June 8, 2011, 7:26 pm

Dr. B.J.C.Perera MBBS(Ceylon), DCH(Ceylon), DCH(England), MD(Paediatrics), FRCP(Edinburgh), FRCP(London), FRCPCH(United Kingdom), FSLCPaed, FCCP, FCGP(Sri Lanka) Consultant Paediatrician

KEY POINTS

* Sexual practices are changing the world over

and the age at which young people engage in  sex is getting earlier.

* Young adolescents and teenagers are particularly at risk of contracting sexually transmitted infections.

* A considerable number of diseases can be contracted through sexual practices.

* Some people with these diseases are quite normal to outward appearances.

* Protective sexual practices are the only way of preventing these diseases in those who engage in sex.

* Confidentiality and anonymity are guaranteed by medical personnel who deal with these diseases.

In the process of development in children, an important phase is the pubertal stage. there is marked physical development at this stage and in many the increase in physical stature is quite amazing. Additionally, and in both sexes, the pubertal stage signifies the development of sexual prowess and the ability to procreate. The hormonal changes produce natural sexual urges and it is a time at which information on the many and varied aspects of sexual behaviour should be provided for these children and adolescents. all over the world, there is an ongoing change in the sexual behaviour patterns of young people. Although our cultural barriers have so far managed to rein in this type of behaviour to some extent, there are some concerns that the age of onset of sexual activity in our young people is also getting earlier and earlier, particularly in the urban areas. this is now seen mostly with boys but there is no definite evidence that it is not so in girls too. With the changing world scenario and less and less emphasis now being placed on virginity in the West, our children too are, in all probability, gradually moving in the same direction. there is a definite and perceptible paradigm shift in the way young people think and behave with regard to sexuality all over the world. many of the cultural taboos and beliefs regarding sexual practices considered to be the norm in the years gone by are now considered to be "old fashioned" and "unnecessary" by many youngsters in our country. one must come to terms with the fact that it is the way in which things progress in the new world.

It is most important that these young people, both boys and girls are provided with adequate and scientific information regarding sexuality and particularly on Sexually Transmitted Diseases (STDs) or Sexually Transmitted Infections (STIs). Adults being prudes do not help at all in the current social and global scenario. The electronic media and particularly the internet can provide some of this type of information but the very same portals are also guilty of things like pornography which is a most undesirable development. The developing and immature minds of these young people are that much more susceptible to all kinds of adverse influences emanating from ill-conceived information technology portals. however, there is very little one could do about such things and the only way of preventing these diseases is to provide young people with up-to-date scientific information regarding sexuality and the possible ramifications of unbridled sexual practices.

Sexually transmitted infections are caused by a myriad of different types of microorganisms or bugs ranging from bacteria to viruses. Some of these like syphilis and gonorrhoea have been very well known to mankind from time immemorial while others like the Human Immunodeficiency Virus (HIV) causing the dreaded Acquired Immunodeficiency Syndrome or AIDS has been a relatively more recent development. all these infections are eminently preventable if proper precautions are taken. The STDs or STIs are infectious diseases that spread from person to person through intimate sexual contact. They can technically affect men, women, boys and girls and these diseases have no social, cultural, caste, religious or creed barriers. It does not matter one little bit whether they are rich or poor or whether they are sexually promiscuous or not. Very often the first exposure to the infective agent results in the person developing the disease. Unfortunately, in many countries, STDs have become common among teens. because teens are more at risk for getting some STDs, it is crucially important for them to learn what one could do to protect oneself. STDs are more than just a plain and simple discomfiture. They are a group of diseases with significant implications as a barrier towards good health. If left untreated, some STDs can cause permanent damage, such as infertility which is the inability to have a baby and in certain diseases like HIV/AIDS, even lead to an eventual fatality. Some of these infections are treatable while others like herpes virys infections and HIV and AIDS can only be controlled with the drugs available today and they cannot be "cured".

One of the reasons that STDs spread so readily is because people think they can only be infected if they have sexual intercourse. this is not entirely correct. A person can get some STDs, like herpes or genital warts, even through skin-to-skin contact with an infected area or sore. Some other diseases like HIV can spread through contaminated needles, blood transfusions with unscreened blood and even from an affected mother to her unborn baby. Another myth about STDs is that it is not possible to get these diseases with other sexual practices apart from conventional sexual intercourse. this notion is also not true because the viruses or bacteria that cause STDs can enter the body through tiny abrasions and injuries in other parts of the body and particularly such tears in the mucous membranes. STDs also spread easily because one cannot tell for sure whether someone has this type of infection without proper testing. The affected person may look quite normal for all purposes and some people with STDs may not even know that they have them. these people are in danger of passing an infection on to their sexual partners without even realizing it.

There are several things that make a person to be at risk of getting STDs. one of these is the onset of sexual activity at a younger age. The younger a person starts having sex, the greater is his or her chances of becoming infected with an STD. In addition, people who have sexual contact, not just intercourse but any form of intimate activity, with many different partners are more at risk than those who stay with the same partner. those who engage in unprotected sexual activities without taking precautions against contracting these diseases are of course that much more liable to get these infections. Spermicides, diaphragms, contraceptive pills and several other birth control methods may help prevent a pregnancy but they do not protect a person against STDs. of all the birth control methods, condoms are the only ones that may have a positive preventive effect in STDs.

There are a whole host of STDs or STIs that can present with many different symptoms. Genital discharges, ulcers, warts and even common symptoms like fever could be the presenting manifestation. What is important is that these symptoms are temporally related to sexual exposure, especially unprotected sexual experiences. on the other hand, exposure to diseases like HIV may not produce any symptoms initially or be associated with a mild illness resembling ordinary flu. The problems caused by HIV infection come on much later, perhaps even years later. Some of these diseases have long-term effects if they are not treated properly. In the same context it is important to point out that not all symptoms related to the genitals are caused by STDs. Sometimes people can get symptoms that seem very like those of STDs, even though they have never had sex. for girls, a yeast infection can easily be confused with an STD. Boys may worry about bumps on the penis that turn out to be pimples or irritated hair follicles. That is why it is important to see a doctor if one ever has questions about sexual health.

So much wrong information about sexually transmitted diseases gets passed around that it is no surprise that these very same diseases do get passed around too. of course, the only way to be one hundred percent sure that one would not get an STD like syphilis, gonorrhoea, herpes, chlamydia or HIV, is not to have any type of sex or in other words, practice complete abstinence. but if a person decides to engage in sexual practices, one way of preventing these diseases is to stay well informed and to learn what is true and what is not true. A basic principle for all these people that would pay dividends in the long run would be to stick to just one sexual partner.

Many young people believe that only trashy people who are promiscuous or the prostitutes are the people who get these diseases. Others may be under the misconception that these diseases can be contracted only from those who engage in sex for commercial purposes. all these are not quite true. Rich people get STDs and poor people get them. Athletes get them. Highly educated as well as the uneducated, could get them. High ranking officials and even professors get them. Even someone having sex for the first time can get an STD. The only people who have no risk of getting an STD are people who have not had sex or any kind of sexual contact. these diseases do not discriminate nor do they have any sort of respect for social standing. It is just the behaviour patterns of humans that make them that much more susceptible to contracting these diseases.

Even doctors often cannot tell by looking if people have STDs. these people look quite normal for all intents and purposes. Doctors often need to do certain tests to diagnose these diseases and to confirm them for sure. these tests include blood tests and special examinations on discharges from the genitalia. to make matters worse, some persons with STDs might not know that they have them as some of these diseases do not always cause symptoms. As far as young people are concerned, even if they think that they are clean, it is probably best to get checked out before having sex.

Some believe that there is some immunity associated with these infections and once a person has got an STD, there is no chance of getting it again. this is a myth and a very dangerous one at that. Some STDs like herpes infections and HIV are, in point of fact, there for life. Others, like syphilis, chlamydia and gonorrhoea, can be contracted over and over again even if treated adequately during the first instance. Some young people believe that if one partner is checked and found to be free of these diseases, the other one is safe as well, even without that person being checked. this too is unfortunately not true. The other one could have one of these diseases and not know it. If there are serious relationships leading to sexual activity, it is best for both partners to get tested together. there are tons of myths out there about sex and STDs. The ones mentioned above are just a few of them.

STDs are more than just an embarrassment. They are a serious health problem. As with many other diseases, prevention is the key. The age old adage "if you cannot be good, you have to be careful" applies quite well to these diseases. It is definitely much easier to prevent STDs than to treat them. People who are considering having sex should get regular gynaecological or male genital examinations. there are two reasons for this. first, these examinations give doctors a chance to teach people about STDs and protecting themselves. Secondly, regular examinations give doctors more opportunities to check for STDs while they are still in their earliest, most treatable stages. In order for these exams and visits to the doctor to be helpful, people need to tell their doctors if they are thinking about having sex or if they have already started having sex. this is true for all types of sex. It is best to let the doctor know if one has ever had any type of sexual contact, even if it was in the past. one should not let embarrassment at the thought of having an STD keep one from seeking medical attention. Just postponing it and waiting for as long as possible before seeing a qualified doctor may allow a disease to progress and cause more damage. If one thinks that there is a possibility of an STD or if one suspects that a partner may have one, one should see a doctor right away. all members of medical staff, including those who work in special government hospital clinics that deal with these diseases, are duty bound to assure confidentiality of the information provided by the patients. They are also trained to be kind to people with these diseases and to have empathy in consideration of the circumstances in which these diseases are transmitted. g

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