Swabs of the anal canal or ‘rectal culture’ can be obtained without using a proctoscope although use of a proctoscope is recommended as it increases the chances of obtaining a satisfactory specimen. Faeces should be avoided and obvious exudate swabbed.

Insert a sterile cotton-tipped applicator moistened with sterile saline approximately one inch into the anal canal.

Move the swab from side to side in the anal canal to sample crypts. Allow 10 to 30 seconds for absorption of organisms on to the swab.

Oropharynx

Swab the posterior pharynx and tonsillar crypts with a cotton-tipped applicator.

Transport media

Most microorganisms causing STD are fastidious and fragile and require careful handling if culture is to be successful. Arrangements should be made with the laboratory for the supply of transport media and the rapid transfer of specimens. Stuart’s transport medium can be used for bacteria and yeasts.
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A vaginal speculum should be used to visualise the cervix. The speculum should be moistened with warm water, do not use any other lubricant.

Remove excess cervical mucus, preferably with a cotton ball held in ring forceps.

Insert a sterile cotton-tipped applicator into the cervical canal; rotate swab; allow 10 to 30 seconds for absorption of organisms on to the swab.

Vagina
Use a sterile cotton-tipped applicator to obtain swabs of the lateral wall of the vagina or the posterior fornix.

Urethra
Wipe away frank pus and exudate. Use a sterile bacteriological loop or a disposable plastic loop or a sterile urethral swab moistened with sterile saline.
The loop or swab is inserted several centimetres to reach the columnar epithelium of the anterior urethra which is scraped.
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This letter should be followed, a week or so later, by a gift—perhaps a dozen roses delivered by hand, with a note:

“Always thinking about you.—Your Mystery Lover.”

When the husband sees the flowers, he might ask, “Who are these flowers from?”—to throw her off. Then, a week later, there might be a short poem. It should be simple and not overly sentimental:

“I think of you and wish/That you and I—/I think of you and wonder/What would be if we—/I think of your beautiful, intelligent eyes/And how it would be/if they looked at me/with love/Or surprise./I think of you. . . .”

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Aim: In an exaggerated fashion, to mirror the wife’s need for politically correct sex so as to point up its absurdity.

Game Plan: One evening or weekend the husband approaches the wife and asks how she would feel about having sex. If she says she would like to, he continues to question her.

“Are you sure you want to have sex?” “Yes, I’m sure. Why do you ask?”

“Because Robin Morgan, the editor of Ms., says that even when a woman consents to having sex with a man, it’s still rape—since all men are in a position of dominance in our society, and hence even when a woman agrees to sex it constitutes giving in to the specter of male dominance and is a kind of psychological rape.”

“Yes, I can see the point of that statement.”

“So, how do I know you really want to have sex? How do I know you aren’t simply giving in to my male dominance now? How do I know it won’t be a form of rape?”

“You don’t know.”

“Then maybe we shouldn’t have sex.” “Maybe not. Unless I ask you.”

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Activists: Both spouses. Setting: Hotel.

Aim: Play out a primary fantasy of impulsive couples, but with a twist: Instead of writhing and running, writhe and review.

Game Plan: This game can be played with or without an actual authority figure—a therapist or a nonprofessional friend. (This book may serve as the authority if no other is available.) The authority instructs the couple to go to a hotel or motel and play out their impulse to have a one-night stand—with each other. However, this time they are to end the sham affair different than usual. Usually, the morning after such an event is awkward as each partner finds the quickest way to the exit. This happens because in a one-night stand a couple quickly achieves a false intimacy based on their impetuous sexuality— but they have not really communicated and bonded so that they can sustain a relationship, and they are reluctant to do so. Hence, the next morning they find themselves having been sexually intimate but thinking all kinds of thoughts about one another that they do not want to talk about. Indeed, they fear that talking about these things would be harmful. (In reality, in many cases talking about these things would lead to a deeper, more realistic relationship.)

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of membranes and premature delivery of the infant. Vaginal infection with trichomonas can also be passed to the newborn during delivery, causing either genital or lung infection in the child.

Men usually do not experience any symptoms of trichomonas infection, although a few men have symptoms of urethritis (urethral infection), such as burning with urination, discharge, or simply a sensation of irritation in the penis. Rarely, trichomonas may also be a cause of prostate and epididymis infection. If left untreated, trichomonas has been shown to cause scarring (called strictures) in the urethra, which may impair the flow of urine.

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cause: virus (human immunodeficiency virus) symptoms: sometimes viral illness after infection, but often none initially;

later, weight loss, fever, lymph node swelling, recurrent

infections

treatment: no cure, but medications can slow disease process

WHAT IS IT?

The human immunodeficiency virus (HIV) is the virus that causes the acquired immunodeficiency syndrome (AIDS). HIV and AIDS are not the same thing, although people sometimes erroneously use the terms interchangeably. The first reports of people dying from AIDS emerged in the early 1980s, and the understanding that HIV was the cause of this syndrome came soon after. Recently tissue and blood samples from people who lived in Africa in the 1950s have been found to have evidence of the virus, so it appears to have been around longer than was previously thought. No one knows exactly how, when, or where HIV originated.

Two types of HIV are recognized: HIV-1 and HIV-2. There are also some variations among the HIV-1 types,- nine have so far been recognized. HIV-1 is the primary strain seen in all areas of the world except West Africa, where HIV-2 predominates. Only about forty cases of HIV-2 have been reported in the United States, and all of these were among people who had traveled to West Africa or had had sexual contact with someone from West Africa. Nevertheless, in most areas of the United States, testing for HIV usually includes testing for both types of the virus.

The virus infects certain cells of the body, specifically those that have a particular protein, the CD4 protein, on their surface. One cell type, CD4 lymphocytes or T helper cells, is an important part of the immune system, which is the body’s defense system against infections and the development of cancer. HIV is a type of virus called a retrovirus, a term used to describe the process by which it infects a target cell. When the virus attaches to a cell, its genetic material is incorporated into the genetic material of the cell. The infected cell then makes new HIV which can then go on to infect other cells.

When a person is first infected, a large amount of virus circulates in the system, and initially the number of CD4 cells declines; however, the body’s immune system then regains control and suppresses the vims for a period of about ten years. Eventually, however, the virus somehow “outsmarts” the body’s immune system and starts destroying the cells it has infected, a process that makes the infected person very vulnerable to other infections and malignancies. At this point, a person is considered to have AIDS. Why this happens, and why it occurs at different times for different people, is not clear, although genetic differences may determine a person’s susceptibility to infection with AIDS as well as how long it will take the person to develop AIDS if he or she becomes infected.

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