The organisms that cause MPC are transmitted through sexual contact with a partner who is infected. This is generally through genital contact, although it may be possible for women who have sex with women to transmit these organisms through sex toys. Genital rubbing, without penetration, may also be sufficient to transmit the herpes virus from one partner to another.

A man or woman performing oral sex on a woman probably does not transmit gonorrhea, chlamydia, or the bacteria that cause nongonococcal urethritis since there is no direct contact with the cervix, although genital herpes infection with the cold sore type of herpes virus (type 1) can occur through oral sex. The use of dental dams or plastic wrap may help prevent such infection.

Condoms, if they are used properly and do not break, effectively prevent transmission of the bacteria that cause cervicitis (such as chlamydia and gonorrhea), as well as such protozoa as trichomonas,

the section on pelvic inflammatory disease).

through vaginal intercourse. However, herpes simplex virus may be transmitted even with the use of condoms.The cervical cap and diaphragm, used with the spermicide nonoxynol-9, also may help prevent such bacterial infections as gonorrhea and chlamydia, but condoms are still the best method of protection.

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When the virus comes out to the skin after the initial infection, it may cause symptoms or shed horn any area on the skin supplied by the nerve that is infected. For example, a person with oral herpes infection can experience a cold sore or shedding of the virus in any area on the face, but most commonly between the nose and the chin, and usually around the mouth. Although oral herpes may (rarely) cause symptoms on the gums and hard palate, sores inside the mouth are usually not the result of herpes infection. Aphthous ulcers, the painful ulcers that occur inside the mouth, are not cold sores; it is not clear what causes them, but they are very common and not serious.

Genital herpes infections can occur in any part of the body supplied (reached) by the infected nerve, but they most commonly occur in the genital area, including the pubic hair region, the groin, and (for men) the penis, scrotum, and urethra, and (for women) the labia, urethra, vagina, and cervix. Genital herpes outbreaks can also occur on the anal area and part of the buttocks. If someone has always had outbreaks in one area of the genitals, such as on the labia, and then has a recurrence on the buttocks, she may worry that she has somehow “spread” the infection herself. What has actually happened is that the virus took a different path along a nerve root during that outbreak, causing symptoms to appear in a different spot. Furthermore, people often shed the virus from many of these regions during an outbreak. A lesion on the penis, for example, is obviously shedding virus, but virus may also be found on the testicles and anal area at that time. Asymptomatic shedding can occur from any skin area that the nerve supplies.

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Prostatitis, too, can be caused either by sexually transmitted or by nonsexually transmitted bacteria. Younger, sexually active men are more likely to have prostatitis from a sexually transmitted cause (such as bacteria that cause gonorrhea, chlamydia, or nongonococcal urethritis), and older men are more likely to have prostatitis from a nonsexually transmitted bacterium such as Escherichia coh, although older men who have unprotected sex with a new partner can develop a sexually transmitted prostate infection. As discussed previously, older men are more likely to have benign prostate enlargement, which predisposes them to UTIs. Prostate infection can result from urethral infection, bladder infection, or possibly seeding of the prostate with bacteria that are transmitted through the blood. Bacterial prostate infections can become chronic.

Some prostate inflammation is not caused by bacteria but rather by viruses, fungus, trichomonas, or tuberculosis; there are also other possibilities that are not yet well understood. Prostate pain does not necessarily indicate prostate infection. Before antibiotics became available, prostatitis was a common complication of urethral infection with sexually transmitted bacteria. Now the likelihood of developing prostatitis after a sexually transmitted urethral infection is about 1 percent. Prompt treatment of bacterial urethritis further decreases the chances of this happening.

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Lack of self-esteem can be a big problem in sexual communication. For example, a person with low self-esteem may be more vulnerable to being bullied by a sexual partner into doing things that he or she doesn’t want to do. If a partner says “You would have sex with me if you loved me” or “If you don’t have sex with me, it means you’re frigid,” a person with low self-esteem may do what the partner wants instead of being able to recognize these lines for what they are: unfair pressure to have sex. A person who lacks self-esteem may feel that he or she doesn’t even deserve to express his or her needs, much less insist on having those needs honored. There are those people who feel so bad about themselves that they may think they deserve to become infected if it happens, so they don’t protect themselves at all.

By practicing what to say in different situations, you can pre- your feelings of low self-esteem and who is unwilling to change, think about finding a new partner. You may also want to think about seeking counseling, to sort out why you feel that you don’t deserve to have your needs met. There are also self-help books that may enable you to begin developing a better sense of yourself and becoming more confident and assertive in your relationships. By learning to care for yourself and about yourself, you can learn to make smart decisions, and thus keep yourself healthy.

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Pelvic inflammatory disease. PID is an infection of the uterus, Fallopian tubes, ovaries, or all of these structures, and it is usually caused by sexually transmitted bacteria such as gonorrhea and chlamydia. These bacteria cause inflammation of the cervix, and then they, as well as vaginal bacteria, may move through the cervix up into the pelvic organs. Pelvic infection may also be caused by a complication of pregnancy such as incomplete abortion or by bacteria introduced during gynecological surgery. The consequences of PID can be severe; for example, scarring can lead to chronic pelvic pain, infertility, or a tubal pregnancy. There may be other symptoms of infection—such as discharge, spotting between periods or heavier than usual periods, fever, chills, and nausea—or pain may be the only symptom.

Pregnancy in a Fallopian tube (ectopic pregnancy). When a fertilized egg becomes implanted in the Fallopian tubes instead of in the lining of the uterus, there will be pain, and the tube may rupture, causing significant bleeding and possibly even death. Any sexually active woman with pelvic pain should promptly seek medical care to rule out this medical emergency.

Trichomoniasis. Although trichomoniasis, a vaginal infection, does not usually cause symptoms higher up in the genital tract, occasionally pelvic pain occurs with trichomoniasis for unclear reasons. The other, more common, symptoms of trichomonas infection—such as inflammation and itching of the vulva, discharge, and a fishy odor—may also be present.

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