When to start treatment and which treatments to start are the topics of much research and discussion. Different health care providers have different approaches to using these medications, mostly because information about them and studies of their effectiveness are being disseminated so rapidly.

Many specialists believe that the new drugs ought to be prescribed only by health care providers who know the latest guidelines for how and when to prescribe them, because prescribing them incorrectly, or taking them in the wrong way, can lead to resistance and so limit treatment options in the future. Studies have shown that the providers who care for larger numbers of patients with HIV infection will often offer the best care, because they are more up to date with newer developments in treatment options. If your provider does not have the time to treat you and listen to you, you may want to consider working with another provider who does, relying on a specialist to act as a consultant for certain decisions.

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Carriers. Although 95 percent of people who are infected with hepatitis B go on to clear the infection and then have lifelong protection against ever becoming infected again, about 5 percent of them become carriers. A carrier is a person whose immune system was not able to clear the infection from the body, so the virus persists and the carrier remains infectious to others throughout his or her lifetime. People with impaired immune systems, such as those with HIV infection, are more likely than others to be carriers. Those who develop symptoms of hepatitis B infection are also more likely to become carriers than those who do not.

There are two kinds of carriers, with different prognoses. About one-third of carriers develop chronic active hepatitis, in which the virus continues to cause destruction of the liver. This chronic destruction can lead to scarring of the liver, known as cirrhosis. These people are the most infectious to others through the types of contact listed in the next section, on transmission. They are also at risk of developing liver cancer [hepatocellular carcinoma). The risk of developing liver cancer is about one hundred times higher in those people who have been infected with hepatitis B than in the noninfected population, and about 1-2 percent per year for someone with chronic active hepatitis B infection.

Both cirrhosis and hepatocellular carcinoma can be fatal. Hepatocellular carcinoma usually takes years to develop after someone acquires a chronic infection, although occasionally the tumor can be seen after a shorter time, and it is sometimes seen in childhood among children who had been infected at birth. It is more common in populations in which the rate of chronic infection and transmission to newborns is higher, such as in Asian countries. There is as yet no cure for hepatocellular carcinoma, although surgery and chemotherapy may have some success, depending on the person and the stage of the cancer.

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Some studies have tried to replace the Lactobacillus in the vagina and eliminate the “bad” bacteria through a diet containing yogurt or nutritional supplements (such as acidophilus-containing milk, yogurt, or pills). So far this strategy has been unsuccessful, because the Lactobacillus in yogurt is different from the Lactobacillus in the vagina. Currently, there is no effective way to replace this type of Lactobacillus in the vagina by simply putting it there, although studies continue.

Another “treatment” often prescribed to women, or initiated on their own, is douching. Douching should absolutely be avoided by all women. Not only does douching put women at higher risk for pelvic infections, it only masks symptoms and thus prevents many women from seeking health care for potentially serious problems.

Male partners of women with BV do not need to be treated. There is no evidence that treatment of male partners changes the course of the infection in women, nor does it prevent recurrences of BV If a woman with a male sexual partner is diagnosed with By however, it is reasonable to test both the woman and the man for other sexually transmitted infections, such as chlamydia, since a chlamydia infection can trigger BV in women, as mentioned previously.

A case can be made for treating female partners of women who have BV especially if there is evidence of the infection in the partner. Among women who have sex with other women, BV may be considered a sexually transmitted infection, since female partners of women with BV have a high rate of infection themselves. This may occur through vaginal fluid transmission from the sharing of sex toys.

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After the examination, blood tests for infections such as HIV, syphilis, hepatitis, or herpes may be performed. A health care provider will explain all the tests, what a positive or negative result means, and how much they cost and will decide with you which tests need to be done.

Depending on when your last sexual contact took place, you may want to wait to have some of these tests done. For example, the most common blood test for HIV is unlikely to show an accurate result immediately after a person has been infected. It may take up to three to six months after infection to show a positive blood test for HIV. Your health care provider should explain this, so a decision can be made about which tests are appropriate at this time. You may decide to come back at a later time for these tests so that they will be more accurate, or you may want to test now and retest at a later time.

Make sure you know how you are going to find out the results of your tests. Are you supposed to call or is your health care provider supposed to call you? Do you need to return to the office or clinic to learn the results of your tests? If you don’t get a telephone call, don’t assume that everything was normal. Sometimes offices and clinics are understaffed, and making even important phone calls can be overlooked. Be sure to find out your results.

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Mucopurulent cervicitis is an infection of the cervix that may be caused by several bacteria, including chlamydia and gonorrhea. Other infections, such as herpes and trichomoniasis, may also cause irritation of the cervix. The most common symptom of MPC is a discharge, which can range in color from clear-white to yellow-green. Occasionally, there may also be spotting of blood between periods, or after sexual intercourse, because the cervix is inflamed and bleeds very easily.

Herpes. Although the typical symptom of herpes is sores or breaks in the skin, discharge may be the only symptom if there is an outbreak on the cervix that is causing irritation. The discharge is usually white to yellow in color, and it maybe accompanied by external sores or irritated areas on the skin. Occasionally lymph nodes in the groin may become swollen, the person may have pain in the back of the legs, and flu-like symptoms may occur, especially with a first infection.

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