Feature Article

Understanding Sexually Transmitted Diseases

Sexually transmitted diseases are serious illnesses that can be irritating, painful, or even deadly. Although thinking about sexually transmitted diseases can be uncomfortable, learning about these diseases and how they are spread is the best way for people to protect themselves. As a direct support professional, it’s important that you know about STDs and the resources available for the person you support. Resources are, for example, trained counselors, physicians, clinics, etc. in your local area. You can talk to your regional center to find out more about these resources and where they are located.

These professionals can educate the individuals you support and help them understand what sexually transmitted diseases are, how they are spread, what common symptoms and treatments are, and how people can protect themselves. You can also learn about how to recognize behavior changes in individuals that may indicate that they are suffering from sexually transmitted diseases or other pelvic infections. As a DSP, the first step is learning about STDs, symptoms, and resources. Then you can help the person you support get the resources they need through the Individual Program Plan process and assistance from the regional center. By helping individuals get these resources from professionals, you are assisting the individuals you support as they work to remain healthy and strong.

What are sexually transmitted diseases?
Sexually transmitted diseases, often called STDs, are a group of diseases that spread from person to person through sexual contact. Sexually transmitted diseases can be spread through sexual contact that includes vaginal sex, anal sex, and oral sex. There are many different types of STDs that have different signs and symptoms, but all STDs are passed from person to person during sex.

Some common STDs include:

  • Chlamydia
  • Genital HPV (Human Papilomavirus Infection)
  • Genital warts
  • Gonorrhea
  • Hepatitis B and C
  • Herpes
  • Syphilis
  • Trichomoniasis

Who is at risk of catching an STD?
Anyone who is sexually active can catch this kind of disease, but individuals are more likely to catch an STD if:

  • They have sex with many different partners
  • They have sex without using a condom

Are people with developmental disabilities at risk?
Some people may think that individuals with developmental disabilities do not have the same sexual feelings as other people. However, people with developmental disabilities do express their sexual feelings and have sexual relations with other people. However:

  • Some doctors, teachers, and others may be less likely to talk to people with developmental disabilities about having safe sex and avoiding STDs
  • Some doctors may be less likely to examine people with developmental disabilities for STDs at their check-ups

In addition, certain individuals with developmental disabilities may find it difficult to verbalize the symptoms they are experiencing. This may be because they do not know what words to use or because they are embarrassed to talk about the symptoms that they feel in their genital areas.

All of these factors can put people with developmental disabilities at greater risk of catching an STD or having an STD that is not treated properly. As a direct support professional, you can take the lead in reminding each person’s doctor to talk to the person about STDs and safe sex and, if the person is sexually active, to examine and test the person for STDs. You can also encourage the individuals you support to bring up the topic of safe sex and STDs with their doctors, and to ask questions until they understand how to protect themselves. Lastly, you can be aware of changes in each person’s behavior that may indicate that they are experiencing the symptoms of STDs or other pelvic infections – we will discuss some of these behavior changes later in this article.

What are the signs and symptoms of STDs?
Different STDs have different signs and symptoms. These symptoms can range from itching and pain around the sexual organs to flu-like feelings and rashes on the body. Many STDs will mainly affect the person’s sexual organs, but others can affect the person’s whole body, and still others can have almost no symptoms at all.

This information sheet lists different STDs along with their symptoms and what can happen if an individual has the disease, but does not get treatment: STD INFORMATION SHEET

Some general signs and symptoms that a person with an STD may notice are:

  • Unusual discharge from the penis or vagina
  • Unusual warts or blisters on the sexual organs
  • Itching or burning around the sexual organs
  • Burning or pain when going to the bathroom
  • Needing to urinate more often than usual
  • Feeling tired all of the time
  • Flu-like symptoms that will not go away
  • Rashes on the body
  • Diarrhea

If any of the individuals who you support are experiencing these symptoms, you can encourage them to talk to their doctor or nurse as soon as possible.

Will I be able to recognize the signs of STDs even among individuals who can’t or won’t describe their symptoms?
Some individuals with developmental disabilities may not be able to explain their symptoms to you. Other individuals may be too embarrassed to bring up symptoms that are affecting their sexual organs. As a direct support professional, you may be able to help these individuals get needed treatment by being aware of changes in their behavior that may indicate an STD or other pelvic infection.

Behavior changes that may indicate an individual is experiencing the symptoms of an STD or other pelvic infection include:

  • Scratching or rubbing around the pelvic area (lower stomach) or genitals
  • Recurrent masturbation

These behaviors could be signs that the individual is experiencing discomfort in their genital or pelvic area and may have an STD or other pelvic infection. By reporting this behavior to the individual’s doctor and asking that the individual be tested for STDs, you are supporting this individual to receive the proper treatment.

In addition, because of your close contact with many of the individuals who you support, you may notice other signs that could indicate that the individual has an STD or other pelvic infection. For instance, you may be able to observe:

  • That the individual seems to be feeling pain when they use the bathroom
  • That the individual’s urine is a different color than usual
  • That a woman’s menstrual cycle is different than usual – for instance, shorter, longer, heavier, or lighter

These are all signs that the individual may have an STD, pelvic inflammatory disease, or other infection and such information should be shared with the individual’s health care professional so that they can receive the proper diagnosis and treatment.

Is it important for the person to see the doctor?
If you think that one of the individuals who you support has an STD or other pelvic infection, it is very important for this person to see his or her doctor. The person’s doctor will be able to perform tests to determine if the person has an STD and, if so, which one(s).

Before individuals visit the doctor, you can assist by helping the individuals to make a list of all of their symptoms. This will make sure the person does not forget anything when they are at the appointment and will assist the doctor to make the correct diagnosis.

People who are sexually active should be tested regularly, at the time of their annual medical exams, for STDs even if they are not showing symptoms. Encourage individuals to let their doctors know if they are having sex; this will remind the doctor that he or she should test the individual for common STDs on a regular basis.

If a person has an STD, but does not get treatment, they are putting themselves and others in danger. If individuals have STDs that are not treated properly, they can:

  • Spread the disease to people they have sexual contact with
  • Get infections in other parts of their bodies
  • Die from complications from the untreated STD

In women, untreated STDs can also lead to a type of infection called pelvic inflammatory disease. A pelvic inflammatory disease is an infection of a woman’s uterus, fallopian tubes, or ovaries – all parts of a woman’s reproductive system. In particular, untreated gonorrhea and untreated chlamydia can lead to pelvic inflammatory disease in women.

Untreated pelvic inflammatory disease can lead to chronic (long-term) pelvic pain and also to infertility (the inability to become pregnant or have a child). Fortunately, pelvic inflammatory disease can be treated in the same way as most STDs – with antibiotic pills.

Can STDs be cured?
Most STDs and pelvic inflammatory diseases can be cured with antibiotics. Once the person’s doctor determines which STD the person has and if the person has a pelvic inflammatory disease, the doctor will know which kind of medicine to prescribe. If any of the individuals who you support have an STD or pelvic inflammatory disease, you can support these individuals to get better safely by:

  • Making sure the person’s doctor is aware of any other medications the person is taking; the doctor will know if the new medicine can safely be taken with the individual’s other medications
  • Asking the doctor or pharmacist questions about how to take the medication correctly – for instance, how often, at what times of day, with food or drink, etc.
  • Supporting the person to take their medicine as instructed
  • Supporting the person to take the medication until it is gone, even if the symptoms have already improved
  • Encouraging individuals to let their current and recent sexual partners know that they have an STD so these individuals can be tested and treated as well

Although most STDs can be cured with antibiotics, some STDs cannot be cured. For instance, both HIV and herpes are STDs that do not have a cure. Even though these STDs cannot be cured, it is very important for individuals who have one of these diseases to get treatment. In the case of herpes, there are medications that can reduce some of the painful symptoms of the disease (such as sores and burning around the penis and vagina). In the case of HIV, there are medications that can slow the course of the disease so that people can live with HIV for many years.

How can individuals protect themselves from STDs and pelvic inflammatory disease?
The only sure way that individuals can avoid catching an STD is through abstinence. This means not having vaginal sex, anal sex, or oral sex. Whether or not to practice abstinence is up to each individual, but before having sex the first time, individuals should understand the risk they are taking. If any of the individuals you support are in a relationship and may be thinking about having sex, you can encourage them to talk to a healthcare professional or licensed counselor about how to have sex in a safe way.

For individuals who are deciding to have sex for the first time or who are already sexually active, there are several ways that they can significantly lower their chances of catching a sexually transmitted disease or developing a pelvic inflammatory disease. You can encourage individuals to talk to a healthcare professional or licensed counselor about safe sex. Individuals can protect themselves from STDs and pelvic inflammatory disease by:

  • Using a condom every time they have sex (a doctor can explain the correct way to use a condom)
  • Being monogamous (this means having only one sexual partner)
  • Having themselves and their partners tested for STDs on a regular basis

It is also important that individuals understand that many birth control methods will not protect them from STDs or pelvic inflammatory disease. Although birth control pills or other forms of birth control are important topics for a health care professional or licensed counselor to discuss with individuals who are sexually active, it is important that they know that these methods will only protect them from becoming pregnant and not from catching an STD from their sexual partner. Condoms are the best way to prevent both pregnancy and STDs at the same time. As a DSP, you can connect individuals with resources such as health care professionals and licensed counselors who will be able to discuss these topics with the individuals you support.

What can I do?
As a direct support professional, you can encourage the individuals who you support to talk to their health care professionals about STDs and pelvic inflammatory disease. You can be aware of and inform individuals about resources available from professionals who are licensed and trained to provide this information. Also, you can support individuals by helping them request an IPP meeting with their regional center service coordinator and their person centered planning team. It is through the IPP process that resources can be identified to support the individual’s needs. Although sex can be an uncomfortable topic to bring up, it is an important one and is vital to the health of the individuals you support.
Individuals can learn some basic information about STDs and pelvic inflammatory disease through this month’s DDS Safety Net content:

  • This month’s feature presentation on “Understanding STDs” – FEATURE POWERPOINT
  • This month’s Safety Point on “Safe Relationships and Safe Sex” – SAFETY POINT
  • This month’s Health Point on “Understanding HIV/AIDS” – HEALTH POINT

Another good resource for the individuals you support is The Riot. This is a quarterly self advocacy newsletter that often has articles about romance and healthy relationships. The Riot can be found at www.theriotrocks.org. On this webpage, you will also see a link for a handbook on healthy relationships and safe sex aimed at self advocates with developmental disabilities.

Remember that you can also talk to each individual’s doctor about your concerns and ask the doctor or nurse to talk to the individual about healthy relationships and safe sex.

How can I learn more?
To learn more about sexually transmitted diseases and pelvic inflammatory disease, you can visit these websites:

  • Centers for Disease Contract and Prevention’s STD Fact Sheets – http://www.cdc.gov/std/healthcomm/fact_sheets.htm
  • WebMD’s Guide to Sexually Transmitted Diseases – http://www.webmd.com/content/article/10/2953_511/htm
  • WebMD’s Guide to Pelvic Inflammatory Disease – http://www.webmd.com/hw/health_guide_atoz/stp1500.asp?navbar=hw43368
  • Indiana State Department of Health – http://www.in.gov/isdh/prgrams/hivstd/basic.htm
  • DDS Wellness Digest - http://www.dds.cahwnet.gov/Wellness/pdf/WellnessDigest_V3_1.pdf
  • For more information on the rights of individuals with developmental disabilities and on intimate relationships, see the DSP Professional Training Guide –
    • http://www.dds.ca.gov/DSPT/Student/StudentYear1_2.pdf
    • http://www.dds.ca.gov/DSPT/Student/StudentYear2_11.pdf

You can also call the National STD Hotline for support and advice about sexually transmitted diseases:

  • In English – 1-800-343-2437
  • In Spanish – 1-800-344-7432
  • TDD – 1-800-243-7889

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