{"id":789,"date":"2020-07-22T18:54:46","date_gmt":"2020-07-22T18:54:46","guid":{"rendered":"http:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/?post_type=chapter&#038;p=789"},"modified":"2020-12-15T00:14:03","modified_gmt":"2020-12-15T00:14:03","slug":"2-11-2-common-stis","status":"publish","type":"chapter","link":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/chapter\/2-11-2-common-stis\/","title":{"raw":"2.12.2. Common STIs","rendered":"2.12.2. Common STIs"},"content":{"raw":"<h1>What Are the Most Common Types of STIs?<\/h1>\r\nThe following information about the most common STIs is published by the US Department of Health and Human Services and found on the NIH\u2019s website on the page \u201c<a href=\"https:\/\/www.niaid.nih.gov\/diseases-conditions\/sexually-transmitted-diseases\">Sexually Transmitted Diseases<\/a>.\"\r\n\r\nApproximately 20 different infections are known to be transmitted through sexual contact. Here are descriptions of some of the most common and well known.\r\n<h1>Chlamydia<\/h1>\r\nChlamydia[footnote]Centers for Disease Control and Prevention. (2012, February 8). Chlamydia-CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/chlamydia\/STDFact- Chlamydia.htm[\/footnote] (pronounced kla-MID-ee-uh) is a common STI caused by the bacterium Chlamydia trachomatis. Chlamydia can be\u00a0transmitted during vaginal, oral, or anal sexual contact with an infected partner. While many individuals will not experience symptoms, chlamydia can cause fever, abdominal pain, and unusual discharge of the penis or vagina.\r\n<div class=\"page\" title=\"Page 133\">\r\n<div class=\"layoutArea\">\r\n<div class=\"column\">\r\n\r\nIn women, whether or not they are having symptoms and know about their infection, chlamydia can cause pelvic inflammatory disease (PID). In PID, the untreated STI progresses and involves other parts of the woman's reproductive system, including the uterus and fallopian tubes. This progression can lead to permanent damage to the woman's reproductive organs. This damage may lead to ectopic pregnancy (in which the fetus develops in abnormal places outside of the womb, a condition that can be life-threatening) and infertility.\r\n\r\nAdditionally, if the woman is pregnant, her developing fetus is at risk, because chlamydia can be passed on during her pregnancy or delivery and could lead to eye infections or pneumonia in the infant. If chlamydia is detected early, it can be treated easily with an antibiotic taken by mouth.\r\n<h1>Gonorrhea<\/h1>\r\nGonorrhea[footnote]Centers for Disease Control and Prevention. (2012, June 4). Gonorrhea-CDC Fact Sheet.Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/gonorrhea\/STDFact- gonorrhea.htm[\/footnote]<sup>\u00a0<\/sup>(pronounced gon-uh-REE-uh) is caused by the bacterium Neisseria gonorrhoeae, which can grow rapidly and multiply easily in the warm, moist areas of the reproductive tract. The most common symptoms of gonorrheal infection are a discharge from the vagina or penis and painful or difficult urination.\r\n\r\nAs with chlamydial infection, the most common and serious complications of gonorrhea occur in women and include\u00a0pelvic inflammatory disease (PID), ectopic pregnancy, infertility, and the potential spread to the developing fetus if acquired during pregnancy. Gonorrhea also can infect the mouth, throat, eyes, and rectum and can spread to the blood and joints, where it can become a life-threatening illness.\r\n<div class=\"page\" title=\"Page 134\">\r\n<div class=\"layoutArea\">\r\n<div class=\"column\">\r\n\r\nIn addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are also more likely to transmit the virus to someone else.[footnote]Centers for Disease Control and Prevention. (2012, April 11). Basic Information about HIV and AIDS. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/hiv\/basics\/index.html[\/footnote]\r\n<h1>Genital Herpes<\/h1>\r\nGenital herpes[footnote]Centers for Disease Control and Prevention. (2012, January 31). Genital Herpes-CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/herpes\/STDFact- Herpes.htm[\/footnote] is a contagious infection caused by the herpes simplex virus (HSV). There are two different strains, or types, of HSV: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Both can cause genital herpes, although most cases of genital herpes are caused by HSV-2.5 When symptomatic, HSV-1 usually appears as fever blisters or cold sores on the lips, but it can also infect the genital region through oral-genital or genital-genital contact. Symptomatic HSV-2 typically causes painful, watery skin blisters on or around the genitals or anus. However, substantial numbers of people who carry these viruses have no or only minimal signs or symptoms. Neither HSV-1 nor HSV-2 can be cured, and even during times when an infected person has no symptoms, the virus can be found in the body's nerve cells. Periodically, some people will experience outbreaks in which new blisters form on the skin in the genital area; at those times, the virus is more likely to be passed on to other people.\r\n\r\nPregnant women, especially those who acquire genital herpes for the first time\u00a0during pregnancy, may pass the infection to their newborns, causing life-threatening neonatal HSV, an infection affecting the infant's skin, brain, and other organs.[footnote]Marquez, L., Levy, M. L., Munoz, F. M., &amp; Palazzi, D. L. (2011). A report of three cases and review of intrauterine herpes simplex virus infection. The Pediatric Infectious Disease Journal, 30, 153-157. PMID 20811312[\/footnote]\r\n<div class=\"page\" title=\"Page 134\">\r\n<div class=\"layoutArea\">\r\n<div class=\"column\">\r\n<h1>HIV\/AIDS<\/h1>\r\nHIV, or the human immunodeficiency virus, is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV destroys the body's immune system by killing the blood cells that fight infection. Once HIV destroys a substantial proportion of these cells, the body's ability to fight off and recover from infections is compromised. This advanced stage of HIV infection is known as AIDS.\r\n\r\nPeople whose HIV has progressed to AIDS are very susceptible to opportunistic infections that do not normally make people sick and to certain forms of cancer. AIDS can be prevented by early initiation of antiretroviral therapy in those with HIV infection. Transmission of the virus primarily occurs during unprotected sexual activity and by sharing needles used to inject intravenous drugs, although the virus also can spread from mother to infant during pregnancy, delivery, and breastfeeding.\r\n\r\nIn 2013, NIH-supported researchers reported that a 2-year-old child who was born with HIV and was treated starting in the first few days of life has had her HIV infection go into remission. This appears to be the first case of functional cure of HIV.\r\n<h1>Human Papillomavirus (HPV)<\/h1>\r\n<div class=\"page\" title=\"Page 135\">\r\n<div class=\"layoutArea\">\r\n<div class=\"column\">\r\n\r\nHPV[footnote]Committee on Infectious Diseases. (2012). HPV vaccine recommendations. Pediatrics, 129, 602-605.[\/footnote] is the most common STD\/STI. More than 40 HPV types exist, and all of them can infect both men and women. The types of HPVs vary in their ability to cause genital warts; infect other regions of the body, including the mouth and throat; and cause cancers of the cervix, vulva, penis, and mouth.\r\n\r\nAlthough no cure exists for HPV infection once it occurs, regular screening with a Pap smear test can prevent or detect at an early stage most cases of HPV-caused cervical cancer. (A Pap smear test involves a health care provider taking samples of cells from the cervix during a standard gynecologic exam; these cells are examined under a microscope for signs of developing cancer). A newly available vaccine protects against most (but not all) HPV types that cause cervical cancer. The American Academy of Pediatrics recommends this vaccine for school-aged boys and girls.[footnote]Centers for Disease Control and Prevention. (2011, November 17). 2010 Sexually Transmitted Diseases Surveillance: Syphilis. Retrieved June 7, 2012, fromhttp:\/\/www.cdc.gov\/std\/stats10\/syphilis.htm[\/footnote]\r\n<h1>Syphilis<\/h1>\r\nSyphilis infections, caused by the bacterium Treponema pallidum, are passed from person to person during vaginal, anal, or oral sex through direct contact with sores, called chancres. Between 2001 and 2009, the Centers for Disease Control and Prevention (CDC) data show that the syphilis rate increased each year. Those people at highest risk for syphilis include men having sex with both men and women and people residing in the south.[footnote] 10. Centers for Disease Control and Prevention. (2011, November 17). 2010 Sexually Transmitted Diseases Surveillance: Syphilis. Retrieved June 7, 2012, from http:\/\/www.cdc.gov\/std\/stats10\/syphilis.htm[\/footnote] \u00a0The first sign of syphilis is a chancre, a painless genital sore that most often appears on the penis or in and around the vagina. Beyond being the first sign of a syphilis infection, chancres make a person two to five times more likely to contract an HIV infection. If\u00a0the person is already infected with HIV, chancres also increase the likelihood that the virus will be passed on to a sexual partner.[footnote]Centers for Disease Control and Prevention. (2012, April 11). Basic Information about HIV and AIDS. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/hiv\/basics\/index.html[\/footnote] \u00a0These sores typically resolve on their own, even without treatment. However, the body does not clear the infection on its own, and, over time, syphilis may involve other organs, including the skin, heart, blood vessels, liver, bones, and joints in secondary syphilis. If the illness is still not treated, tertiary syphilis can develop over a period of years and involve the nerves, eyes, and brain and can potentially cause death.\r\n<div class=\"page\" title=\"Page 135\">\r\n<div class=\"layoutArea\">\r\n<div class=\"column\">\r\n\r\nExpectant mothers harboring the bacterium are at an increased risk of miscarriage and stillbirth, and they can pass the infection on to their fetuses during pregnancy and delivery. Infants that acquire congenital syphilis during pregnancy may suffer from skeletal deformity, difficulty with speech and motor development, seizure, anemia, liver disease, and neurologic problems.\r\n<h1>Bacterial Vaginosis<\/h1>\r\nBacterial vaginosis[footnote]Centers for Disease Control and Prevention. (2010, September 1). Bacterial Vaginosis- CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/bv\/STDFact- Bacterial-Vaginosis.htm[\/footnote]<sup>\u00a0<\/sup>is a common, possibly sexually transmitted, vaginal infection in women of reproductive age. While it is healthy and normal for a vagina to have bacteria, just like the skin, mouth, or gastrointestinal (GI) tract, sometimes changes in the balance of different types of bacteria can cause problems.\r\n\r\nBacterial vaginosis occurs when problematic bacteria that are normally present only in small amounts increase in number, replace normal vaginal lactobacilli bacteria, and upset the usual balance. This situation becomes more likely if a woman douches frequently or has new or multiple sexual\u00a0partners. The most common sign of a bacterial vaginosis infection is a thin, milky discharge that is often described as having a \"fishy\" odor. However, some women will have no symptoms at all.\r\n<div class=\"page\" title=\"Page 136\">\r\n<div class=\"layoutArea\">\r\n<div class=\"column\">\r\n\r\nRegardless of symptoms, having bacterial vaginosis increases the risk of getting other STIs and is also associated with pelvic inflammatory disease (PID), an infection of the female reproductive organs, including the uterus and the fallopian tubes (which carry eggs to the uterus), and postoperative infections. Preterm labor and birth are also possibly more common in women with bacterial vaginosis.\r\n<h1>Trichomoniasis<\/h1>\r\nTrichomoniasis[footnote]Centers for Disease Control and Prevention. (2011, November 30). Trichomoniasis-CDC Fact Sheet. Retrieved July 11, 2012, fromhttp:\/\/www.cdc.gov\/std\/trichomonas\/STDFact-Trichomoniasis.htm[\/footnote]<sup>\u00a0<\/sup>(pronounced trik-uh-muh- NAHY-uh-sis) infection is caused by the single-celled protozoan parasite Trichomonas vaginalis and is common in young, sexually active women. The parasite also infects men, though less frequently. The parasite can be transmitted between men and women as well as between women whenever physical contact occurs between the genital areas. Although Trichomonas infections do not always cause symptoms, they can cause frequent, painful, or burning urination in men and women as well as vaginal discharge, genital soreness, redness, or itching in women. Because the infection can occur without symptoms, a person may be unaware that he or she is infected and continue to re- infect a sexual partner who is having recurrent signs of infection. As with bacterial STIs, all sexual partners should be treated at the same time to avoid re-infection.\r\n<div class=\"page\" title=\"Page 136\">\r\n<div class=\"layoutArea\">\r\n<div class=\"column\">\r\n\r\nNICHD-sponsored research has shown that during pregnancy, Trichomonas infection is associated with an increased risk of premature birth and infants with low birth weight. Moreover, infants born to mothers with Trichomonas infection are more than twice as likely as infants born to uninfected women to be stillborn or to die as newborns.[footnote]Klebanoff, M. A., Carey, J. C., Hauth, J. C., Hillier, S. L., Nugent, R. P., Thom, E. A., et al.; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. (2001). Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. New England Journal of Medicine, 345, 487-493.[\/footnote]\r\n<h1>Viral Hepatitis<\/h1>\r\nViral hepatitis is a serious liver disease that can be caused by several different viruses, which can be transmitted through sexual contact.\r\n\r\nHepatitis A virus (HAV) causes a short-term or self-limited liver infection that can be quite serious, although it does not result in chronic infection. While there are other ways the virus can be transmitted, HAV can be spread from person to person during sexual activity through oral-rectal contact. Vaccination can prevent HAV infection.[footnote]Klebanoff, M. A., Carey, J. C., Hauth, J. C., Hillier, S. L., Nugent, R. P., Thom, E. A., et al.; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. (2001). Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. New England Journal of Medicine, 345, 487-493.[\/footnote]\r\n\r\nHepatitis B virus (HBV) causes a serious liver disease that can result in both immediate illness and lifelong infection leading to permanent liver scarring (cirrhosis), cancer, liver failure, and death. HBV spreads through both heterosexual and homosexual contact as well as through contact with other bodily fluids, such as blood, through shared contaminated needles used for injecting intravenous (IV) drugs, tattooing, and piercing. Pregnant women with HBV can transmit the virus to their infants during delivery. HBV infection is preventable through vaccination.[footnote]Centers for Disease Control and Prevention. (2012, February 8). Chlamydia-CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/chlamydia\/STDFact- Chlamydia.htm[\/footnote]\r\n<div class=\"page\" title=\"Page 137\">\r\n<div class=\"layoutArea\">\r\n<div class=\"column\">\r\n\r\nHepatitis C virus (HCV) can cause an immediate illness affecting the liver, but it more commonly becomes a silent, chronic infection that leads to liver scarring (cirrhosis), cancer, liver failure, and death. HCV is most commonly transmitted through sharing needles or exposure to infected blood. However, it can spread through sexual contact or from mother to fetus during pregnancy and delivery. There is no vaccine for HCV, and treatments are not always effective.<sup>[footnote]Centers for Disease Control and Prevention. (2011, January 28). Sexually transmitted diseases (STDs). Sexually transmitted diseases treatment guidelines, 2010. Hepatitis C.Retrieved June 3, 2012, from http:\/\/www.cdc.gov\/std\/treatment\/2010\/hepC.htm[\/footnote]<\/sup>\r\n<div class=\"page\" title=\"Page 137\">\r\n<div class=\"section\">\r\n<div class=\"layoutArea\">\r\n<div class=\"column\">\r\n<h1>Rate Your Risk[footnote]Sexually Transmitted Infections. Government of Canada. https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/reports-publications\/infections.html#t2. Updated on June 1, 2015. Accessed on February 2, 2020.[\/footnote]<\/h1>\r\nVarious sexual activities and the possible STIs that can be transmitted through them are listed in Table 2.12.2.1 \"Sexual Activities, Potential STIs and Methods of Prevention.\" It is important to know your risk of catching and STI and to know how your risk can me minimized.\r\n\r\n<div>\r\n<p class=\"no-indent\"><b>Table 2.12.1.1<\/b> <em>Sexual Activities, Potential STIs and Methods of Prevention <\/em><\/p>\r\n<table border=\"0\">\r\n<tbody>\r\n<tr>\r\n<td><strong>Activity<\/strong><\/td>\r\n<td><strong>STI risk<\/strong><\/td>\r\n<td><strong>Prevention methods\u00a0<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Kissing<\/td>\r\n<td>Herpes, hepatitis B<\/td>\r\n<td>Avoid kissing when cuts or sores are present in or around the mouth.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Skin to skin touching<\/td>\r\n<td>Syphilis, HPV, genital herpes, public lice and scabies<\/td>\r\n<td>Abstinence, condoms (male or female), dental dam, gloves<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Giving oral sex<\/td>\r\n<td>Chlamydia, gonorrhoea, syphilis, HPV, herpes, hepatitis B, HIV<\/td>\r\n<td>Abstinence, condoms (male or female), dental dam<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Receiving oral sex<\/td>\r\n<td>Chlamydia, gonorrhoea, syphilis, genital herpes, HIV<\/td>\r\n<td>Abstinence, condoms (male or female), dental dam<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Vaginal sex<\/td>\r\n<td>Chlamydia, gonorrhoea, syphilis, HPV, genital herpes, hepatitis B, HIV, pubic lice<\/td>\r\n<td>Abstinence, condoms (male or female)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Anal sex<\/td>\r\n<td>Chlamydia, gonorrhoea, syphilis, HPV, genital herpes, hepatitis B, HIV, pubic lice<\/td>\r\n<td>Abstinence, condoms (male or female)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Exposure to infected needles<\/td>\r\n<td>Hepatitis B &amp; C, HIV<\/td>\r\n<td>Abstinence<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<sup><em>Source:<\/em> Sexually Transmitted Infections. Government of Canada.\u00a0https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/reports-publications\/infections.html#t2. Updated on June 1, 2015. Accessed on February 2, 2020.<\/sup>\r\n<\/div>\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>","rendered":"<h1>What Are the Most Common Types of STIs?<\/h1>\n<p>The following information about the most common STIs is published by the US Department of Health and Human Services and found on the NIH\u2019s website on the page \u201c<a href=\"https:\/\/www.niaid.nih.gov\/diseases-conditions\/sexually-transmitted-diseases\">Sexually Transmitted Diseases<\/a>.&#8221;<\/p>\n<p>Approximately 20 different infections are known to be transmitted through sexual contact. Here are descriptions of some of the most common and well known.<\/p>\n<h1>Chlamydia<\/h1>\n<p>Chlamydia<a class=\"footnote\" title=\"Centers for Disease Control and Prevention. (2012, February 8). Chlamydia-CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/chlamydia\/STDFact- Chlamydia.htm\" id=\"return-footnote-789-1\" href=\"#footnote-789-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a> (pronounced kla-MID-ee-uh) is a common STI caused by the bacterium Chlamydia trachomatis. Chlamydia can be\u00a0transmitted during vaginal, oral, or anal sexual contact with an infected partner. While many individuals will not experience symptoms, chlamydia can cause fever, abdominal pain, and unusual discharge of the penis or vagina.<\/p>\n<div class=\"page\" title=\"Page 133\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>In women, whether or not they are having symptoms and know about their infection, chlamydia can cause pelvic inflammatory disease (PID). In PID, the untreated STI progresses and involves other parts of the woman&#8217;s reproductive system, including the uterus and fallopian tubes. This progression can lead to permanent damage to the woman&#8217;s reproductive organs. This damage may lead to ectopic pregnancy (in which the fetus develops in abnormal places outside of the womb, a condition that can be life-threatening) and infertility.<\/p>\n<p>Additionally, if the woman is pregnant, her developing fetus is at risk, because chlamydia can be passed on during her pregnancy or delivery and could lead to eye infections or pneumonia in the infant. If chlamydia is detected early, it can be treated easily with an antibiotic taken by mouth.<\/p>\n<h1>Gonorrhea<\/h1>\n<p>Gonorrhea<a class=\"footnote\" title=\"Centers for Disease Control and Prevention. (2012, June 4). Gonorrhea-CDC Fact Sheet.Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/gonorrhea\/STDFact- gonorrhea.htm\" id=\"return-footnote-789-2\" href=\"#footnote-789-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><sup>\u00a0<\/sup>(pronounced gon-uh-REE-uh) is caused by the bacterium Neisseria gonorrhoeae, which can grow rapidly and multiply easily in the warm, moist areas of the reproductive tract. The most common symptoms of gonorrheal infection are a discharge from the vagina or penis and painful or difficult urination.<\/p>\n<p>As with chlamydial infection, the most common and serious complications of gonorrhea occur in women and include\u00a0pelvic inflammatory disease (PID), ectopic pregnancy, infertility, and the potential spread to the developing fetus if acquired during pregnancy. Gonorrhea also can infect the mouth, throat, eyes, and rectum and can spread to the blood and joints, where it can become a life-threatening illness.<\/p>\n<div class=\"page\" title=\"Page 134\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are also more likely to transmit the virus to someone else.<a class=\"footnote\" title=\"Centers for Disease Control and Prevention. (2012, April 11). Basic Information about HIV and AIDS. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/hiv\/basics\/index.html\" id=\"return-footnote-789-3\" href=\"#footnote-789-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/p>\n<h1>Genital Herpes<\/h1>\n<p>Genital herpes<a class=\"footnote\" title=\"Centers for Disease Control and Prevention. (2012, January 31). Genital Herpes-CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/herpes\/STDFact- Herpes.htm\" id=\"return-footnote-789-4\" href=\"#footnote-789-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a> is a contagious infection caused by the herpes simplex virus (HSV). There are two different strains, or types, of HSV: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Both can cause genital herpes, although most cases of genital herpes are caused by HSV-2.5 When symptomatic, HSV-1 usually appears as fever blisters or cold sores on the lips, but it can also infect the genital region through oral-genital or genital-genital contact. Symptomatic HSV-2 typically causes painful, watery skin blisters on or around the genitals or anus. However, substantial numbers of people who carry these viruses have no or only minimal signs or symptoms. Neither HSV-1 nor HSV-2 can be cured, and even during times when an infected person has no symptoms, the virus can be found in the body&#8217;s nerve cells. Periodically, some people will experience outbreaks in which new blisters form on the skin in the genital area; at those times, the virus is more likely to be passed on to other people.<\/p>\n<p>Pregnant women, especially those who acquire genital herpes for the first time\u00a0during pregnancy, may pass the infection to their newborns, causing life-threatening neonatal HSV, an infection affecting the infant&#8217;s skin, brain, and other organs.<a class=\"footnote\" title=\"Marquez, L., Levy, M. L., Munoz, F. M., &amp; Palazzi, D. L. (2011). A report of three cases and review of intrauterine herpes simplex virus infection. The Pediatric Infectious Disease Journal, 30, 153-157. PMID 20811312\" id=\"return-footnote-789-5\" href=\"#footnote-789-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/p>\n<div class=\"page\" title=\"Page 134\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<h1>HIV\/AIDS<\/h1>\n<p>HIV, or the human immunodeficiency virus, is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV destroys the body&#8217;s immune system by killing the blood cells that fight infection. Once HIV destroys a substantial proportion of these cells, the body&#8217;s ability to fight off and recover from infections is compromised. This advanced stage of HIV infection is known as AIDS.<\/p>\n<p>People whose HIV has progressed to AIDS are very susceptible to opportunistic infections that do not normally make people sick and to certain forms of cancer. AIDS can be prevented by early initiation of antiretroviral therapy in those with HIV infection. Transmission of the virus primarily occurs during unprotected sexual activity and by sharing needles used to inject intravenous drugs, although the virus also can spread from mother to infant during pregnancy, delivery, and breastfeeding.<\/p>\n<p>In 2013, NIH-supported researchers reported that a 2-year-old child who was born with HIV and was treated starting in the first few days of life has had her HIV infection go into remission. This appears to be the first case of functional cure of HIV.<\/p>\n<h1>Human Papillomavirus (HPV)<\/h1>\n<div class=\"page\" title=\"Page 135\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>HPV<a class=\"footnote\" title=\"Committee on Infectious Diseases. (2012). HPV vaccine recommendations. Pediatrics, 129, 602-605.\" id=\"return-footnote-789-6\" href=\"#footnote-789-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a> is the most common STD\/STI. More than 40 HPV types exist, and all of them can infect both men and women. The types of HPVs vary in their ability to cause genital warts; infect other regions of the body, including the mouth and throat; and cause cancers of the cervix, vulva, penis, and mouth.<\/p>\n<p>Although no cure exists for HPV infection once it occurs, regular screening with a Pap smear test can prevent or detect at an early stage most cases of HPV-caused cervical cancer. (A Pap smear test involves a health care provider taking samples of cells from the cervix during a standard gynecologic exam; these cells are examined under a microscope for signs of developing cancer). A newly available vaccine protects against most (but not all) HPV types that cause cervical cancer. The American Academy of Pediatrics recommends this vaccine for school-aged boys and girls.<a class=\"footnote\" title=\"Centers for Disease Control and Prevention. (2011, November 17). 2010 Sexually Transmitted Diseases Surveillance: Syphilis. Retrieved June 7, 2012, fromhttp:\/\/www.cdc.gov\/std\/stats10\/syphilis.htm\" id=\"return-footnote-789-7\" href=\"#footnote-789-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/p>\n<h1>Syphilis<\/h1>\n<p>Syphilis infections, caused by the bacterium Treponema pallidum, are passed from person to person during vaginal, anal, or oral sex through direct contact with sores, called chancres. Between 2001 and 2009, the Centers for Disease Control and Prevention (CDC) data show that the syphilis rate increased each year. Those people at highest risk for syphilis include men having sex with both men and women and people residing in the south.<a class=\"footnote\" title=\"10. Centers for Disease Control and Prevention. (2011, November 17). 2010 Sexually Transmitted Diseases Surveillance: Syphilis. Retrieved June 7, 2012, from http:\/\/www.cdc.gov\/std\/stats10\/syphilis.htm\" id=\"return-footnote-789-8\" href=\"#footnote-789-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a> \u00a0The first sign of syphilis is a chancre, a painless genital sore that most often appears on the penis or in and around the vagina. Beyond being the first sign of a syphilis infection, chancres make a person two to five times more likely to contract an HIV infection. If\u00a0the person is already infected with HIV, chancres also increase the likelihood that the virus will be passed on to a sexual partner.<a class=\"footnote\" title=\"Centers for Disease Control and Prevention. (2012, April 11). Basic Information about HIV and AIDS. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/hiv\/basics\/index.html\" id=\"return-footnote-789-9\" href=\"#footnote-789-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a> \u00a0These sores typically resolve on their own, even without treatment. However, the body does not clear the infection on its own, and, over time, syphilis may involve other organs, including the skin, heart, blood vessels, liver, bones, and joints in secondary syphilis. If the illness is still not treated, tertiary syphilis can develop over a period of years and involve the nerves, eyes, and brain and can potentially cause death.<\/p>\n<div class=\"page\" title=\"Page 135\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>Expectant mothers harboring the bacterium are at an increased risk of miscarriage and stillbirth, and they can pass the infection on to their fetuses during pregnancy and delivery. Infants that acquire congenital syphilis during pregnancy may suffer from skeletal deformity, difficulty with speech and motor development, seizure, anemia, liver disease, and neurologic problems.<\/p>\n<h1>Bacterial Vaginosis<\/h1>\n<p>Bacterial vaginosis<a class=\"footnote\" title=\"Centers for Disease Control and Prevention. (2010, September 1). Bacterial Vaginosis- CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/bv\/STDFact- Bacterial-Vaginosis.htm\" id=\"return-footnote-789-10\" href=\"#footnote-789-10\" aria-label=\"Footnote 10\"><sup class=\"footnote\">[10]<\/sup><\/a><sup>\u00a0<\/sup>is a common, possibly sexually transmitted, vaginal infection in women of reproductive age. While it is healthy and normal for a vagina to have bacteria, just like the skin, mouth, or gastrointestinal (GI) tract, sometimes changes in the balance of different types of bacteria can cause problems.<\/p>\n<p>Bacterial vaginosis occurs when problematic bacteria that are normally present only in small amounts increase in number, replace normal vaginal lactobacilli bacteria, and upset the usual balance. This situation becomes more likely if a woman douches frequently or has new or multiple sexual\u00a0partners. The most common sign of a bacterial vaginosis infection is a thin, milky discharge that is often described as having a &#8220;fishy&#8221; odor. However, some women will have no symptoms at all.<\/p>\n<div class=\"page\" title=\"Page 136\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>Regardless of symptoms, having bacterial vaginosis increases the risk of getting other STIs and is also associated with pelvic inflammatory disease (PID), an infection of the female reproductive organs, including the uterus and the fallopian tubes (which carry eggs to the uterus), and postoperative infections. Preterm labor and birth are also possibly more common in women with bacterial vaginosis.<\/p>\n<h1>Trichomoniasis<\/h1>\n<p>Trichomoniasis<a class=\"footnote\" title=\"Centers for Disease Control and Prevention. (2011, November 30). Trichomoniasis-CDC Fact Sheet. Retrieved July 11, 2012, fromhttp:\/\/www.cdc.gov\/std\/trichomonas\/STDFact-Trichomoniasis.htm\" id=\"return-footnote-789-11\" href=\"#footnote-789-11\" aria-label=\"Footnote 11\"><sup class=\"footnote\">[11]<\/sup><\/a><sup>\u00a0<\/sup>(pronounced trik-uh-muh- NAHY-uh-sis) infection is caused by the single-celled protozoan parasite Trichomonas vaginalis and is common in young, sexually active women. The parasite also infects men, though less frequently. The parasite can be transmitted between men and women as well as between women whenever physical contact occurs between the genital areas. Although Trichomonas infections do not always cause symptoms, they can cause frequent, painful, or burning urination in men and women as well as vaginal discharge, genital soreness, redness, or itching in women. Because the infection can occur without symptoms, a person may be unaware that he or she is infected and continue to re- infect a sexual partner who is having recurrent signs of infection. As with bacterial STIs, all sexual partners should be treated at the same time to avoid re-infection.<\/p>\n<div class=\"page\" title=\"Page 136\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>NICHD-sponsored research has shown that during pregnancy, Trichomonas infection is associated with an increased risk of premature birth and infants with low birth weight. Moreover, infants born to mothers with Trichomonas infection are more than twice as likely as infants born to uninfected women to be stillborn or to die as newborns.<a class=\"footnote\" title=\"Klebanoff, M. A., Carey, J. C., Hauth, J. C., Hillier, S. L., Nugent, R. P., Thom, E. A., et al.; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. (2001). Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. New England Journal of Medicine, 345, 487-493.\" id=\"return-footnote-789-12\" href=\"#footnote-789-12\" aria-label=\"Footnote 12\"><sup class=\"footnote\">[12]<\/sup><\/a><\/p>\n<h1>Viral Hepatitis<\/h1>\n<p>Viral hepatitis is a serious liver disease that can be caused by several different viruses, which can be transmitted through sexual contact.<\/p>\n<p>Hepatitis A virus (HAV) causes a short-term or self-limited liver infection that can be quite serious, although it does not result in chronic infection. While there are other ways the virus can be transmitted, HAV can be spread from person to person during sexual activity through oral-rectal contact. Vaccination can prevent HAV infection.<a class=\"footnote\" title=\"Klebanoff, M. A., Carey, J. C., Hauth, J. C., Hillier, S. L., Nugent, R. P., Thom, E. A., et al.; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. (2001). Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. New England Journal of Medicine, 345, 487-493.\" id=\"return-footnote-789-13\" href=\"#footnote-789-13\" aria-label=\"Footnote 13\"><sup class=\"footnote\">[13]<\/sup><\/a><\/p>\n<p>Hepatitis B virus (HBV) causes a serious liver disease that can result in both immediate illness and lifelong infection leading to permanent liver scarring (cirrhosis), cancer, liver failure, and death. HBV spreads through both heterosexual and homosexual contact as well as through contact with other bodily fluids, such as blood, through shared contaminated needles used for injecting intravenous (IV) drugs, tattooing, and piercing. Pregnant women with HBV can transmit the virus to their infants during delivery. HBV infection is preventable through vaccination.<a class=\"footnote\" title=\"Centers for Disease Control and Prevention. (2012, February 8). Chlamydia-CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/chlamydia\/STDFact- Chlamydia.htm\" id=\"return-footnote-789-14\" href=\"#footnote-789-14\" aria-label=\"Footnote 14\"><sup class=\"footnote\">[14]<\/sup><\/a><\/p>\n<div class=\"page\" title=\"Page 137\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>Hepatitis C virus (HCV) can cause an immediate illness affecting the liver, but it more commonly becomes a silent, chronic infection that leads to liver scarring (cirrhosis), cancer, liver failure, and death. HCV is most commonly transmitted through sharing needles or exposure to infected blood. However, it can spread through sexual contact or from mother to fetus during pregnancy and delivery. There is no vaccine for HCV, and treatments are not always effective.<sup><a class=\"footnote\" title=\"Centers for Disease Control and Prevention. (2011, January 28). Sexually transmitted diseases (STDs). Sexually transmitted diseases treatment guidelines, 2010. Hepatitis C.Retrieved June 3, 2012, from http:\/\/www.cdc.gov\/std\/treatment\/2010\/hepC.htm\" id=\"return-footnote-789-15\" href=\"#footnote-789-15\" aria-label=\"Footnote 15\"><sup class=\"footnote\">[15]<\/sup><\/a><\/sup><\/p>\n<div class=\"page\" title=\"Page 137\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<h1>Rate Your Risk<a class=\"footnote\" title=\"Sexually Transmitted Infections. Government of Canada. https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/reports-publications\/infections.html#t2. Updated on June 1, 2015. Accessed on February 2, 2020.\" id=\"return-footnote-789-16\" href=\"#footnote-789-16\" aria-label=\"Footnote 16\"><sup class=\"footnote\">[16]<\/sup><\/a><\/h1>\n<p>Various sexual activities and the possible STIs that can be transmitted through them are listed in Table 2.12.2.1 &#8220;Sexual Activities, Potential STIs and Methods of Prevention.&#8221; It is important to know your risk of catching and STI and to know how your risk can me minimized.<\/p>\n<div>\n<p class=\"no-indent\"><b>Table 2.12.1.1<\/b> <em>Sexual Activities, Potential STIs and Methods of Prevention <\/em><\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Activity<\/strong><\/td>\n<td><strong>STI risk<\/strong><\/td>\n<td><strong>Prevention methods\u00a0<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Kissing<\/td>\n<td>Herpes, hepatitis B<\/td>\n<td>Avoid kissing when cuts or sores are present in or around the mouth.<\/td>\n<\/tr>\n<tr>\n<td>Skin to skin touching<\/td>\n<td>Syphilis, HPV, genital herpes, public lice and scabies<\/td>\n<td>Abstinence, condoms (male or female), dental dam, gloves<\/td>\n<\/tr>\n<tr>\n<td>Giving oral sex<\/td>\n<td>Chlamydia, gonorrhoea, syphilis, HPV, herpes, hepatitis B, HIV<\/td>\n<td>Abstinence, condoms (male or female), dental dam<\/td>\n<\/tr>\n<tr>\n<td>Receiving oral sex<\/td>\n<td>Chlamydia, gonorrhoea, syphilis, genital herpes, HIV<\/td>\n<td>Abstinence, condoms (male or female), dental dam<\/td>\n<\/tr>\n<tr>\n<td>Vaginal sex<\/td>\n<td>Chlamydia, gonorrhoea, syphilis, HPV, genital herpes, hepatitis B, HIV, pubic lice<\/td>\n<td>Abstinence, condoms (male or female)<\/td>\n<\/tr>\n<tr>\n<td>Anal sex<\/td>\n<td>Chlamydia, gonorrhoea, syphilis, HPV, genital herpes, hepatitis B, HIV, pubic lice<\/td>\n<td>Abstinence, condoms (male or female)<\/td>\n<\/tr>\n<tr>\n<td>Exposure to infected needles<\/td>\n<td>Hepatitis B &amp; C, HIV<\/td>\n<td>Abstinence<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><sup><em>Source:<\/em> Sexually Transmitted Infections. Government of Canada.\u00a0https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/reports-publications\/infections.html#t2. Updated on June 1, 2015. Accessed on February 2, 2020.<\/sup>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-789-1\">Centers for Disease Control and Prevention. (2012, February 8). Chlamydia-CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/chlamydia\/STDFact- Chlamydia.htm <a href=\"#return-footnote-789-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-789-2\">Centers for Disease Control and Prevention. (2012, June 4). Gonorrhea-CDC Fact Sheet.Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/gonorrhea\/STDFact- gonorrhea.htm <a href=\"#return-footnote-789-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-789-3\">Centers for Disease Control and Prevention. (2012, April 11). Basic Information about HIV and AIDS. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/hiv\/basics\/index.html <a href=\"#return-footnote-789-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-789-4\">Centers for Disease Control and Prevention. (2012, January 31). Genital Herpes-CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/herpes\/STDFact- Herpes.htm <a href=\"#return-footnote-789-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-789-5\">Marquez, L., Levy, M. L., Munoz, F. M., &amp; Palazzi, D. L. (2011). A report of three cases and review of intrauterine herpes simplex virus infection. The Pediatric Infectious Disease Journal, 30, 153-157. PMID 20811312 <a href=\"#return-footnote-789-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-789-6\">Committee on Infectious Diseases. (2012). HPV vaccine recommendations. Pediatrics, 129, 602-605. <a href=\"#return-footnote-789-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-789-7\">Centers for Disease Control and Prevention. (2011, November 17). 2010 Sexually Transmitted Diseases Surveillance: Syphilis. Retrieved June 7, 2012, fromhttp:\/\/www.cdc.gov\/std\/stats10\/syphilis.htm <a href=\"#return-footnote-789-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-789-8\"> 10. Centers for Disease Control and Prevention. (2011, November 17). 2010 Sexually Transmitted Diseases Surveillance: Syphilis. Retrieved June 7, 2012, from http:\/\/www.cdc.gov\/std\/stats10\/syphilis.htm <a href=\"#return-footnote-789-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-789-9\">Centers for Disease Control and Prevention. (2012, April 11). Basic Information about HIV and AIDS. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/hiv\/basics\/index.html <a href=\"#return-footnote-789-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><li id=\"footnote-789-10\">Centers for Disease Control and Prevention. (2010, September 1). Bacterial Vaginosis- CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/bv\/STDFact- Bacterial-Vaginosis.htm <a href=\"#return-footnote-789-10\" class=\"return-footnote\" aria-label=\"Return to footnote 10\">&crarr;<\/a><\/li><li id=\"footnote-789-11\">Centers for Disease Control and Prevention. (2011, November 30). Trichomoniasis-CDC Fact Sheet. Retrieved July 11, 2012, fromhttp:\/\/www.cdc.gov\/std\/trichomonas\/STDFact-Trichomoniasis.htm <a href=\"#return-footnote-789-11\" class=\"return-footnote\" aria-label=\"Return to footnote 11\">&crarr;<\/a><\/li><li id=\"footnote-789-12\">Klebanoff, M. A., Carey, J. C., Hauth, J. C., Hillier, S. L., Nugent, R. P., Thom, E. A., et al.; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. (2001). Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. New England Journal of Medicine, 345, 487-493. <a href=\"#return-footnote-789-12\" class=\"return-footnote\" aria-label=\"Return to footnote 12\">&crarr;<\/a><\/li><li id=\"footnote-789-13\">Klebanoff, M. A., Carey, J. C., Hauth, J. C., Hillier, S. L., Nugent, R. P., Thom, E. A., et al.; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. (2001). Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. New England Journal of Medicine, 345, 487-493. <a href=\"#return-footnote-789-13\" class=\"return-footnote\" aria-label=\"Return to footnote 13\">&crarr;<\/a><\/li><li id=\"footnote-789-14\">Centers for Disease Control and Prevention. (2012, February 8). Chlamydia-CDC Fact Sheet. Retrieved July 11, 2012, from http:\/\/www.cdc.gov\/std\/chlamydia\/STDFact- Chlamydia.htm <a href=\"#return-footnote-789-14\" class=\"return-footnote\" aria-label=\"Return to footnote 14\">&crarr;<\/a><\/li><li id=\"footnote-789-15\">Centers for Disease Control and Prevention. (2011, January 28). Sexually transmitted diseases (STDs). Sexually transmitted diseases treatment guidelines, 2010. Hepatitis C.Retrieved June 3, 2012, from http:\/\/www.cdc.gov\/std\/treatment\/2010\/hepC.htm <a href=\"#return-footnote-789-15\" class=\"return-footnote\" aria-label=\"Return to footnote 15\">&crarr;<\/a><\/li><li id=\"footnote-789-16\">Sexually Transmitted Infections. Government of Canada. https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/reports-publications\/infections.html#t2. Updated on June 1, 2015. Accessed on February 2, 2020. <a href=\"#return-footnote-789-16\" class=\"return-footnote\" aria-label=\"Return to footnote 16\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":9,"menu_order":2,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-789","chapter","type-chapter","status-publish","hentry"],"part":493,"_links":{"self":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapters\/789","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/wp\/v2\/users\/9"}],"version-history":[{"count":13,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapters\/789\/revisions"}],"predecessor-version":[{"id":1885,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapters\/789\/revisions\/1885"}],"part":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/parts\/493"}],"metadata":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapters\/789\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/wp\/v2\/media?parent=789"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapter-type?post=789"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/wp\/v2\/contributor?post=789"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/wp\/v2\/license?post=789"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}