New_Head(1, ' Venereal Diseases Were Seen as Punishment for Sexual License, pp. 551–552'); New_Question('Syphilis first appeared in Europe during the ', 4, 2, 'fourteenth', 'fifteenth', 'sixteenth', 'seventeenth', ' century, probably having been brought back from the New World by a member of ', 4, 4, 'a Viking crew', 'Sebastian Cabot’s expedition', 'James Cook’s crew', 'Christopher Columbus’s crew', '. It ran rampant and reinfested the Americas, and by 1918 ', 4, 2, '1 in 7', '1 in 22', '1 in 77', '1 in 170', ' Americans were infected. During the ', 4, 3, 'seventeenth', 'eighteenth', 'nineteenth', 'twentieth', ' century the widespread belief was that syphilis was a punishment for ', 0, 'sinful', ' behavior and little was done to treat victims. Well into the twentieth century, transmission of syphilis was exacerbated by men’s ', 4, 3, 'poor hygiene', 'lack of medical care', 'use of prostitutes', 'ignorance about prophylaxis', '. Today syphilis ', 4, 4, 'has been wiped out', 'remains a plague', 'is mostly controlled', 'is close to eliminated', ' in the United States. ', 0, 'AIDS', ' has mimicked syphilis in many ways including importation, speed of spreading, initial lack of a treatment, ', 0, 'stigmatization', ' of those affected, and disease management via social activism, medical ', 0, 'advances', ', and public ', 0, 'health', '. The two major differences are: As yet there is no cure for ', 0, 'AIDS', ', and the process unfolded in about two decades rather than the ', 4, 3, '200', '300', '500', '1000', ' years seen with syphilis.') New_Head(1, ' STDs Are Still a Major Problem in the United States, pp. 552–553'); New_Question('Each year there are about ', 4, 3, '10', '15', '19', '29', '-million new STD infections and 1 in ', 5, 1, '2', '3', '4', '5', '10', ' sexually active Americans acquire an STD by the age of ', 4, 3, '19', '21/ 23', '25', '27', '. The United States has ', 3, 3, 'the lowest', 'intermediate', 'the highest', ' rates of curable STDs of the developed nations. In the United States there are ', 3, 3, 'no differences', 'moderate differences', 'very marked differences', ' in the incidence of STD’s in different ', 0, 'ethnic', ' or racial groups. Organisms causing STDs range in complexity from viruses to multicellular animals or ', 0, 'insects', '.') New_Question('Some STDs are ', 0, 'reportable', ', meaning that medical professionals who encounter ') New_Head(1, ' Insects Are More of an Annoyance than a Danger, pp. 553–556'); New_Question('Infestations of ', 0, 'pubic', ' lice and ', 0, 'scabies', ' mites can be considered STDs. These lice are informally known as ', 4, 2, 'nibs', 'crabs', 'dots', 'scratchies', '—which they resemble. They are up to ', 0, '1', ' millimeter long and cling to two ', 0, 'hairs', ' in order to avoid being dislodged. Once anchored, they burrow their ', 3, 2, 'whole bodies', 'mouthparts', 'rear section', ' into the skin and gorge themselves on the hosts ', 0, 'blood', '. They are diagnosed either by seeing an adult (which will wave its ', 3, 3, 'antenna', 'arms', 'legs', ' when removed) or its eggs known as “', 0, 'nits', '” in the pubic hair; they ', 2, 1, 'can', 'cannot', ' colonize other hair of the body.') New_Question('Most cases of pubic ', 0, 'lice', ' are transmitted through ', 4, 4, 'clothing', 'towels', 'bedding', 'sleeping with someone', ' and they are readily treated with preparations that contain ', 0, 'insecticides', ', such as pyrethrin along with laundering of all ', 0, 'bedding', '. Pubic lice create a problem by causing ', 0, 'itching', ' and the resultant skin damage done by scratching. The amount of blood loss is ', 2, 2, 'usually considerable', 'very small', '. Importantly, all sex partners who might be affected should be ', 0, 'notified_advised', '.') New_Question('Scabies is caused by mites that live in ', 0, 'tunnels', ' they dig in the skin; these are visible as ', 3, 3, 'purplish', 'bluish', 'reddish', ', tracks, spots, or pustules. Scabies primarily affects ', 4, 4, 'pubic skin only', 'hairy skin only', 'smooth skin only', 'hairless skin', '. ', 2, 2, 'Male', 'Female', ' mites live within the skin for up to ', 4, 3, '2 days', '2 weeks', '2 months', '2 years', ' at a time. After hatching beneath the skin, mites go through several stages, return to the skin surface to ', 0, 'mate', ' and then burrow back into the skin. The major symptom of scabies is ', 4, 3, 'pain', 'anemia', 'itching', 'infection and fever', '. Scabies is best diagnosed by a physician who may examine a skin sample under a ', 0, 'microscope', '. Sexual contact is ', 2, 1, 'one of many modes of transmission', 'the only mode of transmission', '.') New_Head(1, ' Trichomoniasis Is Caused by a Protozoan, pp. 556–557'); New_Question('The infectious agent in trichomoniasis is a single-celled ', 0, 'nucleated', ' organism. It is motile, using ', 0, 'flagella', ' to propel itself throughout its preferred habitat: the ', 0, 'vagina', ' of a woman or the urethra and ', 0, 'urethra', ' of a man. Trichomoniasis in ', 2, 2, 'all', 'some', ' women is marked by an unpleasant, foul-smelling ', 0, 'vaginal discharge_discharge', ' and perhaps itching and a frequent feeling of needing to urinate. In men infection is usually ', 0, 'asymptomatic', ' or accompanied by a slight discharge and urinary discomfort. Trichomoniasis is usually diagnosed by ', 4, 3, 'visual inspection', 'blood tests', 'microscopic examination', 'case history', ' and treated with ', 4, 4, 'repeated injections', 'daily applications', 'a 3-week course', 'one dose', ' of metronidazole. The infected person’s partner should be treated at the same time ', 2, 2, 'if they have symptoms', 'whether they have symptoms or not', '.') New_Head(1, ' Bacterial STDs Can Usually Be Treated with Antibiotics, p. 557'); New_Question('The three main sexually transmitted ', 2, 1, 'bacterial', 'viral', ' infections are syphilis, gonorrhea, and ', 0, 'chlamydia', '. These types of STDs ', 2, 1, 'can be', 'are not', ' fatal. They can impair ', 0, 'fertility', ' and may aid the transmission of ', 0, 'HIV_AIDS', '.') New_Head(1, ' Syphilis Is Down but Not Out, pp. 557–559'); New_Question('Syphilis is caused by a corkscrew-shaped bacterium (', 0, 'spirochete', ') and is spread through contact with a syphilitic sore or ', 0, 'chancre', ' on a sex partner. This chancre ', 2, 2, 'is always visible', 'may be hidden', ' on the body and while active it releases ', 4, 4, 'blood', 'plasma', 'a characteristic odor', 'spirochetes', '. About ', 0, '21', ' days (but anytime between 10 and 90 days) after infection the individual also develops a ', 0, 'chancre', ' which starts as a red bump that eventually ', 4, 1, 'ulcerates', 'goes away', 'turns black', 'spreads', '. At this point it may increase the likelihood of the affected individual contracting ', 0, 'HIV', '. The ', 0, 'chancre', ' spontaneously heals within 3 to 6 ', 3, 2, 'days', 'weeks', 'months', '. In this stage it is known as ', 0, 'primary', ' syphilis.') New_Question('The cardinal symptom of secondary syphilis is a ', 4, 3, 'painful', 'weeping', 'painless', 'festering', ' rash often on the ', 0, 'palms_soles_palms and soles_palms and soles of the feet_soles of the feet', ' that appears as reddish-brown blotches. It may be accompanied by swollen ', 0, 'lymph nodes_nodes', ', fever, sore ', 0, 'throat', ', and muscle pain. The symptoms gradually ', 3, 3, 'improve', 'worsen', 'disappear', ' over the next few weeks.') New_Question('At the end of the secondary stage of syphilis, spirochetes ', 3, 3, 'are eliminated', 'cease to reproduce', 'slowly multiply', ' in most people. After about ', 4, 3, '3 months', '6 months', '1 year', '3 years', ' the person enters the ', 0, 'latent', ' phase and is no longer infectious to others although a woman may still infect her ', 4, 3, 'husband', 'children', 'fetus', 'coworkers', '. During this phase the organism continues to multiply at a slow rate and may gradually invade the ', 5, 5, 'cardiovascular system', 'bones', 'liver', 'nervous system', 'All of the above', ', with the affected individual still not necessarily showing symptoms.') New_Question('In the tertiary phase of syphilis (which affects approximately ', 3, 2, '10', '15', '25/ 50', '% of untreated individuals), large ', 0, 'ulcers', ' may erupt on the ', 0, 'skin', ' or internal organs. Today tertiary syphilis is quite ', 2, 2, 'common', 'rare', '.') New_Question('Syphilis is diagnosed through ', 0, 'clinical', ' signs and symptoms or through the presence of spirochetes or ', 0, 'antibodies', ' in the tissues or blood. Within 1 year of infection it may be treated with a(n) ', 3, 1, 'single dose', 'week-long course', 'extended course', ' of penicillin. Partners of infected individuals must be ', 0, 'notified', '. Having had a bout of syphilis in the past ', 2, 2, 'does', 'does not', ' protect against a new infection.') New_Question('The rate of syphilis was down to ', 4, 2, '1', '2.5', '3.5', '9.5', ' new cases per 100,000 people per year in 2000, but has rebounded to ', 4, 3, '1', '2.5', '3.5', '9.5', ' new infections per 100,000 people. There are two interconnected syphilis epidemics in the United States. One is a heterosexual epidemic among ', 4, 2, 'whites', 'African Americans', 'Hispanics', 'Asian Americans', ' especially those in the ', 4, 2, 'North', 'South', 'East', 'West', ', and a recent series of outbreaks among ', 0, 'homosexual_gay', ' and bisexual men in some major U.S. cities.') New_Question('The ', 0, 'Tuskegee', ' study serves as an example of the exploitation of African-American men and women as research subjects. In this study, ', 0, 'syphilis', ' was allowed to continue unabated in a cohort of poor largely uneducated black Alabaman ', 3, 2, 'women', 'men', 'women and men', '. The study concluded in ', 3, 2, '1962', '1972', '1982', ', long after a simple and effective treatment was available. By this time dozens of the research subjects had died along with approximately ', 4, 3, '20', '30', '40', '50', ' family members.') New_Head(1, ' Gonorrhea Can Lead to Infertility, pp. 560–561'); New_Question('Gonorrhea is commonly known as ', 0, 'the drip_the clap', ' and its symptoms develop ', 2, 1, 'rapidly', 'slowly', ' after infection occurs. In women the primary infection site is the ', 4, 2, 'vagina', 'cervix', 'labia', 'rectum', ', producing symptoms such as a vaginal discharge, bleeding during ', 0, 'coitus', ', and a ', 0, 'burning', ' sensation during urination. If allowed to spread to the oviducts and uterus the infection may trigger ', 0, 'pelvic inflammatory', ' disease (PID) with attendant pain and possible fertility problems. In men the primary infection site is the ', 4, 3, 'prostate', 'glans', 'urethra', 'epididymis', ' resulting in discomfort during ', 0, 'urination', ' and a discharge of pus. If allowed to spread the infection can cause ', 0, 'epididymitis', ', which can impair fertility. In ', 3, 3, 'men', 'women', 'both men and women', ' there can be no symptoms.') New_Question('', 3, 3, 'Men', 'Women', 'Both men and women', ' can be infected with gonorrhea via anal sex. The symptoms of rectal infection include a rectal discharge, anal ', 0, 'itching', ', and painful bowel movements streaked with ', 4, 4, 'pus', 'fluid', 'mucus', 'blood', '. Infections of the mouth or ', 0, 'pharynx', ' can result from oral sex, especially from ', 0, 'fellatio', ' with an infected person.') New_Question('Gonorrhea is diagnosed most accurately by looking for ', 0, 'DNA', ' of the infecting organism in the discharge or urine. Neisseria gonorrhoeae, the infectious agent, shows rapid development of ', 0, 'drug resistance', ' and thus many strains do not respond to common ', 0, 'antibiotics', '. For this reason the CDC recommends that all cases be ', 3, 2, 'first treated with the most common antibiotics and then build up to the stronger ones', 'treated with a class of antibiotics to which all strains are known to be sensitive', 'treat only those cases that show symptoms', '.') New_Question('Within the United States there are about ', 4, 4, '300', '400', '500', '700', '-thousand new gonorrhea cases per year. Rates in the ', 4, 2, 'North', 'South', 'East', 'West', ' and among ', 4, 2, 'whites', 'African Americans', 'Hispanics', 'Asian Americans', ' have been falling, while rates in the ', 4, 4, 'North', 'South', 'East', 'West', ' and among ', 4, 1, 'whites', 'African-Americans', 'Hispanics', 'Asian-Americans', ' have been increasing.') New_Head(1, ' Chlamydia Causes a Common Infection with Serious Complications, pp. 561–562'); New_Question('Chlamydia is a new and common STD. Reported cases in the United States rose from 3 to ', 4, 2, '107', '207', '307', '407', ' per 100,000 persons between 1984 and ', 3, 2, '1994', '1997', '1999', '. This sharp increase is believed to be due to ', 4, 2, 'falling condom sales', 'increased recognition and diagnosis', 'a program dedicated to detection and screening in high schools', 'All of the above', '.') New_Question('Chlamydia is caused by Chlamydia ', 0, 'trachomatis', ' a bacterium that lives entirely within other cells. Outside of the cell, chlamydia exists only in the form of ', 3, 3, 'living', 'nonliving', 'inert', ' infectious particles that are transmitted to other individuals usually through genital contact. C. ', 0, 'trachomatis', ' is a leading cause of ', 4, 2, 'pneumonia', 'blindness', 'HIV', 'cholera', ' in tropical countries.') New_Question('Symptoms of chlamydia usually appear a few days to ', 0, '3', ' weeks after infection. In men, chlamydia infects the urethra causing a ', 2, 2, 'thick', 'thin', ' discharge as well as a burning sensation during urination. It may cause prostatitis or ', 0, 'epididymitis', ' if it migrates up the male reproductive tract. In women, chlamydia usually infects the cervix or urethra causing a thin vaginal ', 0, 'discharge', ' and a burning sensation during urination. A major problem with chlamydia is that a substantial proportion of infected persons experience no symptoms; this is true of roughly ', 4, 3, '25', '50', '75', '90', '% of infected women and ', 4, 2, '25', '50', '75', '90', '% of infected men. Up to ', 4, 3, '10', '20', '40', '60', '% of women with untreated chlamydia will develop PID and about ', 4, 2, '10', '20', '40', '60', '% of those will become infertile as a result. Finally 9% will have an ', 0, 'ectopic', ' pregnancy. Like gonorrhea, chlamydia can pass to an infant during ', 4, 1, 'childbirth', 'lactation', 'placental support', 'None of the above', '.') New_Question('Chlamydia is diagnosed from ', 0, 'cell', ' samples taken from the penis or cervix or it can be diagnosed from a urine sample. It can be cured with a single dose of ', 4, 4, 'doxycycline', 'tetracycline', 'quinine', 'azithromycin', '. In the United States chlamydia is common ', 3, 3, 'in the North', 'in the South', 'throughout the country', ' and tends to strike ', 4, 3, 'whites', 'African-Americans', 'sexually active young people', 'older people whose immune systems are compromised', '. One in ', 4, 2, '5', '10', '25', '100', ' adolescent girls may be infected, and by age ', 0, '30', ' about ', 3, 2, 'one-quarter', 'one-half', 'three-quarters', ' of all sexually active women show evidence of current or prior infection. The CDC recommends that all sexually active women under the age of ', 0, '25', ' be tested for chlamydia once every ', 3, 1, 'year', 'two years', 'five years', '.') New_Head(1, ' The Status of Bacterial Vaginosis as an STD Is Uncertain, pp. 562–563'); New_Question('', 0, 'Bacterial', ' vaginosis is characterized by a ', 2, 1, 'less', 'more', '-acidic, thin, off-white vaginal secretion, a ', 0, 'fishy', ' odor, pain, and itching. ', 2, 2, 'Some', 'Many', ' women however remain asymptomatic. Its status as an STD is currently in question as it is rarely found in women who have not had ', 0, 'sexual intercourse_coitus', '. It is common among sexually active women, especially those with ', 0, 'many_multiple', ' partners, and ', 0, 'lesbian', ' women. Women who use vaginal ', 0, 'douches', ' are at increased risk for developing the disease. Treatment involves a round of ', 0, 'antibiotics', '. Having ', 0, 'bacterial', ' vaginosis increases the likelihood of a woman acquiring or transmitting ', 0, 'AIDs_HIV', '.') New_Head(1, ' Urethritis Can Be Caused by a Variety of Organisms, p. 563'); New_Question('Infections of the urethra are collectively known as ', 0, 'urethritis', ' and are characterized by pain during ', 2, 2, 'coitus', 'urination', ' and often a discharge. They ', 2, 2, 'are', 'are not', ' necessarily caused by sexually transmitted bacteria but they can be. In men, ', 0, 'urethritis', ' can be caused by ', 4, 3, 'syphilis', 'pubic lice', 'gonorrhea', 'None of the above', ' or it can be caused by other organisms, in which case it is known as non-', 0, 'gonococcal', ' urethritis (NGU). It can also be caused by Chlamydia trachomatis and ', 0, 'mycoplasmas', '—tiny cellular organisms.') New_Head(1, ' Viral STDs Can Be Dangerous and Hard to Treat, pp. 563–564'); New_Question('Viruses are extremely small infectious particles that are inert but infectious when outside a host cell. Each of these contains a core of ', 3, 3, 'DNA', 'RNA', 'DNA or RNA', ' surrounded by a crystal-like protein complex called a ', 0, 'capsid', '. In some cases there is also a ', 0, 'lipid', ' envelope that resembles a cell’s ', 0, 'membrane_plasma_membrane', '.') New_Question('A virus may contain as few as ', 4, 1, '10', '100', '1000', '10', '-thousand genes that induce the host cell to make new ', 0, 'viral particles', ' over a variable period of time. Although the body’s ', 0, 'immune', ' system will successful get rid of some viruses, many successfully protect themselves. Viruses are difficult to treat because they contain so little ', 0, 'DNA_RNA_DNA or RNA_nucleic acid_genetic material', ' to provide a unique identity and because in some cases they infiltrate the host cell’s ', 0, 'DNA_genes_chromosomes', '. Viral infections ', 2, 2, 'are', 'are not', ' treatable with antibiotics.') New_Head(1, ' Molluscum Contagiosum Is a Self-Limiting Condition, p. 564'); New_Question('Molluscum contagiosum is a skin condition caused by a ', 0, 'pox', ' virus. It is characterized by ', 3, 3, 'diffuse rashes all over the body', 'pimple-like lesions on the genitals', 'small bump-like growths, each with a central pit', '. The virus is transmitted by ', 5, 5, 'direct skin-to-skin contact', 'infected clothing or towels', 'a number of nonsexual ways', 'sexually', 'All of the above', '. It ', 2, 2, 'can', 'does not', ' cause serious health concerns and it usually disappears within a ', 3, 3, 'week', 'month', 'year', ' of its first appearance.') New_Head(1, ' Genital Herpes Is a Lifelong but Not Life-Threatening Infection, pp. 564–568'); New_Question('Genital herpes is usually caused by the ', 0, 'HSV-2', ' virus, although ', 0, 'HSV-1', ', the causative virus in ', 0, 'oral', ' herpes or cold sores on the lips, can also infect ', 0, 'genital', ' tissue. In ', 0, 'HSV-2', ', about 2 ', 3, 2, 'days', 'weeks', 'months', ' after a person is initially exposed, he or she will experience an outbreak of ', 3, 2, 'pus', 'sores', 'rashes', ' at the site of the initial infection. The outbreak may be preceded by a tingling or ', 0, 'itching', ' sensation at the site. This is followed by a reddish cluster of spots that eventually turn to ', 0, 'blisters', ' or cracks in the skin, that then break, leaving sores or ', 0, 'ulcers', '. The discharge from the blisters contains large numbers of ', 0, 'viral', ' particles and are ', 3, 3, 'not', 'mildly', 'highly', ' infectious. After a few more days the ', 0, 'blisters', ' heal and disappear.') New_Question('After a period of dormancy in the host cell, HSV-2 replication commences and the ', 0, 'viral particles', ' return to the skin surface. A new crop of blisters develops and burst, shedding large numbers of ', 0, 'viral particles', '. The individual is most infectious ', 2, 1, 'during', 'between', ' outbreaks and should take advantage of ', 0, 'anticipatory', ' signs, such as itching, to start using ', 0, 'medicine_medication', ' and take measures to avoid infecting others.') New_Question('A few people infected with genital herpes caused by HSV-2 may experience only the ', 0, 'first_initial', ' outbreak, but the great majority continue to experience outbreaks indefinitely. Typically, the frequency of outbreaks ', 2, 2, 'increases', 'decreases', ' over time, from a median of ', 0, '6', ' outbreaks in the first year to ', 0, '3', ' outbreaks in the fifth year.') New_Question('Genital herpes can be diagnosed by the presence of HSV-2 ', 0, 'antibodies', ' in the ', 4, 1, 'blood', 'urine', 'genital fluids', 'saliva', '. Some people experience only mild symptoms but for many people the sores are painful, especially if they come into contact with ', 0, 'urine', '. It is not clear whether anyone has truly ', 0, 'asymptomatic', ' genital herpes as is widely believed.') New_Question('Some studies that have reported evidence of a link between stress and herpes outbreaks may have failed to account for ', 0, 'observer bias', '; in such cases stressful events are more noticeable because they are temporally linked to the outbreak, not because they are ', 2, 2, 'less', 'more', ' frequent. Two prospective studies using ', 0, 'diaries_logs', ' found ', 3, 3, 'strong', 'weak', 'no', ' evidence that stress induces herpes outbreaks. In one of these studies ', 0, 'observer bias', ' was evident for retrospective accounts of stress prior to an outbreak. There is some evidence that ', 0, 'persistent', ' stress and anxiety can increase the likelihood of a herpes outbreak.') New_Question('Herpes can be easily transmitted during ', 0, 'parturition_birth', ', with severe or lethal results. Delivering a baby via ', 0, 'cesarean', ' section can prevent mother-to-infant transmission. There is some evidence although it is not strong, linking herpes and ', 0, 'cervical_cervix', ' cancer.') New_Question('The drug of choice in treating herpes is ', 0, 'acyclovir', ' (Zovirax) and a few similar compounds. It is available as an ointment or as oral tablets. If taken at the first signs of the outbreak, the outbreak is ', 2, 2, 'stopped', 'shortened', '. Continuous use of this drug can reduce or eliminate the outbreaks, however there is currently ', 2, 1, 'no known cure', 'a very expensive treatment that does provide a cure', ' for herpes.') New_Question('The HSV-2 virus afflicts approximately ', 5, 5, '5', '7', '10', '15', '17', '% of Americans aged 14 to ', 2, 1, '49', '59', '. This number has ', 3, 1, 'decreased', 'remained the same', 'increased', ' in the last 10 years, and is accounted for by a ', 2, 1, 'decline', 'increase', ' in rates among teenagers. This appears to be due to ', 3, 3, 'behavioral changes', 'greater use of outbreak-suppressing drugs', 'All of the above', '. About ', 5, 5, '25', '40', '50', '75', '90', '% of persons infected with HSV-2 are unaware that they are infected.') New_Head(1, ' Cytomegalovirus Is a Common Infection that Can Harm Fetuses, p. 568'); New_Question('Cytomegalovirus (CMV) is a common, often asymptomatic viral infection. It is estimated to have affected ', 4, 4, '20–30', '30–40', '40–70', '50–80', '% of the world’s population. Young children are often infected with CMV by their ', 4, 4, 'parents', 'teachers', 'relatives', 'playmates', ' or it can be acquired via ', 4, 3, 'casual', 'airborne', 'sexual', 'All of the above', ' contact in those who were not exposed to it in childhood. Those women who are infected with the disease during pregnancy have about a ', 0, '30', '% chance of passing the virus onto their fetus. An infected fetus runs a ', 0, '10', '% risk of encountering serious health problems such as ', 0, 'intellectual disability_deafness', '.') New_Head(1, ' Human Papillomaviruses Can Cause Genital Warts—and Cancer, pp. 568–570'); New_Question('Humanpapilloma viruses (HPVs) contain ', 3, 2, 'RNA', 'DNA', 'only proteins', ' and fall into a category of about ', 4, 4, '4', '16', '30', '100', ' types, about ', 4, 3, '4', '16', '30', '100', ' of which may be sexually transmitted, infecting cells of the urogenital tract and skin and often causing ', 0, 'genital warts', ' to appear.') New_Question('Genital warts are small bumps or growths on the skin of the genitals or elsewhere that are usually caused by ', 3, 2, 'HPV 16 and 18', 'HPV 6 and 11', 'HPV 3', '. Warts of this sort are ', 2, 2, 'frequently', 'rarely', ' associated with cancers. They are ', 2, 2, 'not infectious and not painful', 'highly infectious and not painful', '.') New_Question('Cancer of the cervix is especially associated with ', 3, 1, 'HPV 16 and 18', 'HPV 6 and 11', 'HPV 3', ' infection in the majority of cases. Certain strains of type 16 can cause ', 4, 3, 'prostate', 'testicular', 'anal', 'uterine', ' cancer. Because infection with one or more strains of HPV is so common—about ', 4, 3, '10–20', '30–50', '50–75', '75–90', '% of sexually active people will be infected at some point in their lives—it is essential that women have annual ', 0, 'Pap_pap', ' tests. HPV treatments include removal of the warts and treatment with ', 0, 'podophyllin', '; HPV usually ', 2, 2, 'is', 'is not', ' eliminated from the body with treatments.') New_Question('In 2006, the FDA approved ', 0, 'Gardasil', '—the first vaccine against four strains of HPV (6, 11, 16, and ', 0, '18', '). The latter two strains cause ', 4, 3, '30', '50', '70', '90', '% of all cervical cancers and the former causes ', 4, 4, '30', '50', '70', '90', '% of genital warts. It has been approved for use in females aged 9 to ', 4, 2, '24', '26', '40', '46', ' and the recommended age for vaccination is ', 4, 2, '9 to 10', '11 to 12', '12 to 13', '14 to16', '. To be effective against a given HPV, the vaccine must be administered ', 3, 3, 'during an outbreak', 'after an outbreak', 'prior to infection', '. HPV ', 2, 2, 'is', 'is not', ' a substitute for a regular Pap test.') New_Head(1, ' Hepatitis Viruses Can Be Sexually Transmitted, pp. 570–571'); New_Question('Hepatitis viruses attack the ', 4, 2, 'brain', 'liver', 'heart', 'pancreas', ' and are named hepatitis A through ', 0, 'E', '; these viruses are ', 2, 2, 'all related', 'unrelated to one another', '. Hepatitis B virus carries ', 3, 2, 'RNA', 'DNA', 'only proteins', ' and causes the yellowing of the skin and eyes known as ', 0, 'jaundice', ' as well as generalized illness and swelling of the ', 4, 2, 'brain', 'liver', 'heart', 'pancreas', '. It is transmitted through ', 6, 6, 'genital', 'oral', 'anal', 'genital and anal', 'anal and oral', 'genital', ', anal, or oral sexual contact or via contaminated blood. Serious long-term complications arise in about ', 4, 2, '1', '6', '15', '25', '% of infected people. About ', 4, 2, '12', '24', '46', '66', '-thousand new hepatitis B infections occur each year in the United States.') New_Question('Hepatitis A viruses contain ', 3, 1, 'RNA', 'DNA', 'only proteins', ' and are transmitted via direct or indirect contact with an infected person’s ', 3, 3, 'genitals', 'blood', 'feces', '. Hepatitis A has ', 2, 1, 'milder', 'more severe', ' symptoms than hepatitis B and ', 2, 2, 'does', 'does not', ' progress to a chronic state. Hepatitis C ', 2, 1, 'can', 'cannot', ' cause liver disease and ', 2, 2, 'is', 'is not', ' commonly transmitted via sexual contact.') New_Head(1, ' AIDS Is Caused by the Human Immunodeficiency Virus, pp. 571–578'); New_Question('AIDS (', 0, 'Acquired Immune Deficiency_acquired immune deficiency', ' syndrome) is caused by the ', 0, 'human immunodeficiency_Human Immunodeficiency_HIV', ' virus and was first described in ', 4, 3, '1961', '1971', '1981', '1991', ', although there probably were earlier infections. The virus probably originated from another virus that is found in African ', 0, 'primates_monkeys_apes', ', and that was transmitted to humans through eating them. It is a ', 0, 'retrovirus', ' as it contains ', 3, 1, 'RNA', 'DNA', 'only proteins', ', which once inside a host cell is/are transcribed into ', 3, 2, 'RNA', 'DNA', 'protein', '. This is the reverse of what occurs happens during transcription. The first outbreak to be recognized as a new disease struck ', 0, 'gay', ' men in San Francisco, Los Angeles, and New York in the mid-to-late 1970s.') New_Question('The worldwide AIDs death toll has been vast. Approximately ', 0, '12', '-million children have been orphaned by AIDs in the sub-Saharan region of Africa alone. This number is projected to ', 3, 2, 'decrease', 'increase', 'remain the same', '. The death toll in Africa is worse than in other countries for a number of reasons primarily related to ', 5, 4, 'political instability', 'racial discrimination', 'exploitation by Western nations', 'poverty', 'None of the above', ':
  1. The prevalence of untreated ', 0, 'STDs', '.
  2. The ', 2, 2, 'high', 'low', ' prevalence of male circumcision.
  3. The traditional ', 0, 'double standard', ' in matters related to sex.
  4. Labor migration.
  5. ', 3, 3, 'High', 'Moderate', 'Low', ' education levels.
  6. Lack of resources.
') New_Question('Some hopeful signs for reducing AIDs in Africa in the future include:
  1. Risk ', 0, 'reduction', ' campaigns.
  2. ', 0, 'International aid', ' directed specifically to combat AIDs.
  3. Simpler and cheaper ', 0, 'antiretroviral', ' treatments.
') New_Question('HIV virus particles selectively attack cells that express the ', 0, 'CD4', ' receptor—in particular a class of ', 4, 4, 'A', 'B', 'P', 'T', ' lymphocytes. In order to infect the cell there must also be a particular ', 0, 'co-receptor_co receptor_coreceptor', ' molecule nearby—this may be one of at least ', 4, 1, 'three', 'five', 'seven', 'nine', ' different molecules. The virus particle fuses with the cell membrane with the aid of a viral envelope protein and releases its load of viral RNA and ', 4, 3, 'sugars', 'capsids', 'enzymes', 'prions', ' into the host cell. DNA is produced through a reaction catalyzed by the enzyme ', 0, 'reverse transcriptase', ' which is then inserted into the host’s DNA with the help of the viral enzyme ', 0, 'integrase', ' and starts the process of virus replication. The new viral RNA then moves out into the ', 0, 'cytoplasm', ' where it is translated into ', 0, 'proteins', '. ', 0, 'Protease', ', another viral enzyme, trims the infected proteins to size and they are then packaged into viral ', 0, 'envelopes', ' and exported from the infected ', 0, 'host', ' cell.') New_Question('HIV exists at low concentration in ', 0, 'tears_saliva', ' and in high concentrations in ', 0, 'semen', ' and vaginal secretions. Activities such as deep kissing carry ', 2, 1, 'minimal', 'substantial', ' risk for transmission. Transmission by fellatio ', 3, 1, 'is well documented', 'is very uncommon', 'does not occur', '; transmission by cunnilingus or anilingus ', 3, 2, 'is well documented', 'is very uncommon', 'does not occur', '. The most dangerous sexual activities with regard to HIV transmission are ', 0, 'coitus', ' and anal sex. Transmission occurs in both directions but most commonly from ', 2, 1, 'inserter to insertee', 'insertee to inserter', '. Transmission is greatly enhanced by the presence of another ', 0, 'STD_sexually-transmitted disease_sexually transmitted disease', '. The risk of acquiring HIV by any kind of sexual contact between women is ', 3, 3, 'high', 'moderate', 'low', '.') New_Question('During the first few weeks after infection the HIV virus invades the ', 0, 'CD4 lymphocytes', ', a are a type of white blood cell. At this stage there ', 2, 2, 'are', 'are no', ' particular symptoms experienced. Standard blood tests for HIV during this period are ', 2, 2, 'positive', 'negative', '. Often there are ', 2, 2, 'high', 'low', ' levels of virus present at this time which can be detected by ', 0, 'polymerase chain reaction_PCR', '.') New_Question('The major production of antibodies to the virus occurs ', 4, 3, '2–5 days', '1–3 weeks', '6 weeks to 6 months', 'more than 1 year', ' after infection, an event that is called ', 0, 'seroconversion', '. This causes standard HIV tests to be ', 2, 1, 'positive', 'negative', ' and may be accompanied by symptoms that resemble ', 4, 2, 'heart disease', 'the flu', 'arthritis', 'leukemia', '. There follows an ', 0, 'asymptomatic', ' period during which many symptoms subside—this may last for a decade or more during which the virus is ', 3, 3, 'dormant', 'harmless', 'active', '. Eventually the immune system is unable to replace the ', 0, 'CD4', ' cells quickly enough. Acute illness in the form of ', 0, 'AIDS', ' tends to appear when CD4 cell counts decline from their normal level of about ', 4, 3, '100', '300', '1000', '5000', ' per microliter of blood to about ', 3, 2, '10–20', '200–350', '1000', ' per microliter. ') New_Question('Some signs and symptoms may begin to appear several ', 3, 3, 'weeks', 'months', 'years', ' before the diagnosis of AIDS. These signs include ', 0, 'thrush', ' (a fungal infection of the mouth and throat), ', 0, 'shingles', ' (a painful rash caused by reactivation of a latent ', 0, 'chicken', ' pox infection), unexplained fever, diarrhea, night sweats, and a generalized swelling of lymph ', 0, 'nodes', '. To distinguish these disorders from full-blown ', 0, 'AIDS', ', they are referred to as ', 0, 'HIV-symptomatic disease', '.') New_Question('Diseases that define the onset of AIDS include a number of infections, particularly unusual forms of pneumonia and meningitis and various cancers such as lymphoma and ', 0, 'cervical', ' cancer. Patients often exhibit generalized ', 0, 'wasting', ' and cognitive impairments called ', 0, 'AIDs dementia_dementia', '. Once a person’s CD4 levels fall below ', 0, '200', ' cells per microliter, the diagnosis is AIDs, at which time untreated persons typically survive less than ', 4, 2, 'one month', 'one year', 'five years', 'seven years', '. Diseases arising from low CD4 counts may be treated directly, for example, by using drug combinations to fight ', 0, 'opportunistic', ' infections.') New_Question('', 0, 'Antiretroviral', ' drugs were first introduced in ', 4, 3, '1982', '1985', '1987', '1990', ' and fall into four classes that target ', 0, 'four', ' phases of the virus’s replication cycle:') New_Question('', 0, 'Antiretroviral', ' therapy suppresses the virus but does not eradicate it; drug ', 0, 'resistance', ' can occur; the drugs can have substantial ', 0, 'side', ' effects; compliance is burdensome and lapses provoke ', 0, 'drug resistance', '. ', 0, 'Antiretroviral', ' drugs are expensive; and there is often uncertainty as to when to start ', 0, 'antiretroviral', ' therapy given its side effects. It is recommended that therapy begin when CD4 levels fall below ', 4, 4, '100', '250', '300', '350', ' cells per microliter or an AIDs-defining illness is evident.') New_Question('Combination drugs have been used for emergency ', 0, 'post-exposure prophylaxis', ' in cases where recent exposure to HIV has been discovered (such as in accidental needle sticks). This approach is ', 3, 2, 'uniformly effective', 'somewhat effective', 'ineffective', ' in preventing infection. A person who may have been infected should get medical advice immediately, but certainly before ', 0, '72', ' hours has elapsed.') New_Head(1, ' There Are Several Ways to Reduce the Likelihood of STD Transmission, pp. 578–582'); New_Question('Abstinence from sex provides excellent protection from STDs and ', 0, 'pregnancy', ', is inexpensive, and allows for concentrating time and ', 0, 'energies', ' on nonphysical relationships as well as on nonsexual goals, such as ', 0, 'career', ' advancement. Sexual contact other than ', 0, 'coitus_intercourse', ' however may not offer much STD protection.') New_Question('In the majority of states in the United States, notification of partners of a person found to have HIV is ', 2, 2, 'voluntary', 'mandatory', '. This ', 2, 2, 'is', 'is not', ' consistent with the recommendations of the Centers for Disease Control.') New_Question('Ideally, both individuals should be tested for a wide range of ', 0, 'STDs', ' before starting sexual relations. In the many cases in which this does not happen, it would at least make sense to inspect each other’s ', 0, 'genitals_genitalia', ' and discuss each oth’s sexual ', 0, 'history_histories', ' and possible contact with STDs. The absence of visible lesions after careful examination ', 2, 2, 'does', 'does not', ' indicate that a person is STD-free.') New_Question('A recent study randomly assigned youths to receive either a single session of HIV/AIDS education or a series of sessions containing the same information plus ', 0, 'skills', ' training. Youths who received the skills training were ', 2, 2, 'more', 'less', ' likely to have unprotected sex and ', 2, 1, 'more', 'less', ' likely to refrain from sex.') New_Question('A network of ', 0, 'opinion', ' leaders can spark wide dissemination of information—in a recent study of this phenomenon in San Francisco, the systematic dissemination of information regarding safe-sex practices to peer networks led to a ', 4, 3, '10', '25', '50', '75', '% drop in risky anal sex performed by young gay males. A similar phenomenon has been demonstrated among ', 0, 'inner-city black_urban black_black', ' women.') New_Question('Advertising ', 2, 1, 'is', 'is not', ' effective in getting people to use condoms; in Thailand, simple messages in advertising have resulted in a(n) ', 4, 4, '10% decrease', '10% increase', '50% increase', '85% decrease', ' in STDs among men. In Uganda, the ', 0, 'ABC', ' campaign has reduced HIV prevalence rates by as much as ', 4, 3, 'one-third', 'one-half', 'two-thirds', 'three-quarters', ' since the early 1990s. Similar mass-media appeals ', 2, 2, 'are', 'are not', ' currently possible in the United States.') New_Question('High-risk sexual behaviors include coitus, ', 2, 2, 'oral', 'anal', ' sex, and anilingus. Although ', 0, 'HIV_AIDS', ' is seldom transmitted via anilingus, there is heightened danger of transmitting ', 0, 'hepatitis', '. Moderate-risk behavior includes ', 0, 'fellatio and cunnilingus_oral sex', ' by which syphilis and ', 0, 'gonorrhea', ' are easily transmitted. Other sexual behaviors such as kissing hand–', 0, 'genital', ' contact and others carry low (but not zero) risk of STD transmission.') New_Question('The condom is the key to STD prevention, but that recall natural-tissue “', 0, 'lambskin', '” condoms are ', 2, 2, 'effective', 'ineffective', ' barriers to STDs and ', 2, 2, 'all condoms', 'no condom', ' offer(s) complete protection against STDs. Condom breakage is more likely during ', 2, 1, 'anal sex', 'coitus', ' and requires extra-strength condoms.') New_Head(1, ' Not Everything Is an STD, pp. 582–583'); New_Question('People often mistake other medical conditions or normal genital traits as STDs. “Pearly ', 0, 'penile', ' papules” are not an STD, nor are ', 0, 'canker', ' sores in the mouth, or folliculitis, which is caused by shaving ', 0, 'pubic', ' hair.')