, the lesions may regress spontaneously, but healing often requires long waiting times (months/years). It is more complicated for immunosuppressed patients, who often have lesions that are more severe and more difficult to eradicate, even using a pharmacological approach.

Drug therapy involves local application of keratolytic, antiviral or immunosuppressive drugs. In the most aggressive, hard-to-eradicate cases, the lesions are surgically removed by curettage, cryotherapy (cold therapy) or laser therapy to prevent autoinfection or sexual infection. To minimize the risk of possible recurrences, treatment should be started immediately, when the lesions are few and of small dimension.

Using a condom does not completely protect against infection. Molluscum contagiosum genital lesions are generally not restricted to the location covered by the condom, but may spread to many areas of the skin.

Viral hepatitis causes progressive inflammation of the liver that can be acute or chronic. It is caused by different viruses that cause different types of disease.

To date, 5 types of viral hepatitis are known to be caused by the so-called major hepatitis viruses: viral hepatitis A, B, C, D (delta) and E. In about 10-20% of cases, the agent responsible for the hepatitis remains unknown. All these forms of hepatitis cause severe liver pain and intense general symptoms. Some forms may also degenerate into serious illnesses such as liver cirrhosis, which destroys the liver, and liver cancer. Viral hepatitis A is transmitted via the fecal-oral route, and also sexually (oral and anal sex). Viral hepatitis B is the most widespread form, and is transmissible through sexual intercourse, but also through infected blood. Viral hepatitis C is transmitted more frequently through blood and more rarely through sexual intercourse. Viral hepatitis D can be transmitted through sexual intercourse, but it is rarer. Viral hepatitis E, isolated most recently, is a form that is similar to viral hepatitis A. Its transmission occurs via the fecal-oral route, and water contaminated by feces is the main vehicle for infection.

Those with viral hepatitis have a higher risk of acquiring another sexually transmitted disease, including HIV and syphilis. In Italy, hepatitis is included among the diseases for which obligatory notification by the doctor is required (Class II, relevant diseases because of high frequency and necessity for treatment).

Viral hepatitis causes progressive inflammation of the liver that can be acute or chronic. The infection can also cause harm to parts of the intestine (duodenum, jejunum) and the kidneys. The virus penetrates through abrasions or lesions on the skin and mucous membranes and, when reaching the liver, replicates quickly. There are several types of viral hepatitis, the most common of which are viral hepatitis A, B, C, D and E, where each letter indicates a different strain.

VIRAL HEPATITIS A - This is an acute infection caused by the Hepatitis A Virus (HAV virus). Infection is caused by drinking and eating drinks and food that are contaminated or preserved and treated in bad hygienic conditions, eating sea ​​shellfish that is raw or not cooked sufficiently and bred in contaminated waters, or eating unwashed vegetables or fruit. It is mainly transmitted through the fecal-oral route, and therefore also sexually through oral or anal sex, especially among men. It has an incubation period of 15 to 50 days. The virus is present in the stools 7-10 days before the onset of symptoms and up to a week afterward, while it is present in the blood for only a few days.

It has a tendency to be generally asymptomatic, self-limiting and benign, but sometimes it can have more severe forms with a prolonged progression and even fast-acting, rapidly fatal forms (0.1-0.3% with peaks up to 1.8% in adults over 50 years of age). The infection, which lasts for 1-2 weeks, manifests with fever, discomfort, nausea, abdominal pain and jaundice, accompanied by increased bilirubin and liver enzymes (transaminases). In some cases, especially if the infection is contracted at a young age, it remains asymptomatic. Patients heal completely without ever having a recurrence. Therefore, there is no chronic condition of virus A either in the blood or the feces.

VIRAL HEPATITIS B - This is the most common form of viral hepatitis in the world, caused by the Hepatitis B Virus (HBV virus). It is transmitted through infected blood (transfusions, use of infected instruments in surgical and dental procedures, acupuncture, laboratory practices, and tattoos and piercings performed with unsterilized instruments) and unprotected vaginal, oral and anal sex with people carrying the virus, which is present in sperm, menstrual blood and saliva. It can also be transmitted during childbirth. The risk of contagion through transfusion, although still present in developing countries, has been virtually eliminated in industrialized countries due to blood donation controls and subsequent processing mechanisms that can destroy the virus.

Considering that the virus is resistant to environmental surfaces for at least 7 days, contamination can also occur by indirect inoculation or by contaminated objects through minimal skin or mucous membrane lesions (toothbrushes, scissors, combs, razors, bath brushes contaminated by infected blood). Therefore, be very careful not to exchange these types of objects!

At risk, therefore, are addicts, those who engage in unprotected sex, health workers in contact with infected people or who work in a lab in contact with the infectious agent. Family and sexual partners of infected people are also at risk, as are all practices involving the use of non-sterilized needles and syringes, such as tattoos, piercings, manicures, and pedicures.

The virus is not transmitted through casual contact, hand-shakes, hugs, sneezing, coughing or breastfeeding.

Currently, Italy is a low-endemic country for viral hepatitis B (approximately 1% of chronic carriers). Sexual transmission represents the most frequent method of infection. Significant progress in preventing HBV infection has been achieved over the last thirty years due to improved socio-economic conditions and the introduction in 1999 of the requirement for the anti-hepatitis vaccination within the first year of life. Finally, the availability of serological (HBsAg) and biomolecular (Nucleic Acid Technology, HBV-NAT) tests has been more and more effective for the identification of at-risk donors, and has made transmission through transfusion or hemodialysis a particularly rare event.

The incubation period of viral hepatitis B varies between 45 and 180 days, but usually occurs between 60 and 90 days. Especially if acquired at a young age, viral hepatitis B tends to be recurrent 9 times out of 10. In 20% of cases, it can progress to liver cirrhosis over a period of about 5 years. Liver cancer (hepatocellular carcinoma) is another common complication of chronic hepatitis, especially in patients who already have liver cirrhosis.

VIRAL HEPATITIS C - This is caused by the Hepatitis C Virus (HCV virus). It is transmitted primarily through infected blood and more rarely through sexual intercourse. The infection can be transmitted vertically from mother to child in less than 5% of cases. Blood donation controls using the anti-HCV antibody test have considerably reduced the risk of infection following blood and blood-derivative transfusions. It cannot be transmitted by kissing, handshakes or common, everyday-life objects. The incubation period ranges from 2 weeks to 6 months, but is mostly between 6 to 9 weeks.

The majority of infected people (85%) develop chronic hepatitis that in 20-30% of cases will develop into liver cirrhosis within 10 to 20 years, and in about 1 to 4%, subsequent hepatocellular carcinoma.

In Italy, the prevalence of chronic HCV carriers is 0.6-2.5% in the North and 2-20% in the South. Currently in our country, the most important risk factors for HCV infection are the use of intravenous drugs, unprotected sex with more than one partner, tattoos and aesthetic treatments when no effective methods of sterilization and maintenance of instruments are used. Maternal-fetal transmission and breastfeeding are possible methods of contagion, but rarely occur.

VIRAL HEPATITIS D - This is caused by the Hepatitis D Virus (HDV virus). It can be transmitted through unprotected sex, but its multiplication depends on the hepatitis B virus (hence it is called a satellite virus). The infection manifests, therefore, in subjects affected by HBV at the same time or as a superinfection. This latter is the more aggressive form. In some cases, HDV infection can become chronic and have a more serious progression than that of viral hepatitis B. The incubation period ranges from 2 to 8 weeks.
Prevention with the anti-hepatitis B vaccine also protects against the risk of viral hepatitis D.

VIRAL HEPATITIS E - This is caused by the Hepatitis E Virus (HEV virus). Viral hepatitis E is an acute, often self-limiting infection that is very similar to viral hepatitis A. Chronic cases are rare, as are the fast-acting forms that occur primarily in pregnant women in the third trimester of pregnancy. Contagion occurs via the fecal-oral route, and water contaminated by feces is the main vehicle for infection. The incubation period ranges from 15 to 64 days. Viral hepatitis E is present all over the world; sporadic outbreaks and epidemics have been recorded primarily in geographic areas with inadequate levels of hygiene. In industrialized countries, on the other hand, most cases involve people returning from traveling in endemic countries.

There is no specific therapy for viral hepatitis A. The disease is primarily controlled through standards of prevention and preventative care following exposure to the virus.

Treatment for viral hepatitis of type B or type C is strictly based on the competence of the infectious disease specialist. Therapy involves the use of interferon and other antiviral drugs, and is customized on a case-by-case basis, especially in view of the side effects that therapy may induce, particularly in elderly subjects.

The vaccine currently in use for viral hepatitis B is produced by genetic engineering techniques. It has proven to be safe and effective and provides long-lasting immunity. In Italy, since 1991, vaccination has been mandatory for all newborns, and until 2003, was also mandatory for adolescents up to 12 years of age. It is also strongly recommended for the most at-risk population groups (drug addicts, cohabitants of chronic carriers, healthcare workers, etc.).

To date, there is no vaccine that protects against hepatitis C, and the use of immunoglobulins has not been shown to be effective.

A new medication (Sofosbuvir), the first of a new class of drugs capable of acting directly against the hepatitis C virus, has recently been used with very encouraging results.

Effective prophylactic measures are represented by general hygiene rules, sterilization of surgical instruments, and for aesthetic treatments, the use of disposable materials, and protection with a condom during risky sexual encounters.

In some cases of patients affected by chronic viral hepatitis D, interferon-alpha is used. In the most serious cases, liver transplantation may be considered.

Regarding the prevention of viral hepatitis E, administration of gamma globulin has been proposed, especially in pregnant women, but its effectiveness has yet to be documented. Experimental clinical trials for the production of two vaccines are ongoing.

AIDS, or Acquired Immunodeficiency Syndrome, is a viral infection caused by the HIV virus (Human Immunodeficiency Virus). Why is it called a syndrome? Because normally, those who are affected manifest a series of many symptoms. Immunodeficiency means that the immune system of those who have been infected by the virus is fragile, deficient, and over time, will no longer be able to protect the body against attacks by viruses, bacteria or other external agents. HIV is like a chameleon, and can vary greatly. This is why it is difficult to find a definitive cure. Everyone can be affected by HIV: heterosexuals, homosexuals, those receiving blood transfusions, even children.

In 2010, 2884 cases of HIV infection and 718 cases of AIDS were reported in Italy, as well as 66 AIDS-related deaths. The majority of reported cases occurred in male subjects (74%), and the rate of new diagnosis was 5.5 cases per 100,000 inhabitants. The rate of infection is growing, but it is not talked about enough.

Although HIV has been isolated from many biological fluids, only blood, seminal fluid, genital secretions and breast milk have been recognized as a source of infection. Transmission through sex is by far the most common method; even having sex one time is enough to cause contamination.

There is no risk of contagion through a hug, a handshake or a kiss unless there are abrasions or microlesions on the mucous membranes of the mouth through which the virus can enter. Saliva, mucus, sweat, tears, feces, urine and mosquito bites do not transmit the virus.

HIV-positive people can lead a normal life as long as health permits, and can engage in risk-free social life. Living with AIDS is very difficult; those affected by it need to feel accepted, and be able to share their daily lives with their loved ones.

AIDS is a viral infection caused by HIV (Human Immunodeficiency Virus). This virus is able to gradually destroy the affected person's immune system, which over time is no longer able to defend itself against attacks by bacteria, viruses and other external agents. When a person comes into contact with the HIV virus, he/she may or may not be contaminated, but if he/she does contract the infection, he/she may not get sick right away. The virus propagates in its host organism, which initially resists by producing antibodies (Ab). If these antibodies are present when a blood test is performed, the person is defined as a seropositive. Unlike those that occur in other infections, these antibodies do not constitute a defense mechanism but only represent a sign of infection in progress.

It is possible to be HIV-positive for many years without any symptoms, but the virus continues its work of destroying immune defenses until the person becomes ill (full-blown AIDS). At this point, the slightest infection, even the most trivial, can be fatal. The progression of the disease is not the same for everyone, but it also depends a lot on the lifestyle of the person who has HIV. If an HIV-positive person lives a normal life in the sense that he or she has adequate hygiene, sleeps a sufficient number of hours, eats in a healthy and regular manner, does not drink, does not smoke, tries to avoid particularly stressful situations and is surrounded by the love and affection of his/her loved ones, he/she will surely have a longer life expectancy than a drug addict or a person who lives in objectively unstable conditions, and whose immune system is already undermined by drugs and stress.

ALWAYS use a condom during sexual intercourse; this is the most effective way to protect yourself from AIDS and other sexually transmitted diseases. It is best to use prudence in choosing your sex partner, especially if he/she is occasional and not unique (multi-partner sexual relationships). Don't let yourself be persuaded by thinking "why would it happen to me?" Make sure to take all necessary precautions. Be careful not to get infected with blood through small wounds in the skin and/or the mucous membranes.

Do not swap toothbrushes, razors or other personal effects. Observe the normal hygiene standards of common social life. These represent the necessary precautions to be taken to protect yourself from the risk of an HIV infection, and are also valid for any infection that can be transmitted through unprotected sex.

By regularly following the specific treatment, it is now possible to stabilize the disease, but not to cure it definitively. New drug combinations (available since 1996 in Italy) are highly effective, and involve the combined use of three antiretroviral drugs. This approach has revolutionized the treatment of AIDS, and currently, thanks to combination antiretroviral therapy (cART), approximately 80% of patients achieve long-term control of viral replication, with reduced mortality and morbidity for HIV. The goal of antiretroviral therapy is to inhibit replication of the virus to a point where plasma levels are unrecognizable for as long as possible, potentially for life. Therapy does not heal the infection, but it reduces the amount of the virus circulating in the blood. Although the amount of virus circulating is greatly reduced, it remains in the body and the person will always be seropositive and infectious to others. The progression of the disease, however, is noticeably slowed down, allowing the person to live a lot longer.

The toll-free number 800-861061, established by the Istituto Superiore di Sanità in 1987, was created to provide competent and up-to-date information on AIDS and other sexually transmitted diseases. Since 2010, the service has changed its name from the AIDS hotline to the "AIDS and sexually transmitted disease (AIDS/STD) hotline," and offers prompt answers for questions regarding STDs as well.

You can call from anywhere in Italy. The service has 6 telephone lines that operate from Monday to Friday, from 1 pm to 6 pm. In addition to Italian, experts are also available to answer questions in English, French and Portuguese.

Since February 1, 2012, the service also provides legal advice from a lawyer who specializes in the protection of the rights of people with HIV, AIDS and other STDs, and their family members. The lawyer is present at the service twice a week, and answers questions in Italian and English.

The AIDS/STD hotline, 800-861061, has mapped out centers where HIV testing is possible. For each center, the location, address, telephone number and hours of operation are indicated.

The HIV test can be done without a prescription. It involves taking a simple blood sample, and is free of charge in all public facilities (hospitals, university clinics, specialized clinics). According to Law 135 of 1990, it must be done in an anonymous and confidential manner; the result can only be communicated to the person who took the test. HIV-positive people are protected by law from any social, health, labor or other type of discrimination.

The anti-HIV test can identify the presence of specific antibodies that the body produces when it comes into contact with the HIV virus. The test result is only reliable after 6 months from the time of possible contagion.

If the test is negative, there is no infection, but contagion is not excluded in the preceding 3-6 months. If there was an instance of risky sex, the examination should be repeated six months later.

If the test is positive, this means that the infection has been contracted and can be transmitted to other people. In this case, you must rely on one of the specialized centers. Treatments are all free.

Foreigners, even those without a residence permit, can take the test under the same conditions as an Italian citizen.

For more up-to-date information on HIV infection, AIDS, and AIDS Specialist Centers, you can call the 800-861061 toll free number of the Istituto Superiore di Sanità (ISS) from anywhere in Italy, which operates from Monday to Friday, from 1 pm to 6 pm.