1. Reflect on your experiences growing up related to tobacco and smoking: Did you have any family members that smoked when you were growing up? If so, what were your first reactions and opinions to tobacco use? If not, how did you first become aware of tobacco? What did you think? Next, think about your adolescent years: did you ever smoke? Was smoking prevalent amongst your school peers and/or friends? Why you think tobacco is so common even with the wealth of information that exists about its dangers?2. Vaping has reached an all-time high. Research through both the text and sites including CDC.gov, NIH.gov. Why is vaping so popular? What are the health risks involved with vaping? Why is it NOT a good alternative to smoking regular cigarettes?3. Most people that use their cell phones while driving admit they SHOULDN’T do it, but have a hard time stopping. Why do you think this is? Why are people having problems putting their cell phone down while driving? What if a friend of yours is using while driving you? Do you say anything? Do you use your own cell phone while driving? Create a plan and rationale to either encourage yourself (or others) to stop using cell phones while driving. If you have ever been in an accident or know someone who has because of cell phone use while driving, please also share your story.4. What are things you do that help the environment, such as recycling, watching how much water you use, etc.? What are some changes you would like to make that would benefit the environment? How would this be beneficial? Be sure to consult the text and make connections to your own life.5. Throughout this course we’ve touched upon many personal topics, some more relatable than other. What is the most important information you learned from this course? What are some health habits you want to create? What are bad health habits you want to break? Discuss your journey through this course using specific assignments and/or text information to illustrate.

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Dr P. Marazzi/Science Source
Courtesy of CDC/Joe Millar
Human papillomavirus, which
causes g
­ enital warts, is the
most c
­ ommon viral STI.
Although young women under age 25 are most
likely to develop HPV, older women at risk for
cervical cancer can also benefit from vaccination,
according to initial tests of the HPV vaccine in
various age groups. If you are age 26 or older and
have not been vaccinated, talk to your health-care
provider about the relative risks and benefits for
In its first decade, HPV vaccination has cut
infections from this cancer-causing virus by
64 percent among teen girls.29 These declines
should lead to reductions in diseases caused by
HPV, which include cervical cancer and head and
neck cancer. However, it will take decades to see
these reductions because cancer takes years to
HPV Vaccination on Campus Sexually
active young adults are at the highest risk of HPV
infection. But
according to a recent national analAddiction
ysis of some 40,000 female students ages 18 to
24 at schools around the country, fewer than half
had not received the HPV vaccination. Among
these women, similar percentages reported
either not being in a relationship or being in a
Consumer Alert
Should You Get the HPV Vaccine?
Some states are considering legislation to
make HPV vaccination mandatory for all
girls because the vaccine is most effective
when given before a girl becomes sexually
active. Some religious groups oppose mandatory immunization because they feel that
vaccinating girls against an STI gives them
the wrong message about sexual responsibility. Consumer advocates worry about
the unknown long-term effects. Others feel
that the decision should be made privately
by parents, in consultation with their pediatricians. Vaccination is recommended for
both sexes.
Facts to Know
The HPV vaccines have been extensively
tested worldwide and are considered
safe. However, the long-term effects are
not known.
No one yet knows whether a booster
shot or shots will be necessary.
Adverse effects include fainting, nausea,
headache, blood clots, allergic reactions,
chapter 11
and death. The most common side effects
are pain at the injection site and fever.
An estimated 4,000 women die in
the United States and about 274,000
women die internationally annually from
cervical cancer. The National Cancer
Institute estimates 11,300 new cases of
cervical cancer each year.
Steps to Take
Talk with your doctor if you are under age
26 or at risk for cervical cancer and have
not yet been vaccinated.
Check with your insurance provider. Vaccination costs about $400. Most insurance companies cover recommended
Do not get the HPV vaccine if you
Are pregnant
Have ever had a life-threatening allergic
reaction to any component of HPV
Are moderately to severely ill at the
time of vaccination
relationship but not living together. Fewer than
10 percent were living with a partner.30 (See Consumer Alert.)
✓check-in Have you been vaccinated
against HPV?
Signs and Symptoms HPV lives on the skin
or in mucous membranes and usually causes no
symptoms. Some people get visible genital warts
or have precancerous changes in the cervix, vulva,
anus, or penis. After contact with an infected individual, genital warts may appear within 3 weeks
to 18 months, with an average period of about
3 months.
Most HPV infections are asymptomatic in men,
who may unwittingly increase their partners’ risk.
Men who test positive for HPV typically report
significantly more sex partners than those who do
not. HPV may also cause genital warts in men and
increase the risk of cancer of the penis.
HPV infection may invade the urethra and
cause urinary obstruction and bleeding. It greatly
increases a woman’s risk of developing a precancerous condition called cervical intraepithelial
neoplasia, which can lead to cervical cancer. Adolescent girls infected with HPV appear to be particularly vulnerable to developing cervical cancer.
It is not known if HPV itself causes cancer or
acts in conjunction with cofactors (such as other
infections, smoking, or suppressed immunity). A
woman’s risk of cervical cancer is strongly related
to the number of her partner’s current and lifetime
female partners. Women are 5 to 11 times as likely
to get cervical cancer if their steady sex partner
has had 20 or more previous partners.
Diagnosis and Treatment Most women
are diagnosed with HPV after an abnormal Pap
test or HPV DNA test. The results of HPV DNA
testing can help health-care providers decide
whether treatment is necessary to prevent or treat
cervical cancer. (See Chapter 12 for a discussion
of cervical cancer.) Warning signs for cervical cancer include irregular bleeding and unusual vaginal discharge. Precancerous cervical cells can be
destroyed by laser surgery or freezing during a
visit to a doctor’s office.
No form of therapy has been shown to completely eradicate HPV, nor has any single treatment been uniformly effective in removing warts
or preventing their recurrence. CDC guidelines
suggest treatments that focus on the removal of
visible warts—laser therapy, cryotherapy (freezing), and topical applications of podofilox,
podophyllin, or trichloroacetic acid—and then
eradication of the virus. At least 20 to 30 percent
of treated individuals experience recurrence.
Sexually Transmitted Infections
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Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Incidence At least 50 million people in the
United States have genital herpes, including 21 percent of women in the United States. Only a minority know they are affected, and many believe they
could tell if a sexual partner were infected. About
Signs and Symptoms Most people with
genital herpes have no symptoms or very mild
symptoms that go unnoticed or are not recognized as a sign of infection. The most common is
a cluster of blistery sores, usually on the vagina,
vulva, cervix, penis, buttocks, or anus. They may
last several weeks and go away. They may return
in weeks, months, or years.
Other symptoms include blisters, burning
feelings if urine flows over sores, inability to
urinate if severe swelling of sores blocks the
urethra, and itching and pain in the infected
area. Severe first episodes of herpes may also
cause swollen, tender lymph glands in the groin,
throat, and under the arms; fever; chills; headache; and achy flulike feelings.
The virus that causes herpes never entirely
goes away; it retreats to nerves near the lower spinal cord, where it remains for the life of the host.
Herpes sores can return without warning weeks,
months, or even years after their first occurrence,
often during menstruation or times of stress, or
with sudden changes in body temperature. Of
those who experience HSV recurrence, 10 to
35 percent do so frequently—that is, about six or
more times a year. In most people, attacks diminish in frequency and severity over time.
✓check-in Did you know that individuals
can transmit genital herpes even when they
don’t have visible lesions?
St Bartholomew’s Hospital/Science Source
Herpes (from the Greek word that means “to
creep”) collectively describes some of the most
common viral infections in humans. Characteristically, herpes simplex causes blisters on the skin
or mucous membranes.
Herpes simplex exists in several varieties. Herpes simplex virus 1 (HSV-1) can be transmitted by
kissing and generally causes cold sores and fever
blisters around the mouth. Herpes simplex virus
2 (HSV-2) is sexually transmitted and may cause
blisters on the penis, inside the vagina, on the
cervix, in the pubic area, on the buttocks, on the
thighs, or in the mouth and throat (transmitted
via oral sex).
About one in five women and one in nine
men have genital herpes. More than 80 percent do
not realize they are infected.31 HSV transmission
occurs through close contact with mucous membranes or abraded skin. Condoms help prevent
infection but aren’t foolproof.
In the past, physicians viewed herpes as an
episodic disease with the greatest risk of transmission during a flare-up. But as newer research
has documented, “classic herpes” that produces
acute symptoms is not typical. For many people
genital herpes is a chronic, nearly continuously
active infection that may produce subtle, varied,
and often-overlooked symptoms. Most cases are
transmitted by sexual partners who are unaware
of their infections or do not have symptoms at
the time of transmission.
When herpes sores are present, the infected
person is highly contagious and should avoid
bringing the lesions into contact with someone
else’s body through touching, sexual interaction, or kissing. However, the herpes virus is
present in genital secretions even when patients
do not notice any signs of the disease, and
people infected with genital herpes can spread
it even between flare-ups, when they have no
A newborn can be infected with genital herpes
while passing through the birth canal, and the frequency of mother-to-infant transmission seems to
be increasing. Most infected infants develop typical skin sores, which can be cultured to confirm
a herpes diagnosis. Some physicians recommend
treatment with acyclovir. Because of the risk to
the infant of severe damage and possible death,
caesarean delivery may be advised for a woman
with active herpes lesions.
40 percent of new cases of genital herpes occur
in young people ages 15 to 24.
Herpes simplex virus (HSV-1)
as a mouth sore.
Biophoto Associates/Science Source
Genital Herpes
Herpes simplex virus (HSV-2)
Diagnosis and Treatment Testing for the
as a genital sore.
herpes virus has become much more accurate.
Several highly effective antiviral therapies not
only reduce symptoms and heal herpes lesions
but also, if taken continuously, significantly
reduce the risk of transmission of the virus to
sexual partners.
The three antiviral medications approved for
the treatment of genital herpes are as follows:
• Acyclovir. The oldest antiviral medication
for herpes, acyclovir is sold as a generic drug
and under the brand name Zovirax. Available
as an ointment and pill, acyclovir has been
shown to be safe in persons who have used
it continuously (every day) for as long as
10 years.
• Valacyclovir. Sold as Valtrex, this medication delivers acyclovir more efficiently so
that the body absorbs more of the drug and
medication can be taken fewer times during
the day.
Common STIs and STDs
Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
• Famcyclovir. Sold as Famvir, this drug
utilizes penciclovir as its active ingredient to stop HSV. Like valacyclovir, it is well
absorbed, persists for a long time in the
body, and can be taken less frequently than
These antiviral medications are prescribed for
initial and recurrent episodes of herpes. In episodic therapy, a person begins taking medication
at the first sign of recurrence and continues for
several days to hasten healing or prevent a full
outbreak from occurring. In suppressive therapy,
people with genital herpes take antiviral medication daily to prevent symptoms. For individuals
who have frequent recurrences (six or more per
year), suppressive therapy can reduce the number
of outbreaks by at least 75 percent. Suppressive
therapy may also reduce asymptomatic shedding
of HSV. They may be less effective for a first episode of genital herpes.32
Various treatments—compresses made with
cold water, skim milk, or warm salt water; ice
packs; or a mild anesthetic cream—can relieve
discomfort. Herpes sufferers should avoid heat,
hot baths, and nylon underwear. Some physicians have used laser therapy to vaporize the
lesions. Clinical trials of an experimental vaccine
to protect people from herpes infections are
The most widespread sexually transmitted
bacterium in the United States is Chlamydia
­trachomatis, which causes more than a million
cases of chlamydia each year, a number that
continues to rise. Almost half of reported cases
occur among sexually active young adults
between ages 15 and 24. The use of condoms
with spermicide can reduce, but not eliminate, the
risk of chlamydial infection.
Incidence Some 1.4 million, or 1 in 25,
chlamydia A common sexually
transmitted infection caused by
bacteria known as Chlamydia
chapter 11
Americans are infected with chlamydia. Chlamydia is much more prevalent in young black
adults than in young white adults. However,
this may be because black and Hispanic women
are much more likely to be screened. Women
have three times the rate of chlamydia as men.
Chlamydial infections are more common in
younger than in older women, and they also
occur more often in both men and women with
Those at greatest risk of chlamydial infection are individuals 25 years old or younger
who engage in sex with more than one new
partner within a 2-month period and women
who use birth control pills or other nonbarrier
contraceptive methods. The USPSTF recommends
regular screening for chlamydia for all sexually
active women under age 25.
The incidence of chlamydia is lower in older
women, and screening is recommended only for
those with multiple sexual partners, a history of
STIs, or inconsistent use of condoms.33
✓check-in Have you ever been screened for
Signs and Symptoms As many as 75 percent of women and 50 percent of men with
chlamydia have no symptoms or have symptoms
so mild that they don’t seek medical attention.
Without treatment, up to 40 percent of cases of
chlamydia can lead to pelvic inflammatory disease (PID), a serious infection of the woman’s
fallopian tubes that can also damage the ovaries
and uterus. Also, women infected with chlamydia
may have three to five times the risk of getting
infected with HIV if exposed. Babies exposed
to chlamydia in the birth canal during delivery
can be born with pneumonia or with an eye
infection called conjunctivitis, both of which
can be dangerous unless treated early with antibiotics. Symptomless women who are screened
and treated for chlamydial infection are almost
60 percent less likely than unscreened women to
develop PID. Chlamydia may also be linked to
cervical cancer.
When women have symptoms of chlamydia,
they may experience:
• Abdominal pain.
• Abnormal vaginal discharge.
• Bleeding between menstrual periods.
• Cervical or rectal inflammation.
• Low-grade fever.
• Yellowish discharge from the cervix that may
have a foul odor.
• Vaginal bleeding after intercourse.
• Painful intercourse.
• Painful urination.
• The urge to urinate more than usual.
When men have symptoms of chlamydia, they
may experience:
• Pain or burning while urinating.
• Pus or watery or milky discharge from the
• Swollen or tender testicles.
• Rectal inflammation.
Sexually Transmitted Infections
Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Incidence About one in every seven women
Diagnosis and Treatment Various antibi-
• Fever.
otics such as azithromycin and doxycycline kill
Chlamydia bacteria. Some are taken in a single
dose; others over several days. Both partners must
be treated to avoid reinfections.
The CDC recommends that all women with
chlamydia be rescreened 3 to 4 months after treatment is completed. The reason is that reinfection,
which often happens because a patient’s sex partners were not treated, increases the risk of PID
and other complications. Immediately treating
the partners of people infected with gonorrhea
or chlamydia can reduce rates of recurrence of
these infections.
Pelvic Inflammatory Disease
Infection of a woman’s fallopian tubes or uterus,
called pelvic inflammatory disease (PID), is
not actually an STI but a complication of STIs
involving the uterus, oviducts, and/or ovaries.34
Ten to 20 percent of initial episodes of PID lead
to scarring and obstruction of the fallopian tubes
severe enough to cause infertility. Other longterm complications are ectopic pregnancy and
chronic pelvic pain. Smoking may also increase
the likelihood of PID.
Two bacteria—Gonococcus (the culprit in
gonorrhea) and Chlamydia—are responsible for
one-half to one-third of all cases of PID. Other
organisms are responsible for the remaining cases.
Several studies have shown that women with PID
are more likely to have used douches than those
without the disease. Consistent condom use may
decrease PID risk.
✓check-in Did you know that PID can cause
infertility in women?
of reproductive age has PID; half of all adult
women may have had it. Each year, about 1 million new cases are reported.
Most cases of PID occur among women
under age 25 who are sexually active. Gonococcus-caused cases tend to affect poor women;
those caused by Chlamydia range across all
income levels. One-third to one-half of all cases
are transmitted sexually, and others have been
traced to some IUDs that are no longer on the
Signs and Symptoms PID is a silent
­ isease that in half of all cases produces no
noticeable symptoms as it progresses and
causes scarring of the fallopian tubes. Early
symptoms include:
Western Ophthalmic Hospital/
Science Source
Men often don’t take these symptoms seriously
because the symptoms may appear only early in
the day and can be very mild.
Chlamydia, which can spread from a man’s
urethra to his testicles, can also cause a condition called epididymitis, which can cause sterility.
Symptoms include fever, swelling, and extreme
pain in the scrotum. Six percent of men with epididymitis develop reactive arthritis, which causes
swelling and pain in the joints and can progress
and become disabling.
In women and men, chlamydia may cause the
rectum to itch and bleed. It can also result in a
discharge and diarrhea. If it infects the eyes, it
may cause redness, itching, and a discharge. If it
infects the throat, it may cause soreness. Babies
exposed to chlamydia during birth may develop
an eye infection that causes swollen eyelids and
a bloody discharge.
A baby exposed to chlamydial infection in the birth canal
during delivery may develop
an eye infection. Symptoms
include a bloody discharge
and swollen eyelids.
• Abdominal pain or tenderness.
• Vaginal ­discharge that may have a foul odor.
• ­Painful ­intercourse or urination.
• Irregular ­menstrual bleeding.
• Rarely, pain in the right upper abdomen.
Diagn …
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