Disease and Resource Links

Health Information


The following lists many common health issues facing college students. Click on any link and you will be brought to the topic details. 

Men's Health Issues  Women's Helath Issues 
Sex and Sexuality  Sexually Transmitted Diseases 
Non-Sexually Transmitted Diseases  Contraceptive Methods, Pregnancy 
Emergency Contraception  Prevention, and STD Prevention 
Eating Disorders  Vegetarianism 
Conjunctivitis  Upper Respiratory Illness 
Cold Sores (Oral Herpes)  Infectious Mono 
Smoking Cessation  Lower Back Pain 
  Alcohol and Other Drugs 


Here is a great website to check out your pharmaceutical questions: 



Mens Health Issues:


  • Jock Itch

Jock itch is a fungal infection in the groin area. Often it occurs in athletes because the non-absorbent fabric of the athletic supporter provides a warm and moist environment in which fungi thrive. Symptoms include burning, itching, and red, scaly rash. It can be treated with over-the-counter antifungal creams such as Micatin, Cruex, Desenex, Lotrimin, or Tinactin. However, if the rash worsens at any time or fails to improve after seven days of treatment, you should follow up with one of the clinicians at the Health Center. To avoid infection, keep the groin dry by wear absorbent cotton underwear and changing athletic supporters frequently.

  • Prostatitis

Prostatitis is an inflammation or infection of the prostate, the gland surrounding the neck of the bladder and urethra (the tube through which urine passes). Prostatitis may result from a bacterial or sexually-transmitted infection and can be treated with antibiotics. The symptoms of prostatitis include burning with urination, urinating frequently, trouble starting urination or incompletely emptying bladder, fever, chills, and low back pain.

  • Testicular self-examination

Just as women should perform a monthly breast self-exam (BSE), men should do a testicular self-examination (TSE) just as often. A regularly scheduled self-exam will enable you to distinguish between normal and abnormal findings. If you detect any change in your testicles, regardless of how subtle that change might be, you should have a clinician evaluate it. Testicular cancer is one of the most common cancers in men ages 15-34, occurring four times more often in white than black men. Early detection and treatment is usually curative. The first sign of testicular cancer is a slight enlargement of one of the testes and a change in its consistency. If pain is present, it often feels like a dull ache in the lower abdomen and groin. The best hope for early detection is a simple three-minute self-exam. The best time is after a warm bath or shower, when the scrotal skin is most relaxed. Roll each testicle between the thumb and fingers of both hands. The testes should feel completely smooth and slightly rubbery, like a hard-boiled egg with the shell removed. If you find any lumps or nodules, schedule an appointment at the Health Center.

  • Genital Self-Examination

It is also a good idea to perform regular genital self-exams. To do this, look at the entire penis, beginning with the head and progressing down the shaft to the base. Look for any bumps or blisters (either reddish or flesh-colored, possibly resembling pimples), open sores or warts (which might be similar in appearance to warts on other parts of the body). Continue by spreading the pubic hair to check the skin underneath, and then check the underside of the scrotum. Because it is difficult to see the entire genital area, using a hand-held mirror is helpful. Also, check for any unusual drip or discharge from the penis
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Women's Health Issues:

The clinicians at the Health Center (x2018) provide a wide array of gynecological primary care services such as: performing gynecological exams; discussing menstrual problems; prescribing and providing forms of contraception including free condoms, oral contraception (the Pill), the diaphragm, and Depo Provera; treating sexually and non-sexually transmitted vaginal infections; conducting pregnancy tests; and referring to other agencies for pregnancy-options counseling.

Here are some more details on services and issues the Health Center Staff can help you with:

  • A Routine Gynecological Exam

Many young women hesitate to make their first appointment for a GYN exam because they feel either uncomfortable or embarrassed. But every woman should have a GYN exam at age 18 or when she is contemplating becoming sexually active. The clinicians at the Health Center are experienced at doing initial GYN exams and would be willing to meet with you before your appointment to discuss the procedure with you. The visit includes a routine breast and pelvic exam as well as checking your heart, lungs, and thyroid gland. The following is an overview of what to expect.

    • Sexual History

      The clinician will ask you about your periods, when they first began and how often and long they occur; and about your sexual practices. Some of the questions the clinician asks might seem very personal, but your answers will help her/him care for you better. All of the information you give will be kept confidential.


    • Breast Exam

      The breast exam helps detect abnormalities in the breasts that might indicate cancer or other problems. The clinician will feel each breast, moving in a circular motion, to check for lumps or other abnormalities. She/he will show you how to examine your breasts yourself.


    • Pelvic Exam

      A pelvic exam is an essential part of every woman’s health care. It helps the woman and her clinician evaluate the health of her reproductive organs and check for any unusual color, rash, lesions, swelling, irritation, or discharge.  You will be asked to position yourself on your back on the examination table, placing each foot in a footrest, so that the clinician can examine the pelvic area. After looking at the external genitalia, the clinician will insert a speculum, a device that spreads the vaginal walls, to provide a clear view of the vagina and cervix.  The clinician will then collect cells from the vaginal walls and from the opening of the cervix, using a small wooden spatula and a soft brush. This sampling of cells constitutes the Pap smear, a test to detect cellular abnormalities of the vagina or cervix. The clinician also uses a Q-tip to take cultures from the cervix to check for two sexually-transmitted infections, chlamydia and gonorrhea, if the woman’s sexual history warrants it.  Once the tests are performed, the clinician removes the speculum and begins the bimanual exam, by placing one hand on your lower abdomen and two fingers of the other hand in the vagina. This exam enables her/him to get a sense of the size and shape or the uterus and ovaries or to detect any tender areas.


    • Rectal Exam

      Last, the clinician might perform a rectal exam, by briefly inserting one lubricated gloved finger into your rectum. This procedure will push your uterus, ovaries and fallopian tubes toward the surface of the abdomen, allowing the clinician to feel irregularities that may not be detected otherwise.  The entire exam is usually painless. Most women describe a stretching feeling as the speculum is gently opened in the vagina.  It usually takes 1-2 weeks for the laboratory to send the Health Center the results of your Pap and cultures. Your clinician will notify you of your result


  • Breast Self-Examinations

Breast Self Examination (BSE) should be performed every month about one week after the menstrual period ends. It is important to determine what feels normal initially, then to check for any changes. The examination has both a visual and a manual component.


Before a Mirror: Inspect your breasts with arms at your sides. Next, raise your arms overhead. Look for any changes in contour of each breast, a swelling, dimpling of skin or changes in the nipple. Then, rest palms on hips and press down firmly to flex your chest muscles. Left and right breasts will not exactly match – few women’s breasts do. Regular inspection shows what is normal for you and will give you confidence in your examinations.

Lying Down:  To examine your right breast, put a pillow or folded towel under your right shoulder. Place your right hand behind your head – this distributes breast tissue more evenly on the chest. With your left hand, fingers flat, press gently in small circular motions around an imaginary clock face. Begin at the outermost top of you right breast for 12 o’clock, then move to 1 o’clock and so on around the circle back to 12. A ridge of firm tissue in the lower curve of each breast is normal. Then move in an inch toward the nipple; keep circling to examine every part of your breast, including the nipple. This requires at least three more circles. Now slowly repeat the procedure on your left breast with a pillow under your left shoulder and left hand behind your head. Notice how your breast structure feels. Finally, squeeze the nipple of each breast gently between thumb and index finger. Any discharge, clear or bloody, should be reported to your clinician immediately.
Women themselves first discover most breast cancers. Since breast cancers that are found early and treated promptly have excellent chances for cure, learning how to examine your breasts properly can help save your life. If you discover a lump or dimple or discharge during BSE, it is important to see your clinician as soon as possible. Don’t be frightened. Most breast lumps are not cancerous, but only your clinician can make the diagnosis.

  • Vulva Self-Exam

A vulva self-exam is a simple exam than can help you detect any abnormalities of the skin. The vulva is the entire external portion of the vagina. To perform an exam, first undress and examine the area of your genitals covered with pubic hair. It may help to use a mirror. Spread the hair and look for bumps or blisters (either reddish or flesh-colored, possibly resembling pimples), open sores or warts (which may be similar in appearance to warts on other parts of the body). Next, spread the outer lips of your vagina and check the hood of your clitoris. Then look at the clitoris itself by gently pulling up the hood. Again, check for sores, bumps, blisters or warts. Then look at the inner lips on all sides and check the area surrounding the urinary and vaginal opening. Also, check for any unusual discharge from your vagina. 
If you notice anything unusual, call the Health Center (x 2018). Because some sexually-transmitted infections appear in your vagina rather than on the vulva, it is important to have a pelvic exam performed by a clinician if you think you have been exposed.

  • Menstrual Problems

Even if the problem seems minor, you should discuss your concerns about menstrual irregularity, heavy flow and bad cramps with a clinician. Most of these problems can be alleviated with proper treatment. 

  • PMS

Many women experience symptoms, usually occurring one to ten days before their periods begin, that have come to be known as Pre-Menstrual Syndrome (PMS). The most common symptoms are anxiety, depression, angry outbursts, weight gain, bloating, breast tenderness, cramps and cravings for sweets. The two most widely accepted theories about PMS implicate vitamin deficiencies due to poor nutrition and hormonal imbalances. To help alleviate PMS symptoms, you can try:


    • Reducing your consumption of refined sugar, salt, and caffeine.

    • Increasing Vitamin B6 (found in green vegetables) consumption

    • Exercising regularly

    • Using a heating pad on your stomach or back  

If you experience PMS, you may want to consult a clinician at the Health Center to get more recommendations for easing your symptoms.

  • Toxic Shock Syndrome

Toxic Shock Syndrome (TSS) is a serious but very rare disease occurring most often in women under 30 who use tampons. In severe cases, TSS can cause death. Staphylococcus aureus, a bacterium that can release toxins into the bloodstream, is believed to cause this illness. Although tampons themselves do not cause TSS, they are suspected as acting as a carrier for this bacteria. The following symptoms of TSS can appear quickly and be severe:

    • Sudden high fever (102 or higher)

    • Vomiting

    • Diarrhea

    • Dizziness or fainting

    • A rash that looks like a sunburn

Symptoms of TSS may differ; sometimes it seems like a case of the flu. If you think you may be experiencing TSS, remove your tampon if you are using one and get medical attention immediately. Treatment for TSS may include administration of fluids, drugs to raise blood pressure, and antibiotics. 

If you have never had TSS but want to reduce your risk of getting it, choose the lowest absorbency or smallest size of tampons that will still be effective for your menstrual flow, and change your tampon frequently. You can also alternate between using tampons and sanitary pads, especially at night.

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Sex & Sexuality:

Throughout life we are sexual beings, whether we engage in sexual relationships or not. Our deepest feelings for other people, our fantasies, our feelings about our bodies and our sensual pleasures are all part of our personalities and our sexuality. We are all sexual – young or old; married, single or committed; gay, lesbian, bisexual, or transgender; sexually active or celibate; physically challenged or not. Learning about sex and our sexual selves is a life-long process.

  • Making choices

Many of us have been conditioned to view our own sexual desires as dirty or shameful. We learn early on to judge our bodies according to socially-defined standards of beauty and attractiveness. As a result, we may then lose respect for our own uniqueness, and judge ourselves only in relation to others. We may make choices for ourselves based on what we perceive to be cultural expectations. These perceptions influence the way we experience ourselves sexually.
However, leaving home and going away to college present students with the opportunity, sometimes for the first time, to think more independently about sexuality. While learning to think and talk more honestly about sexual decisions, it might help to ask yourself the following questions:

  • How do I feel at this moment?

  • Do I want to be sexually close to this person right now? In what ways?

  • What if I don’t know? Can I say I’m confused?

  • Can I communicate clearly what I want and don’t want?


By encouraging communication, we all might able to ultimately challenge assumptions and misconceptions about sex, while also learning to be more assertive about our own sexual needs and desires. Learning to talk comfortably about sex and acknowledging your feelings might also protect you against some of the unpleasant consequences of sex, such as HIV and other sexually-transmitted infections, unplanned pregnancy, and acquaintance rape.

Sexual Orientation

Few people are completely “straight” or completely “gay” throughout their lives. For example, adolescents who identify themselves as heterosexual might have a same-sex relationship at some point. The researcher Alfred Kinsey found that human sexual orientation exists not as exact categories of behavior, but on a continuous spectrum bounded on the extremes by exclusive heterosexuality and exclusive homosexuality. Few people can truly say they belong exclusively to either extreme. Neither can people claim superiority based on their sexual orientation; the sexual orientation that is best for a given individual is the one with which she or he is most comfortable. That’s it.

Homosexuality is not a disease, nor is it as uncommon as many people think. The most quoted statistic says that one in ten people identifies her- or himself as exclusively gay or lesbian. Others fall on the bisexual continuum. You may consider yourself gay, lesbian or bisexual; if not, you probably know students who do, whether they are close friends, classmates, or teammates. When sexual orientation is thought of in terms of friends or neighbors it becomes obvious that it is of utmost importance that we, as members of the Trinity community, respect the sexual choices of others.



Intimacy and Sexual Intercourse

Deciding to become sexually intimate with a partner is usually a significant step in a relationship, especially since, for many people, having sex involves an emotional as well as physical commitment. You will probably find yourself influenced by cultural, ethical, religious, and moral factors. You should not feel pressured to engage in sexual intercourse, or any other form of sexual activity, unless it is your personal choice to do so. Intimacy does not necessarily mean you have to have sex. Many people abstain from sexual intercourse, choosing other ways to express their affection. What is most important is that you are comfortable with the level of sexual closeness you have chosen.
You will also want to consider your own health risks before engaging in sexual activity. Unfortunately, college-aged students are at risk for contracting sexually-transmitted infections, some of which may be asymptomatic. That means one person could transmit a disease to another without ever being aware of his/her infection. Unplanned pregnancy is another concern in heterosexual relationships (see the “Contraceptive Methods and STI Prevention” section of this web page for a complete discussion of birth control).

Abstinence is the only foolproof method of preventing sexually-transmitted infections and pregnancy, but chastity is not for everyone. Practicing safer sex allows you to show your love, concern, and respect for your partner and yourself by being smart and staying healthy. Safer sex means enjoying sex to the fullest without transmitting or acquiring infections. By using a barrier method -- such as a condom or dental dam during all genital contact, whether this involves oral sex or intercourse -- you can significantly reduce, but not completely eliminate, the risks.

Because you can have only “safer” sex, you and your partner should feel comfortable discussing all aspects of sexuality. Deciding with your partner, through open discussion, how best to minimize the risks can empower you as a couple and strengthen the bond between you.

Male Problems with Sexual Functioning

In our society, men are often expected to exhibit sexual prowess. Because of this, some men might find it difficult to ask questions or raise concerns about sex. They tend to worry a great deal about “size” and “performance.” Potency has nothing to do with the length or width of the penis, nor does size have anything to do with sexual performance. In the flaccid state, penises do vary in size, but when erect these variations become less noticeable.

  • Impotence:  Men sometimes experience situations in which they expect to have an erection but don’t. This temporary form of impotence is usually associated with fatigue, nervousness or large amounts of alcohol and/or other drugs. In young men, the problem is most often performance anxiety – if you worry too much about not having an erection, you probably won’t wind up having one. The ability to have a nocturnal erection (awakening with a stiff penis) is usually an indication that there is not a physical cause for the impotence. The man might find that talking with his partner about his anxiety improves the situation. If the condition occurs frequently, he might want to see a clinician to rule out a medical problem.

  • Unintended Ejaculation:  Unintended or premature ejaculation simply refers to the experience of ejaculating without wanting to. In heterosexual intercourse, men usually become sexually excited and reach orgasm faster than women. This lack of synchronization can cause frustration between partners. Sometimes, especially with a new partner, a man might ejaculate “too soon,” often before the other person has reached orgasm. If sexual activity stops at this point, it is best for the man to be up front about the problem with his partner. Trying to delay its existence or becoming embarrassed will probably lead to further misunderstanding and may contribute to a recurrence of the problem. On the other hand, talking about it often leads to a solution, possibly based on a change of position or foreplay. Solving the problem together usually increases the comfort level and thus the intimacy. If unintended ejaculation continues, partners can easily be taught techniques to improve ejaculatory control.

  • Blue Balls:  Prolonged sexual excitement without ejaculation can sometimes cause a cramping feeling in the testicles and/or urinary tract, commonly known as “blue balls.” One of the oldest lines men have used with their partners after heavy or prolonged foreplay is that they will incur pain or even bodily harm if unable to ejaculate. Although this condition can be indeed uncomfortable, it is short-lived and physically harmless. It provides no rationale for pressuring a woman to have sexual intercourse. Masturbation can relieve the cramping and tightness in the testicles.

Female Problems with Sexual Functioning

Male sexual dysfunction often receives more attention than female anorgasmia (the inability to have an orgasm). In heterosexual relationships, men are typically perceived as the partner who must “perform.” But women may also have problems preventing them from fully enjoying intercourse. When both partners are conscious of each other’s emotional and physical feelings, sexual intimacy – whether it takes the form of sexual intercourse or other activities – may be a more pleasurable experience for each.

  • Dyspareunia:  Women may experience uncomfortable or painful intercourse, known as dyspareunia, for a variety of physical reasons. The first few times a woman has intercourse, she might feel pain due to an unstretched hymen or to anxiety. Waiting until she is aroused and helping her relax might help reduce this discomfort. A lack of readiness or arousal can interfere with vaginal lubrication, which is needed to facilitate penetration. A spermicidal or water-based lubricant is the best method for adding moisture to the vagina, particularly if you are using condoms. Avoid oil-based lubricants with condoms because they will break down the latex and make the condom ineffective as protection against STIs or pregnancy. Women can also develop reactions to contraceptive products, lubricants or other feminine hygiene products. Vaginal infections or irritations might make vaginal penetration uncomfortable; and penetration itself sometimes might actually contribute to an infection. If any pain during intercourse persists, the woman should see her clinician.


  • Vaginismus:  Strong involuntary contraction of the vaginal muscles, specifically of the outer third of the vagina, may make penetration sharply painful. This spasm of the vagina muscles, known as vaginismus, may be an unconscious defense against an uncomfortable sexual situation. Previous unwanted sexual experiences, including rape, may also result in vaginismus. Health care professionals or psychotherapists may be able to suggest self-treatment techniques to help alleviate painful penetration.

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Sexually Transmitted Infection (STIs):

The term “sexually-transmitted infection” (STI) has replaced the term “venereal disease.” This shift in terminology serves to expand awareness of a greater number of infectious diseases transmitted through sexual contact. There are more than twenty STIs, including HIV, chlamydia, herpes and other organisms and syndromes. Every year millions of STIs are passed from person to person, primarily through sexual contact. Many STIs can be treated, if not cured.

  • STI Transmission

The organisms that cause these diseases usually enter the body through mucous membranes, such as the warm, moist surfaces of the vagina, urethra, anus, and mouth. STIs can be transmitted through intimate contact with someone who is infected, especially during oral, anal, or genital sex. Sexually active college-aged women and men are at the highest risk for contracting STIs. 

  • STI Protection

You can protect yourself from acquiring an STI in a number of ways:
Talk to your partner about STIs before having sex, and ask if she/he has any signs or symptoms of infection.
Look carefully at your partner’s body. If you notice any unusual discharge, sores, bumps or redness and think your partner may have an infection, you should refrain from intercourse until he/she is evaluated and treated.
Use a dental dam or condom, cut length-wise, during vaginal oral sex (cunnilingus) or a latex condom during the penile oral sex (fellatio).
Use a latex condom with spermicidal lubrication during intercourse. Consider using vaginal spermicidal jelly as well. Spermicides containing nonoxynol-9 provide some protection against some STIs.
Also, please remember that condoms are not foolproof, but they are the best choice for infection protection during intercourse.

  • If You Think You Have an STI

First of all, don’t be embarrassed. If you think you have an STI, call the Health Center for an appointment. In most cases, antibiotics can cure bacterial STIs. Antibiotics are not effective, however, in fighting viral infections like HIV, herpes, and genital warts. If you have an STI, your partner should also seek care and oral/genital/anal intercourse should be avoided until treatment is complete for you and your partner.

  • HIV and AIDS

The Human Immune Deficiency Virus (HIV) causes a breakdown in the body’s immune system, which leaves a person incapable of fighting infection and disease. AIDS, or Acquired Immune Deficiency Syndrome, is the final stage of a progressive illness caused by HIV. Having HIV does not necessarily mean one has AIDS; a person can be a carrier of the virus and not manifest AIDS symptoms, but only HIV-infected people can develop AIDS. It may also take many months or years for a person to develop AIDS after becoming infected with the virus.

  • HIV Transmission

Anyone, any age, male or female, who engages in unprotected sex, shares needles, or receives blood from someone infected with HIV is at risk. The virus that causes AIDS is transmitted through the exchange of bodily fluids, especially blood, semen and vaginal secretions. The virus enters the body through mucous membranes, open cut or sore, or can be injected directly into the bloodstream. HIV can be transmitted between sexual partners during anal, oral or vaginal sex; through the sharing of contaminated needles; or from mother to child during pregnancy, birth or breast-feeding.

  • Symptoms and Diagnosis of HIV

Most people infected with HIV show no symptoms for months or years after becoming infected. When they do exhibit symptoms, their illness can be confused with a flu-like virus. Often all they experience initially is nausea, diarrhea, and fatigue. Some may also have weight loss and/or fatigue; swollen glands; fever, shaking or chills lasting more than several weeks; blurred vision; severe headaches; easy bruising; and pink to purple blotches, flat or raised and usually painless, found beneath the skin or mucous membranes such as the nose, mouth, eyes or rectum. As AIDS progresses, people might develop opportunistic infections (the most common of which is Pneumocystis carinii pneumonia [PCP] – a lung infection), indicating a compromised immune system. Once these symptoms appear, a health care professional might suspect and diagnose AIDS. Though it can be a life-threatening illness, there are many new medications that can significantly extend the lives of people with AIDS.
At present, the best way to determine if you have been exposed to HIV is to have an HIV antibody test. This is NOT a test for AIDS, however. It simply tests for the presence of antibodies (substances produced in the blood to fight invading organisms) to HIV. A substantiated positive test indicates that a person had been exposed to the HIV virus.

For a conclusive result to be obtained, testing for HIV must take place six months after a possible exposure. Individual circumstances sometimes dictate that a test be done as early as three months after a possible exposure; in the case of a negative result at three months, re-testing might be necessary. If you think you might have been exposed to the virus, you should abstain from any activities in which you could expose someone else. It is especially important to avoid donating blood during this time. Although all donated blood is now screened for HIV and other blood-borne viruses, there is still a small chance of a donor infecting the blood supply during the window period, the time between exposure and six months later. Furthermore, donating blood is not the way to find out if you are infected with HIV. Other safer and more reliable means are available and should be used.

The Trinity College Health Center performs both confidential and anonymous HIV testing.  Below is a list of other agencies that also do this testing:

AIDS Ministries Program of Connecticut 525-5955
Community Health Services 249- 9625
Hartford Hospital 545-5398
Planned Parenthood 953-620


Because HIV is spreading at an alarming rate and no cure has been found, prevention is crucial. If you do not have anal, oral or vaginal intercourse and never share needles, you have almost no risk of becoming infected with HIV. But it is possible to be sexually active and remain healthy. Safer sex practices can reduce your risk of HIV infection:

  • Reduce your number of sexual partners. Remember, in terms of your risk for contracting HIV, when you have sexual intercourse with a person, consider yourself to be having intercourse with every other partner she/he has had before you.

  • Avoid the exchange of bodily fluids. Use latex condoms and dental dams correctly during all types of intercourse.

  • Ask about the health status of your partners. It is possible to overcome shyness, but it may well not be possible to overcome AIDS.

  • Avoid sexual contact when under the influence of alcohol and/or other drugs


Chlamydia is the most prevalent STI in the United States, particularly among people in the their late teens and early twenties. It can coexist with gonorrhea and other STIs. Approximately 20% of college students are infected with chlamydia. The infection is most commonly transmitted through sexual intercourse. Infants can also be infected while passing through the birth canal of an infected mother. Left untreated, chlamydia can cause Pelvic Inflammatory Disease (PID) in women and can cause scarring of the internal reproductive organs and subsequent sterility in both males and females. There is also an increased risk of ectopic pregnancy (a pregnancy in one of the fallopian tubes) associated with untreated chlamydia.
People with chlamydia do not necessarily know that they are infected. Sixty to eighty percent of women and ten percent of men who have chlamydia exhibit no symptoms. In women, symptoms, when present, include genital itching and burning, vaginal discharge, dull pelvic pain, bleeding between periods and cervical inflammation. In men, symptoms include mucus discharge from the penis (gradual onset five to twenty-one days after exposure) and painful urination. Again, these symptoms may be so mild as to go unnoticed. Treatment with an antibiotic is usually successful. To diagnose chlamydia, a small Q-tip is used to culture the mucus or discharge from the cervix or penis.


Gonorrhea is another bacterial infection that can be cured with antibiotics. It is spread through vaginal, anal, or oral-genital contact with an infected person. Like chlamydia, if untreated, gonorrhea can cause Pelvic Inflammatory Disease (PID) in women and sterility in both sexes. Though frequently asymptomatic, it can cause a vaginal or penile discharge and painful urination two days to two weeks after exposure.
Gonorrhea is diagnosed by taking a culture of the cervical or penile discharge. If you have had oral and/or anal sexual intercourse with an infected partner, a culture of these areas might be taken as well. Avoid oral-genital contact until the antibiotic treatment is completed for you and your partner. Continue to practice safer sex with a condom.


Although almost completely eradicated at present, syphilis is still an important STI to be aware of because it has serious long-term consequences if untreated. It is spread by contact with a syphilitic sore, sexually or otherwise. Because the disease can be killed with soap and water when it is present on the skin alone, it is a good idea to wash the genital area after sex.
A chancre -- a painless, rounded, ulcerated sore -- is the first sign of syphilis. This skin lesion appears, usually in the genital area, between nine and ninety days after transmission, and heals spontaneously in 3 to 6 weeks.

The second stage of syphilis presents with a whole-body rash, including the palms and the soles. This rash spontaneously heals and the patient becomes symptom-free, though not disease-free, once again.

The third stage of syphilis is serious and systemic, as the disease becomes more invasive, leading to insanity, blindness, paralysis and even death. Syphilis has been dubbed “the Great Imitator” because it mimics many other diseases, and is therefore frequently difficult to diagnose. You should be tested for syphilis, along with other STIs, if you have had unprotected sex. Penicillin and similar antibiotics can cure the disease.


Trichomonas vaginalis, a flagellated protozoon, causes the sexually-transmitted infection commonly called “trich” (pronounced “trick”). Women may be markedly symptomatic with a foamy, malodorous yellow-green vaginal discharge, along with a burning sensation, itching, redness and swelling. Or they may be asymptomatic. Men are usually asymptomatic carriers of the infection. It is treated with an antibiotic called metronidazole, which can be given in a single or 7-day dosing regimen. Vomiting and flushing can occur with the use of alcohol when taking this medication so complete abstention is important during and a few days after treatment. Both partners should be treated concurrently to avoid re-infection.

Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease is a general term for an infection anywhere in the female pelvic organs, including the lower abdomen. The condition starts as a cervical infection and spreads upward into the uterus, fallopian tubes, and ovaries and into the abdominal cavity. Two common STIs, chlamydia and gonorrhea, cause most PID found in college-aged women. Minor symptoms might be a slight fever and aching in the lower abdomen, and more serious symptoms might include high fever and intense pelvic pain resembling appendicitis. It is important to see a clinician immediately because the infection and complications can be life threatening, and because scarring and blockage of the fallopian tubes can cause infertility. PID is now the leading cause of infertility in young women.

Genital Warts (Human Papilloma Virus)

Human Papilloma Virus (HPV) causes lesions in the genital area similar to common skin warts found elsewhere on the body. In women, these warts can be anywhere on the vulva, inside the vagina, or on the cervix. In men, warts usually appear on the scrotum or the head (glans) or shaft of the penis. Warts may also appear around the anus if you have had anal intercourse with an infected partner. Though HPV cannot be cured, the lesions can be removed with the weekly application of weak acid or liquid nitrogen until the warts are resolved. Numerous applications may be necessary. You can still infect a partner with HPV even if there are no visible lesions.

There is a relationship between HPV and pre-cancerous cells on the cervix, particularly among women who smoke cigarettes. Therefore, it is especially important to have annual pap smears.


“Herpes” comes from the Greek word meaning “to creep.” In keeping with its name, the Herpes Simplex Virus (HSV) enters the body through the skin and mucous membranes of the mouth and genitals, and then travels along the nerve endings to the base of the spine. There are two types of Herpes Simplex Virus. Type I is characterized by cold sores or fever blisters on the lips, face, and mouth. Type II usually causes genital sores. While Type I is usually found above the waist and Type II below, there can be some crossover, primarily from oral-genital sex. Most people contract Type II HSV from genital skin-to-skin contact with an infected partner.
Herpes cannot be cured. Medications are available by prescription at the Health Center, however, that can reduce the pain of the blisters and the duration of an outbreak.

Where Else Can Help Be Found For Herpes Simplex Virus?

Here are several sources of info concerning herpes:

The American Social Health Association (ASHA), Herpes Resource Center, PO Box 13827, Research Triangle Park, NC 27709.
For the National Herpes Hotline call (919) 361-8488 to speak to a counselor and call 800-230-6039 to order information.
The Internet address is


 The organization provides up-to-date practical information and publishes a newsletter.  
National Women's Health Network
514 10th St. NW, Suite 400
Washington, DC 20004
Call (202) 347-1140.
Centers for Disease Control and Prevention
1600 Clifton Road, NE
Atlanta, GA 30333
Call (404 639-2709)
On the Internet


Internet Resources for Herpes Information

Original Herpes Home Page:


British Herpes Management Forum:


Lists foods high in lysine and low in arginine:


Hepatitis B

Hepatitis B is a virus that can cause liver inflammation, which can be either mild and transient or chronic and debilitating. Although not commonly thought of as an STD, this potentially fatal disease can be spread sexually through bodily fluids or blood (more commonly through needle-sharing). Symptoms, occurring one to six months after exposure, include fatigue, loss of appetite, nausea, vomiting, diarrhea, tenderness in the upper right abdomen, low-grade fever, sore muscles and joints, and an altered sense of taste and smell, malaise and jaundice. Because there is no current cure for hepatitis B, vaccination against it provides the best protection. The Health Center offers the three-shot series of the vaccine.

Pediculosis (Pubic Lice or Crabs) and Scabies

Crabs is caused by small, grayish-white lice that infest the pubic and axillary hair. Their eggs, resembling specks of thick paste, may be seen attached to the base of individual hairs. Itching of the pubic area is the main symptom of pediculosis, but because this is probably an allergic skin reaction to the louse, itching might not always occur in every individual.
Tiny mites, at most half a millimeter in length, making them very difficult to see, cause scabies. A clinician can, however, reliably diagnose this problem by examining typical areas of infestation, such as the areas between the fingers and toes, the wrists, elbows, armpits, buttocks, breasts, and genitals. Small red bumps or tiny lines (burrows) may appear.

Treatment is by commercially available lotions like ELIMITE, Nix, or Kwell, which are applied following a bath or shower. It is usually necessary to use a nit comb to comb out and remove the lice eggs. To avoid re-infestation, all clothing and bedding should be washed in very hot water or dry-cleaned and all sexual partners should be treated.

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Non-Sexually Transmitted Diseases:



Yeast Infections

Yeast, or Candida albicans, is always present in the vagina. Normally, it doesn’t cause any problems because the vagina’s normal secretions inhibit its overgrowth. But under certain conditions -- such as pregnancy, menstruation, diabetes, or when you begin taking antibiotics or birth control pills -- the pH of the vaginal secretions can change. This shift can create an environment more conducive to yeast, causing its over-growth. It is possible to contract the fungus through sexual intercourse, but it is not usually a sexually-transmitted infection.
When a woman has a yeast infection, her discharge might become thick and white, resembling cottage cheese. It might even smell “yeasty.” Typically, intense vaginal itching, burning and discomfort, particularly with intercourse or with urine running over the labia (vaginal lips), will accompany the discharge.

Such symptoms usually warrant a pelvic exam because other vaginal discharges can mimic a yeast infection; it is important to determine the particular organism and provide specific treatment. Anti-fungal vaginal cream or suppositories, such as the two over-the-counter medications Gyne-Lotrimin and Monistat, will usually relieve the symptoms in 3 to 5 days. Self-medication, if done at all, is only for those women who have been diagnosed previously for a yeast infection by a clinician and are certain they are having a recurrence.

Bacterial Vaginosis

Formerly considered a sexually-transmitted infection, bacterial vaginosis (BV) is now known to result from a disruption in the pH of the vagina, where the environment becomes more alkaline, allowing for the overgrowth of bacteria. Women typically experience a milky white, fishy-smelling vaginal discharge. Treatment is with metronidazole, either orally or vaginally. Partners do not need to be treated.



Urinary Tract Infections (UTIs)

Cystitis and urethritis are infections, usually bacterial, of the urinary tract that cause frequent and painful urination, lower abdominal pain, and/or pain during intercourse. UTIs primarily affect women because the female urethra (the transport tube from the bladder to the opening in the genital area) is relatively short; bacteria do not have as far to travel as in the longer male urethra. Nonetheless, men can also get UTIs.

Some UTIs are sexually transmitted in that they are caused by vigorous or repeated intercourse. Simple hygiene rules can minimize the risk of infection. It is good practice to wipe from front to back after defecation, which will reduce the chance of bacteria from the anal area getting into the vagina or the urethra. Urinate when feeling the urge rather than waiting for a long time; urinate immediately after intercourse; and drink fluids to keep the urine diluted and the urinary tract flushed.

UTIs are usually treated with sulfa drugs or other antibiotics. Treatment often brings relief within 48 hours. You should avoid intercourse until after your urinary symptoms are completely gone.

Non-Gonococcal Urethritis (NGU)

Non-gonococcal urethritis is the inflammation of the male urethra (the tube through which urine passes) caused by organisms other than gonorrhea. It is similar to a urinary tract infection, with painful urination and can be treated with antibiotics.

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Contraceptive Methods, Pregnancy Prevention, & STD Prevention:



Deciding on a method of Contraception

Because no form of contraception, except for total abstinence, is 100% effective at preventing pregnancy and infection, you need to understand the advantages and disadvantages of the various forms and find what works for you and your sexual relationship. People engaging in vaginal intercourse will likely choose to try to combine both contraception (birth control) and STI/HIV prevention. When performing oral or anal sex, the primary concern will be the STI/HIV protection. There are a number of questions that should be considered when making a decision about a particular method or combination of methods:
Is this method right for me?
Am I comfortable with my ability to use it correctly?
Does this method protect against STD/HIV transmission?
How much can I afford to spend?
Will I feel shy or embarrassed about using this method?
Am I comfortable touching my body in the way the use of this method requires?
Is this a first or new relationship?
Do I plan to have more than one sexual relationship at a time?

The bottom line is that the “best” method is the one that you will use correctly and consistently. The effectiveness rates below are based on the first year an average couple uses a particular contraceptive method. The rates take into account user error and motivation.

Method  Highest Expected
Typical User 
Abstinence  100%   
Norplant  99.9%  99.9% 
Depo-Provera  99.7%  99.7% 
Oral Contraceptives  99.9%  97% 
Condom and Spermicide  99%  95% 
Condom  98%  88% 
Spermicide  97%  79% 
Diaphragm  96%  82% 


Choosing a method for contraception and/or STI prevention at a particular time does not mean it becomes a permanent method for the duration of your sexual life. The method that is right for a person at any given point in her or his life may evolve along with a changing body, personal preferences, relationships and reproductive technology.


Abstinence ranks among the cheapest forms of contraception and has been utilized for thousands of years.
Abstinence, when used as a form of birth control, means abstaining from vaginal intercourse, but not necessarily abstaining from other behaviors which would put him/her at risk for HIV and other STDs. “Outercourse,” intimate sexual activity without actual intercourse, can provide great fulfillment. Non-coital forms of intimacy can range from holding hands, hugging, kissing and dancing to mutual masturbation, petting, oral-genital sex and the use of stimulating devices like vibrators.

  • Advantages
    Very low risk of pregnancy
    Reduced risk of STD
    No cost

  • Disadvantages:
    May be difficult to sustain


Norplant is one of the newest and statistically most effective methods of birth control available to women today. Six matchstick-sized implants are inserted in the skin of a woman’s inner arm under a local anesthetic. These sticks release a continuous low dosage of the synthetic form of the hormone progestin, which inhibits ovulation and also thickens the cervical mucous, making it difficult for the sperm to travel. Norplant is effective for five years but may be removed earlier if the woman desires.

  • Advantages:
    Norplant does not involve any interruption between foreplay and intercourse.
    Effectiveness rates are statistically higher than those are for female sterilization.
    Unlike oral contraceptives, you do not need to remember to take a pill every day.

  • Disadvantages:
    Norplant does not protect against STIs.
    Menstrual irregularities such as vaginal spotting between periods and skipped periods can occur.
    Implants are expensive. There is no refund if a woman decides to have Norplant removed early.
    Implants can be slightly visible.
    Implants must be inserted and removed by a clinician.
    Removal of implants can be difficult and may cause minor scarring.


Depo-Provera is an intra-muscular injection of the hormone progestin, which must be given once every 13 weeks. Like Norplant and the “pill,” Depo-Provera prevents ovulation. It also changes the consistency of the cervical mucus, thereby reducing the sperm’s ability to enter the uterus.
The first injection or “shot” of Depo-Provera must be given within five days of the beginning of a menstrual period, unless the woman has been using the “pill” consistently or an IUD. Depo-Provera begins to give protection against pregnancy within 24 hours after the first injection. The drug slowly wears off over time, and one cannot count on being protected from pregnancy after the twelve-week mark.

  • Advantages:
    No need to remember to take a pill each day.
    Highly effective.
    No interruption between foreplay and intercourse.
    Some women consider it an advantage that Depo-Provera may eliminate monthly menstrual periods.

  • Disadvantages:
    Depo-provera does not protect against STIs.
    Possible side effects include menstrual changes, pregnancy symptoms, weight changes and mental depression.
    Once Depo-Provera is injected, it cannot be neutralized or reversed should side effects be experienced. Side effects may last until the shot wears off.
    Return to fertility may be delayed up to 6 or 12 months after the last injection. 

    Oral Contraception (OC)

OC works to prevent the release of the egg from the ovary. It usually contains the synthetic forms of both hormones estrogen and progestin. For it to be effective, a woman must take a birth control pill each day at approximately the same time. Oral contraceptives are available by prescription at the Health Center.
OC is not recommended for women who have a history of high blood pressure or heart disease, blood clots in the legs or lungs, angina pectoris, tumors in the breast or sex organs or any unusual vaginal bleeding.

  • Advantages:
    OC is one of the most effective methods of pregnancy prevention.
    Many women prefer this method because they find it convenient and relatively problem free.
    It requires no pause between foreplay and intercourse.
    Physical benefits of using oral contraception may include a more regular menstrual cycle, decreased menstrual flow and decreased cramping.
    Some studies have associated the use of oral contraception with reduced risk of benign breast disease, ovarian cysts, ovarian cancer, Pelvic Inflammatory Disease, endometriosis, cancer of the endometrium, and iron deficiency anemia.

  • Disadvantages:
    OC does not protect against STIs.
    Use of OC involves changing body chemistry through the addition of synthetic hormones, something to which some women may object.
    There may be a reduction in blood levels of folic acid and Vitamins B6, B12, and C, so OC users should eat more foods containing these vitamins or take dietary supplements.
    Some women on OC may experience side effects including weight gain or loss, bloating, nausea, vomiting, breast tenderness or enlargement, headaches, moodiness or depression, yeast infections, spotting between periods, improvement or worsening of acne and increased or decreased sex drive. These problems are usually not dangerous and vary from woman to woman. They may subside after two or three cycles on OC.
    There are several serious but rare side effects associated with OC including circulatory disorders (abnormal blood clotting, heart disease, and stroke), formation of tumors and gall bladder disease. The chance of circulatory problems is greater in women who smoke or are over the age of 35.

If You Miss a Birth Control Pill

If a woman forgets to take an OC pill at the usual time one day, she should take the missed pill as soon as she remembers and next pill at the usual time. If she forgets for two days in a row, she should take two the day she remembers and two the next day. If one missed pill is taken more than twelve hours late at any point during the cycle, another form of contraception must be used or intercourse avoided for the remainder of the cycle. Back-up contraception must be used even if your period occurs or a new pill pack is started. If three or more consecutive pills are missed, the remainder of the packet for that cycle should be thrown away and a new packet started after the menstrual period. Another form of contraception must be used through the first two weeks of the next packet. Vaginal spotting is likely to occur if you miss any pills.




(Prophylactics or Rubbers), Dental Dams, and Vaginal Spermicides
A condom is a sheath or “skin” of latex or polyurethane that fits over the erect penis. It prevents the escape of ejaculated semen during vaginal, oral, or anal intercourse or manual play. Condoms are available in various shapes, colors and flavors. Some people may opt for specialty condoms that have ribs or bumps. Non-lubricated or flavored condoms can and should be used during oral sex to protect against STIs.



How to Use a Condom

1. When used in vaginal intercourse, a condom should be used in conjunction with another method of contraception to assure maximum protection against pregnancy. Options include spermicidal foam, cream, jelly, the diaphragm, and the pill

2. Be sure to put the condom on the erect penis before it comes in contact with any mucous membranes or genitalia.

3. Unroll the condom approximately one half inch, then place the open end over the erect penis. This extra half-inch should hang loosely past the head of the penis to catch the semen. Many condoms also have reservoir tips that serve the same purpose. Squeeze the end to make sure no air is trapped inside. The condom should then be unrolled down to the base of the penis. When unrolling the condom, be careful not to puncture or tear it with your fingernails.

4. After ejaculation, the penis should be withdrawn before erection subsides. When withdrawing, a man should be careful to hold onto the rim at the base of the condom to prevent spilling. Should the condom tear or come off during vaginal intercourse, you should immediately insert a spermicidal foam, gel, or cream into the vagina, and the female partner should come to the Health Center to discuss Emergency Contraception (the “morning-after” pill).

Condom Care

Condoms come with expiration dates and must be kept away from heat. Condoms that are still “good” should have an air bubble in the package. If either the package or the condom is flat, cracked, or looks dried, the condom should not be used.

A condom should be used only once and then it should be discarded.

A non-petroleum-based lubricant, like K-Y Jelly, should be used with condoms. Vaseline, or any other products containing petroleum jelly, will weaken the condom.

For highest effectiveness, condoms should always be used with a vaginal spermicide, such as creams, jellies, suppositories and foam – all of which block the cervix and kill sperm. Nonoxynol-9 is the active ingredient in almost all spermicides. Effectiveness varies greatly. Vaginal contraceptives are most effective when used in conjunction with some form of barrier method, like a condom, and should never be used alone.

  • Advantages: Condoms, along with dental dams, provide the best protection, short of abstinence, against STIs, including HIV.
    They are highly effective contraception when used with another form of birth control.
    They have little health risk. Some people may have an allergic reaction to the latex or lubricant of a certain condom brand, but this problem can usually be resolved by trying a different brand.
    They are easily accessible and available free of charge from the Health Center.

  • Disadvantages: Some couples consider it a disadvantage that a condom must be put on prior to intercourse, thus interrupting foreplay. Others, however, integrate condom application into their foreplay.
    Some men find that a condom dulls sensation, but this can often be remedied by adding a drop of K-Y Jelly or another lubricant to the inside of the condom.
    Some men may find a particular brand of condom too tight or too loose. They may need to try several different kinds of condoms to find one they like.

Dental Dam

Like a condom, a dental dam is made of thin latex. It is used to prevent the transmission of STIs during cunnilingus (oral sex on women). When used, this small rectangular piece of latex is stretched across a woman’s vaginal opening and labia to prevent the exchange of bodily fluids. The dental dam itself is not lubricated, but using a water-based lubricant on the vaginal side of the dam may help keep it in place and increase feeling.




A diaphragm is a dome-shaped rubber cup with a firm flexible metal band or spring rim. For use, the diaphragm is coated with a spermicidal cream or jelly and inserted into the vagina. The latex dome covers the cervix and holds the cream or jelly inside, directly against the cervix. The pubic bone helps hold the diaphragm in place. The diaphragm itself does not create a tight seal against the vagina. Sperm can swim around the rim of the diaphragm to the cervix. The spermicidal jelly will immobilize and kill these sperm before they enter the cervical canal.
Since the width of the vagina varies with the woman, the diaphragm must be fitted by a clinician. The object is to select the largest one comfortable for the woman, thus insuring that the diaphragm stays in place during sexual intercourse. The clinicians at the Health Center are available to discuss and prescribe this option.

  • Advantages:
    A diaphragm does not cause any physical, chemical or hormonal changes in the woman’s body, and there are no serious side effects directly related to its use.
    A diaphragm is used only when needed.
    Contraceptive jellies and creams made with Nonoxynol-9 may decrease the risk of contracting HIV.
    With proper care, a diaphragm will last several years.
    A diaphragm cannot be felt during intercourse.

  • Disadvantages:
    A diaphragm may be embarrassing or inconvenient for either partner to use because it requires thought and action before each act of intercourse.
    A diaphragm may slip out of place due to improper insertion.
    Some people may have allergic reactions to the rubber or spermicides.
    A diaphragm may exert pressure on the urethra or bladder, causing some diaphragm users to develop recurrent urinary tract infections. Using a different type or size may alleviate this problem.
    Vaginal infections may result if the diaphragm is not properly cleaned and dried between uses or if it is left in the vagina for too long.
    There is an increased risk for Toxic Shock Syndrome.
    A woman may have trouble inserting or removing the diaphragm correctly on any given occasion, necessitating the use of an alternate method.

Female Condom

Also known as the vaginal pouch, the female condom is a disposable sheath designed to protect a woman from pregnancy and STIs by lining and covering the vagina. The man’s penis must be guided into the sheath. After intercourse, the man may stay in the woman; unlike with traditional condoms, there is no need for immediate withdrawal.

  • Advantages:
    This method allows a woman to protect herself from STIs as well as pregnancy.
    The vaginal pouch does not require the male to be fully erect; therefore, it can be inserted well before penetration is desired.
    There is no need for withdrawal immediately following a male orgasm.

  • Disadvantages:
    Some women complain that the sheath moves or is uncomfortable.


Creams and Jellies


Spermicidal creams and jellies should be used with another method of birth control (e.g., condoms or a diaphragm). With a condom, spermicidal cream or jelly increases contraceptive protection. It is also useful as a lubricant, helping to reduce the chances of condom breakage. With a diaphragm, the spermicidal cream or jelly is essential in creating a protective seal around the cervix. In addition, the spermicide will help trap and immobilize any sperm that make it past that seal.


A small, film-like square of spermicide, vaginal film is placed on the fingertip and inserted against the cervix at least fifteen minutes prior to intercourse. It is effective for one hour.



Foam is the most effective spermicide. While lying down, the woman inserts an applicator full of foam into the vagina. With the applicator tip approximately half an inch from the cervix, the plunger should be pressed to dispense the foam. Care should be taken not to draw back on the plunger while removing the applicator. Additional applications must be made before each new act of intercourse.


Vaginal Suppositories 

Suppositories are small, solid spermicidal pellets that are inserted into the vagina at least twenty minutes prior to intercourse. During that twenty-minute interval, the suppository melts and covers the cervix with a spermicidal film. Because this birth control method relies on a particular timing of events, spermicidal suppositories are not convenient for some couples.


Cervical Cap

The cervical cap works in much the same way as the diaphragm and has similar effectiveness rates. A small latex cap is inserted by the woman before intercourse and fits over the cervix, serving as a barrier to semen. Spermicide inside the cap is held against the cervix and can destroy any sperm that make it pass the barrier.


Fertility Awareness

Fertility Awareness methods of birth control are not recommended for college-aged women because they require a relatively stable ovulation cycle. Because stress, illness and exercise easily effect ovulation, college-aged women are not likely to have stable cycles.
Fertility awareness hinges on the identification of a woman’s fertile and infertile days. Most important, a woman must determine when she ovulates. Usually, a woman will work with a clinician to accurately determine her cycle by charting her body temperature and mucous discharge. It is important that consistent and accurate records are kept and that thorough initial instruction is received.

Almost every religious group accepts these methods. They are relatively inexpensive and require no medication. Fertility awareness can be discontinued easily and can be used to plan a pregnancy.

Keeping precise records requires a high level of motivation. Abstaining from intercourse on fertile days can be frustrating for some couples. Finally, women with irregular periods or whose emotional or physical habits might alter hormonal changes may have difficulty predicting ovulation.

Intrauterine Device (IUD)

The IUD is a small device that is placed inside the uterus to prevent pregnancy. Currently, only two IUDs are on the market: the Progestasert, which must be replaced yearly; and Paraguard-T-380A, which is approved for 8 years of use.

The exact way the IUD functions to prevent pregnancy is not fully understood. It appears to interfere with the implantation of a fertilized egg. Infection fighting white blood cells gather in the lining of the uterus and disrupt the normal structure of the uterine lining. The Progestasert IUD further improves its effectiveness by releasing into the uterus the hormone progesterone, which causes the uterine lining to be thinner and thus less hospitable for implantation.

Because an IUD can make an existing vaginal infection worse or cause pelvic inflammatory disease (PID), it is recommended only for women who are at very low risk for STIs, such as being in a mutually monogamous relationship. Also, IUDs are easier to insert in women who have either experienced childbirth or have had an abortion because the cervical opening has been previously dilated during these events.

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Emergency Contraception:


Coitus Interruptus (Withdrawal)

Coitus interruptus, also known as “withdrawal,” has long been used as a contraceptive technique. Using this non-method, a couple may have intercourse until ejaculation seems imminent. At that point, the male withdraws his penis and ejaculates away from his partner’s genitalia.

There are many disadvantages associated with “withdrawal.” The male may fail to withdraw or may not withdraw fast enough. Even if he successful, preliminary ejaculatory fluid released before ejaculation can carry enough sperm to result in pregnancy.


Emergency Contraception (“The Morning-After” Pill)
Up to 72 hours after unprotected intercourse, you may choose to take Emergency Contraception (EC). This treatment consists of two pills, one taken initially and one more taken twelve hours after the first dose. Each of the pills contains an identical high dosage of the synthetic hormone progesterone. It is believed that the pills prevent ovulation or implantation of a fertilized egg into the uterus. Some women may experience headache, nausea, or vaginal spotting, though most experience very few side effects with this medication.

EC is 89% effective if taken within the first 72 hours following unprotected intercourse. If pregnancy does occur, the hormones may pose some slight risk to the developing fetus, though no birth defects have been linked to EC. If a woman is already pregnant when she takes EC, it will not induce an abortion.

“The Morning-After Pill” is a form of emergency contraception. Sexually-active individuals should use other, more reliable methods of birth control to ensure adequate contraception.

Emergency Contraception is available at the Health Center. If the Health Center is closed, EC can be obtained by calling 888-NOT-2-LATE.

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Vegetarianism in a Nutshell

Vegetarian diets can be healthful and meet all your nutritional needs. However, proper planning and correct nutritional advice is the key factor. The Vegi diet needs to include fruits, vegetables (plenty of leafy greens), whole-grain products, nuts, seeds, and legumes on a daily basis and in the correct amounts.

There are different types of vegetarian diets:

  • Vegan – excludes all animal products, including meat, fish, poultry, milk, cheese, eggs and other dairy products. Many vegans do not eat honey.

  • Lactovegetarian – excludes meat, poultry, fish and eggs, but includes dairy products.

  • Lacto-ovo vegetarian – excludes meat, poultry and fish, but includes dairy products.



Making The Change To a Vegetarian Diet . . .

Meat, fish, and poultry contain high amounts of protein, iron, and vitamin B12. Dairy products are abundant in calcium, vitamin D and protein. If these foods are to be eliminated from the diet, it is important to get the correct amounts from other food sources in order to meet your needs.

  • Sources Of Protein (2-3 servings/day)
    Legumes, nuts, seeds, peanut butter, tofu, tempeh, soy products, hummus and low-fat dairy products are all excellent sources.

  • Sources Of Iron (2 or more/day)
    Dried beans, leafy dark green vegetables, dried fruits, (i.e., raisins, figs, prunes), iron-fortified cereals, blackstrap molasses, pumpkin seeds, sesame seeds, and soybean nuts.  For maximum absorption of iron, eat these products with foods high in vitamin C, such as citrus fruits or juices, broccoli, tomatoes, or green peppers!!

  • Sources Of Calcium (3-4 servings/day)
    Low-fat dairy products, collard greens, broccoli, kale, tofu prepared with calcium, calcium-fortified soy milk and orange juice.

  • Sources Of Vitamin B12
    A diet containing dairy products or eggs provides vitamin B12. Fortified foods, such as Grape Nuts cereal, some brands of nutritional yeast and soy milk, some soy analogs are all good sources of B12. If you are a vegan who does not consume these fortified foods regularly, you can take a non-animal derived vitamin supplement.

With the addition of plenty of fruits, vegetables and whole-grain products, your vegetarian diet should be nutritionally complete! You’re always welcome to talk with the Registered Dietician at the Trinity College Health Center to ensure you’re on the right track.

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Eating Disorders:



What are Eating Disorders?

Eating disorders -- such as anorexia, bulimia, and binge eating disorder -- include extreme emotions, attitudes, and behaviors surrounding weight and food issues. Eating Disorders are serious emotional and physical problems that can have life-threatening consequences for females and males.

Anorexia Nervosa

Anorexia Nervosa is characterized by self-starvation and excessive weight loss.  Symptoms include:

  • Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level

  • Intense fear of weight gain or being "fat"

  • Feeling "fat" or overweight despite dramatic weight loss

  • Loss of menstrual periods

  • Extreme concern with body weight and shape

Bulimia Nervosa

Bulimia Nervosa is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food--more than most people would eat in one meal--in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse, or over-exercising. Symptoms include:

Repeated episodes of bingeing and purging
Feeling out of control during a binge and eating beyond the point of comfortable fullness
Purging after a binge, (typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, or fasting)
Frequent dieting
Extreme concern with body weight and shape



Binge Eating Disorder (also known as Compulsive Overeating)

This is characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full. While there is no purging, there may be sporadic fasts or repetitive diets and often feelings of shame or self-hatred after a binge. People who overeat compulsively may struggle with anxiety, depression, and loneliness, which can contribute to their unhealthy episodes of binge eating. Body weight may vary from normal to mild, moderate, or severe obesity.

Other Eating Disorders

These can include some combination of the signs and symptoms of anorexia, bulimia, and/or binge eating disorder. While these behaviors may not be clinically considered a full syndrome eating disorder, they can still be physically dangerous and emotionally draining. All eating disorders require professional help.

What Causes An Eating Disorder?

Eating disorders are complex conditions that arise from a combination of long-standing behavioral, emotional, psychological, interpersonal, and social factors. Scientists and researchers are still learning about the underlying causes of these emotionally and physically damaging conditions. We do know, however, about some of the general issues that can contribute to the development of eating disorders.

While eating disorders may begin with preoccupations with food and weight, they are most often about much more than food. People with eating disorders often use food and the control of food in an attempt to compensate for feelings and emotions that may otherwise seem over-whelming. For some, dieting, bingeing, and purging may begin as a way to cope with painful emotions and to feel in control of one's life, but ultimately, these behaviors will damage a person's physical and emotional health, self-esteem, and sense of competence and control.

Psychological Factors that can Contribute to Eating Disorders:

  • Cultural pressures that glorify "thinness" and place value on obtaining the "perfect body"

  • Narrow definitions of beauty that include only women and men of specific body weights and shapes

  • Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths

 Interpersonal Factors that can Contribute to Eating Disorders:

  • Troubled family and personal relationships

  • Difficulty expressing emotions and feelings

  • History of being teased or ridiculed based on size or weight

  • History of physical or sexual abuse

Social Factors that can Contribute to Eating Disorders

  • Cultural pressures that glorify "thinness" and place value on obtaining the "perfect body"

  • Narrow definitions of beauty that include only women and men of specific body weights and shapes

  • Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths

Other Factors that can Contribute to Eating Disorders

Scientists are still researching possible biochemical or biological causes of eating disorders. In some individuals with eating disorders, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be imbalanced. The exact meaning and implications of these imbalances remains under investigation.
Eating disorders are complex conditions that can arise from a variety of potential causes. Once started, however, they can create a self-perpetuating cycle of physical and emotional destruction. All eating disorders require professional help.

Health Consequences of Eating Disorders

Eating disorders are serious, potentially life-threatening conditions that affect a person's emotional and physical health.

Eating disorders are not just a "fad" or a "phase." People do not just "catch" an eating disorder for a period of time. They are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships.

People struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery.

Health Consequences of Anorexia Nervosa

In anorexia nervosa's cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences:

Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower.
Reduction of bone density (osteoporosis), which results in dry, brittle bones.
Muscle loss and weakness.
Severe dehydration, which can result in kidney failure.
Fainting, fatigue, and overall weakness.
Dry hair and skin, hair loss is common.
Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

Health Consequences of Bulimia Nervosa

The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Some of the health consequences of bulimia nervosa include:

Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
Potential for gastric rupture during periods of bingeing.
Inflammation and possible rupture of the esophagus from frequent vomiting.
Tooth decay and staining from stomach acids released during frequent vomiting.
Chronic irregular bowel movements and constipation as a result of laxative abuse.
Peptic ulcers and pancreatitis.



Health Consequences of Binge Eating Disorder

Binge eating disorder often results in many of the same health risks associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:

High Blood Pressure
High cholesterol levels.
Heart disease as a result of elevated triglyceride levels.
Secondary diabetes.
Gallbladder disease.

How to Help a Friend with an Eating and Body Image Issue

Learn as much as you can about eating disorders. Read books, articles, and brochures.

Know the differences between facts and myths about weight, nutrition, and exercise. Knowing the facts will help you reason against any inaccurate ideas that your friend may be using as excuses to maintain her disordered eating patterns.

Be honest. Talk openly and honestly about your concerns with the person who is struggling with eating or body image problems. Avoiding it or ignoring it won't help!

Be caring, but be firm. Caring about your friend does not mean being manipulated by her. Your friend must be responsible for her actions and their consequences. Avoid making "rules," promises, or expectations that you cannot or will not uphold (For example, "I promise not to tell anyone." or, "If you do this one more time I'll never talk to you again.").

Tell someone. It may seem difficult to know when, if at all, to tell someone else about your concerns. Addressing body image or eating problems in their beginning stages probably offers your friend the best chance for working through these issues and becoming healthy again. Don't wait until the situation is so severe that your friend's life is in danger. If you have already spoken with your friend and still feel like more steps need to be taken to address these issues, consider telling her parents, a teacher, a doctor, a counselor, a nutritionist, or any trusted adult. She needs as much support and understanding as possible from the people in her life.

Remember: You cannot force someone to seek help, change their habits, or adjust their attitudes. You will make important progress in honestly sharing your concerns, providing support, and knowing where to go for more information! People struggling with anorexia, bulimia, or binge eating disorder do need professional help. There is help available, and there is hope!

What Should I Say? - Tips for Talking to a Friend Who May Be Struggling with an Eating Disorder

If you are reading this handout, then chances are, you are concerned about the eating habits, weight, or body image of someone you care about. We understand that this can be a very difficult and scary time for you. Let us assure you that you are doing a great thing by looking for more information!! This list may not tell you everything you need to know about what to do in your specific situation, but it will give you some helpful general ideas on what to do to help your friend:

Share your memories of two or three specific times when you felt concerned, afraid, or uneasy because of her eating rituals.
Talk about the feelings you experienced as a result of these events. Try to do this in a very supportive, non-confrontational way.
Use "I" statements. For example: "I'm concerned about you because you refuse to eat breakfast or lunch." or "It makes me afraid to hear you vomiting."
Avoid accusational "You" statements. For example: "You have to eat something!" " You must be crazy!" or "You're out of control!"
Avoid giving simple solutions. For example: "If you'd just stop, everything would be fine!"
If your friend has become obsessed with eating, exercising, or dieting, she probably needs professional help. Your friend may be angry that you are questioning her attitudes and behaviors. Your friend may deny that there is a problem. If your friend won't listen to your concerns, you may need to tell someone else -- someone who can help. Consider talking to your friend's parents, a teacher, a doctor, a counselor, a nutritionist, or any trusted adult. Your friend needs as much support and understanding as possible from the people in her life.

Where Can I Get More Information About Eating Disorders?

For more information, contact Eating Disorders Awareness and Prevention, Inc. at 603 Stewart St., Suite 803, Seattle, WA 98101



© 2000 EDAP.

This handout may be copied for educational purposes only.

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Upper Respiratory Infections:

What Are Upper Respiratory Tract Illnesses?

Upper respiratory tract infections affect the airways in the nose, ears, and throat. Viruses, bacteria, or other microscopic organisms can cause them. In most cases these infections, including colds, flus, and acute bronchitis, are mild, temporary, and harmless. In rare cases, they can cause serious infections in the ears or sinuses or even evolve into pneumonia.

Common Cold

The common cold is the most common upper respiratory tract infection. More than 200 viruses can cause colds, the most common being the rhinovirus, which causes more infections in humans than any other microorganism. Symptoms of a common cold (nasal congestion, muscle aches, fatigue, and fever) are mild. A cold nearly always starts with throat irritation and stuffiness in the nose. Within hours, full-blown cold symptoms usually develop, which can include sneezing, mild sore throat, low-grade fever, minor headaches, muscle aches, and coughing. Nasal discharge is usually clear and runny the first one to three days; it then thickens and becomes yellow to greenish. A runny nose usually lasts two to seven days, although coughing and nasal discharge can persist for more than two weeks.

Influenza (Flu)

A virus always causes influenza, commonly called the flu. The symptoms usually always include headache, muscle aches, fatigue, and high fever (>101 degrees F.). Influenza may also cause a cough (which is usually dry but can be severe) and sometimes a runny nose and sore throat.

Strep Throat

Sore throat during a cold is very common and usually mild and in nearly all such cases is caused by a virus. The symptoms of the more serious so-called strep throat, which is caused by the group A Streptococcal bacteria, include a sudden onset of severe sore throat, difficulty in swallowing, and fever. The patient may also have a headache, stomach pain, and vomiting. Only about half of patients with strep throat have such clear-cut symptoms, however. Furthermore, half of people who have these symptoms do not actually have strep throat. Strep throat is most likely to occur in late winter and early spring and is not usually accompanied by a cough or nasal congestion.

Acute Bronchitis

Acute bronchitis is an infection in the passages that carry air from the throat to the lung, causing a cough that produces phlegm. In such cases, the airway tubes have become inflamed and collected mucus. In 95% of cases, acute bronchitis is caused by a virus and is spread from person to person through coughing. In some cases other tiny microbes called Mycoplasma or Chlamydia may be responsible. The cough usually lasts for about a week to ten days but in about half of patients coughing can last for up to three weeks and 25% of patients continue to cough for over month.

Who Gets Upper Respiratory Infections?

Everyone gets a cold or upper respiratory infection at some time. On average, Americans develop two to four colds a year, which totals to about 200 million colds a year.

Smoke and Environmental Pollutants

The risk of respiratory infections is increased by exposure to cigarette smoke, which can injure airways and damage the cilia (tiny hair-like structures that help keep the airways clear). Toxic fumes, industrial smoke, and other air pollutants are also risk factors.

Medical Conditions

People with AIDS and other medical conditions that damage the immune system are extremely susceptible to serious infections. Cancers, especially leukemia and Hodgkin's disease, put patients at risk. Patients who are on corticosteroid (steroid) treatments, chemotherapy, or other medications that suppress the immune system are also prone to infection. People with diabetes are at higher risk for flu. Certain genetic disorders predispose people with these problems to respiratory infections. They include sickle-cell disease, cystic fibrosis (which causes mucus abnormalities), and Kartagener's syndrome (which results in malfunctioning cilia).

People under Stress

Much evidence suggests that stress increases one's susceptibility to a cold perhaps by increasing specific immune factors that cause inflammation in the airways. In one study, people with high stress levels averaged 2.7 upper respiratory infections during a six-month period and those reporting low stress averaged 1.5 infections. In another well-conducted study, high-stress individuals were 1.7 times more likely to have a cold than low-stress people were. Stress appears to increase the risk for a cold regardless of lifestyle or other health habits. And once a person catches a cold or flu, stress can exacerbate symptoms.

Excessive Exercise

Although long-term effects of regular exercise are known to improve health, the immediate effect of exercise on the immune system is uncertain. In people who already have colds, exercise has no effect on the illness' severity or duration of the infection. People should avoid strenuous physical activity when they have high fevers or widespread viral illnesses, however. High-intensity or endurance exercises appear to suppress the immune system while they are being performed. Some highly trained athletes, for instance, report being susceptible to colds after strenuous events; very low fat diets appear to support this negative effect on the immune system. A higher fat-diet may help redress this imbalance (omega-3 fatty acids, found in fish and canola oil are preferred). Whether carbohydrate loading provides much additional value is not clear.


Although most people get colds in the winter, this is not due to cold weather but most likely because people spend more time indoors and are exposed to higher concentrations of rhinovirus, the cause of colds. Dry winter weather also dries up nasal passages, making them more susceptible to viruses.

How Serious Are Upper Respiratory Tract Infections?

In general, upper respiratory tract infections are common and not serious. However, an average of 20,000 Americans die every year from complications of influenza, and there is some indication that the mortality rates are increasing in recent years. They are a major cause of hospitalization in people with chronic medical conditions, especially the elderly and the very young, and particularly those in low socioeconomic groups. Such hospitalizations have also been increasing over the past few decades. For example, almost 1.5 million persons were hospitalized in 1995 after an average increase of more than 28,000 per year since 1980. The hospitalization rate for persons 65 years of age or older with pneumonia increased by 50% from 1985 to 1995. Such rates do not include exacerbations of asthma or chronic obstructive pulmonary disease, such as emphysema or chronic bronchitis.

Complications of Colds

Colds rarely cause serious complications. In about 1% of cases, a cold can lead to other complications, such as sinus or ear infections. It can also aggravate asthma and, in uncommon situations, increase the risk for lower respiratory tract infections.

Sinusitis. Between 0.5% and 5% of people with colds develop sinusitis, an infection in the sinus cavities (air-filled spaces in the skull). Sinusitis is usually mild, but if it becomes severe, antibiotics generally eliminate further problems. In rare cases, however, sinusitis can be serious.

Lower Respiratory Tract Infections. The common cold poses a risk for bronchitis and pneumonia in people who may be susceptible to infection. Some experts believe that the rhinovirus may play a more significant role than the flu in causing lower respiratory infections in such people.

Aggravation of Asthma. Rhinovirus infections can acerbate asthma in both children and adults and has reported to be the most common infectious organism associated with asthma attacks. Some studies have reported the common cold being associated with between 33% and 71% of severe asthma episodes.

Complications of Strep Throat

The use of antibiotics has removed the threat of most complications from streptococcus infection in the throat (strep throat). However, untreated strep throat could lead to abscess in the tonsils, scarlet fever, and may even cause rheumatic fever. Although very rare in the US, rheumatic fever still occurs occasionally in children. The condition can injure the heart and have long-term, serious effects.

Complications of Acute Bronchitis

Acute bronchitis is nearly always temporary. Sometimes it can last for weeks to months if the airways are not healing properly. Pneumonia may be present if coughing is continuous and hacking, if blood appears in the sputum, and if the patient has a high fever and signs of severe illness, such as shortness of breath or extreme weakness and fatigue. Of particular interest and some concern are the roles of Mycoplasma and Chlamydia, two of the infectious organisms that cause acute bronchitis. These agents are being investigated for their roles as possible causes of asthma. Chlamydia is also being investigated as a trigger for processes leading to coronary artery disease.

Complications of Influenza

Every year, influenza strikes millions of people worldwide. Although it is usually not serious in healthy adults, the flu can cause severe complications, particularly pneumonia, and, in fact, is responsible for about 20,000 deaths a year. It is uncommon in healthy adults but can develop about five days after viral influenza, usually in susceptible individuals, such as people with weakened immune systems, very young children, hospitalized patients, and drug abusers who use needles. Influenza epidemics are most serious when they involve a new strain against which most people are not immune. Such pandemics are worldwide; they can infect more than one fourth of the population within a three-month period.

What Tests May Be Required To Diagnose Complications Of Upper Respiratory Infections?

Diagnostic tests or examinations are usually needed only if a clinician suspects serious complications of colds and flus; although with new treatments available for influenza, rapid diagnostic tests may become more widely available.

Ruling out Strep Throat

Most cold-related sore throats are caused by viruses and require no treatment. They may come on suddenly but are not severe or long-lasting. When the sore throat is very painful the clinician will want to rule out or confirm the presence of group A Streptococcal bacteria, the cause of strep throat, which can be treated with antibiotics. The clinician will first look for redness, swelling, and pus-filled patches on the tonsils and back of the throat and feel the sides of the neck for swollen lymph nodes. The clinician uses a cotton swab to take a sample of pus in the throat. A culture taken from the throat sample is the most effective and least expensive test for confirming the presence of the Streptococcal bacteria. A faster test called the rapid strep antigen test uses chemicals to detect the presence of bacteria, but it is not quite as accurate.

Ruling out Allergic Rhinitis

Symptoms of allergic rhinitis include nasal obstruction and congestion, similar to the symptoms of a cold. People with allergies, however, are apt to have thin, clear, and runny nasal discharge, an itchy nose, eyes, or throat, and recurrent sneezing. Symptoms that appear only during allergy season (spring or fall) are called seasonal rhinitis (commonly known as hay or rose fever). Allergens in the house, such as house dust mites, molds, and pet dander, can cause year-long allergic rhinitis, referred to as perennial rhinitis.

Ruling out Sinusitis

The signs and symptoms suggestive of true acute sinusitis include a return of congestion and discomfort after initial improvement in a cold (called double sickening); purulent (pus-filled) nasal secretion; a lack of response to decongestant or antihistamine; pain in the upper teeth pain on one side of the head; and on leaning forward, facial pain above or below both eyes. When the diagnosis is unclear or complications are suspected, further tests may be required

Ruling out Causes of Persistent Coughing

Over 30 million people seek medical help each year for persistent coughing. If coughing continues for longer than a month, the clinician usually checks for causes other than acute bronchitis. It should be noted, however, that acute bronchitis caused by a cold can last for several weeks, and some clinicians believe that a cough should not be considered to be chronic until it persists for eight weeks. The best approach is to use diagnostic methods for the most to least common cause. After acute bronchitis, the other three most common causes of persistent coughing in adults are, in order of frequency, asthma, postnasal drip, and gastroesophageal reflux disorder. Chronic bronchitis is the fourth most common cause. Some experts suggest that persistent cough first be treated with antihistamines and decongestants. If coughing doesn't resolve, asthma therapies should be added. If coughing still persists the patient should be treated for gastroesophageal reflux disorder. If such treatments fail, then more invasive tests are required. A simple lung examination and medical history can often quickly determine a diagnosis. For more complicated or uncertain cases, other tests may be required, including lung function studies and x-rays.


Acute bronchitis can easily be confused with asthma, particularly if the cough is accompanied by wheezing and occurs mostly at night or during activity. Coughing from acute bronchitis usually (but not always) clears up within days to a couple of weeks while that from asthma persists. Asthmatic symptoms from occupational causes can also cause persistent coughing, which is usually worse during the work week. Tests called the methacholine inhalation challenge and pulmonary function studies may be effective in diagnosing asthma.

Postnasal Drip

Postnasal drip is often a symptom of allergies, viral infections or sinusitis, but sometimes the cause cannot be determined.

Gastroesophageal Reflux Disorders

Gastroesophageal reflux disorder (GERD), in which acid rises from the stomach into the esophagus, can cause persistent coughing, which is usually worse when lying down. A diagnosis of gastroesophageal reflux disease can often be made if taking antacids relieves symptoms. Coughing is the only symptom, however, in 75% of cases when GERD is its cause. In such cases, 24-hour monitoring employing an endoscopy, a test using a tube inserted down the esophagus, may be required for a diagnosis of GERD. Some research indicates, however, that taking a medication called a proton pump inhibitor, usually omeprazole, for two weeks can help treat and diagnose patients with GERD after asthma and postnasal drip have been ruled out.

Chronic Bronchitis

Chronic bronchitis also causes shortness of breath and is often accompanied by infection, mucus production, and coughing, but it is a long-term and irreversible condition. A diagnosis of chronic bronchitis is suggested when a patient experiences coughing with sputum on most days for at least three months of a year, for a minimum of two years. Lying down at night worsens the condition.


A patient should always check with the clinician right away if a high fever and signs of severe weakness and debility or when blood appears in the phlegm accompany the cough. When pneumonia is present, coughing is usually persistent and hacking. Sometimes it is violent enough to affect the chest muscles or ribs and produce severe pain. The appearance of thick, greenish or yellowish sputum (phlegm that the patient coughs up) indicates a bacterial infection but it is not always helpful in diagnosing pneumonia or assessing severity. In most cases, a clinician will take a chest x-ray.

Miscellaneous Causes

Some obvious common causes of chronic coughing include heavy smoking or the use of drugs known as ACE inhibitors. Uncommon causes of coughing include lung cancer and tuberculosis, which are usually easily identified by other symptoms and by specific diagnostic methods.

Diagnostic Tests for Influenza

Rapid tests are now available for diagnosing influenza A and B.

What Are the Treatments for the Common Cold?

Drinking plenty of fluids and getting lots of rest when needed is still the best bit of advice to ease the discomforts of the common cold. Chicken soup does indeed help congestion and achiness, but it appears to be the hot steam that offers the benefit; tea or any hot beverage may have the same effect.

Stuffy Nose and Congestion

Nasal Wash: For common colds and mild allergic rhinitis, a nasal wash can be helpful for removing mucus from the nose. A saline solution can be purchased at a drug store or made at home. One study reported that neither a homemade solution (using one teaspoon of salt and one pinch of baking soda in a pint of warm water) nor a commercial hypertonic saline nasal wash had any effect on cold symptoms. Some clinicians, however, argue for the effectiveness of a traditional nasal wash, used for centuries, that uses no baking soda and more fluid for each dose and less salt than the saline washes in the study. The patient leans over the sink head down, pours some solution into the palm of the hand, and inhales it through the nose one nostril at a time. The patient spits the remaining solution out and blows the nose gently. The solution may also be inserted into the nose using a large rubber ear syringe, available at a pharmacy. Leaning over the sink head down, the patient inserts only the tip of the syringe into one nostril. He or she gently squeezes the bulb several times to wash the nasal passage and then presses the bulb firmly enough so that the solution passes into the mouth. The process should be repeated in the other nostril. A nasal wash should be performed several times a day.
Nasal Strips:  Nasal strips (Breathe Right) are placed across the lower part of the nose and pull the nostrils open. These strips may open the nasal passages and ease congestion due to a cold or hay fever. As of yet, there is no scientific evidence that they offer such benefits.
Nasal Decongestants:  Decongestants may help dry nasal congestion, but they should not be taken for more than one or two days. They work by shrinking vessels in the nose. By reducing blockage, they decrease the risk of developing sinusitis caused by viruses or bacteria. Many over-the-counter decongestants are available, either in tablet form or as nasal or inhaled decongestants that are applied directly into the airways as sprays, drops, or vapors.
Active ingredients in nasal decongestants include oxymetazoline (Sinex Long-Lasting, Afrin, Sinarest, Dristan 12-Hour, Neo-Synephrine 12-Hour, Nostrilla, NTZ, Vicks), xylometazoline (Otrivan), phenylephrine (Neo-Synephrine, Nostril Nasal Decongestant, Sinex), naphazoline (Naphcon Forte, Privine), and tetrahydrozoline (Tyzine). Oxymetazoline and xylometazoline are long-acting decongestants; they are effective in a few minutes and remain so for six to eight hours.

When using a nasal spray, the patient should spray each nostril once, wait a minute to allow absorption into the mucosal tissues, and then spray again. This procedure is repeated again in four hours with drugs containing pseudoephedrine and every 12 hours with those containing oxymetazoline. All forms of nasal decongestants may dry out the affected areas and damage tissues. Keeping the area moist is very important to prevent this.

Any sprayers, inhalators, or devices used to deliver the decongestants become reservoirs for bacteria over time, so should be discarded when the medication is no longer needed. If the medicine becomes cloudy or unclear, it, too, should be discarded. Droppers and inhalators should not be shared with other people, and they should not be inserted into the nostril.

Nasal decongestants are generally recommended for no more than one to three days because of the risk of nasal irritation, rebound effect, and dependency. With prolonged use, nasal decongestants become ineffective; some people then increase the frequency of their doses to as often as every hour. Withdrawal from the drug after three to five days then causes a rebound effect; that is, symptoms of sinusitis and nasal congestion return. Short-acting nasal decongestants may have a rebound effect after only eight hours. Nasal forms work faster than oral decongestants and have fewer side effects but often require frequent administration.

Inhaled decongestants contain propylhexedrine or levmetamfetamine, also called desoxyephedrine.

Oral decongestants also come in many brands and contain pseudoephedrine (eg, Sudafed, Vicks NyQuil Multi-Symptom Cold/Flu Relief Liquid, and Robitussin PE). Sudafed, which contains pseudoephedrine, is the only over-the-counter single ingredient oral decongestant.

The most common side effects of most decongestants are agitation and nervousness. All nasal and oral decongestants can cause changes in heart rate and blood pressure, with oral decongestants having a greater effect. The FDA warns that anyone with heart disease, high blood pressure, thyroid disease, diabetes, or prostate enlargement problems that cause urinary difficulties should not use oral or nasal decongestants without a doctor's guidance. Inhalers that contain propylhexedrine or levmetamfetamine do not pose these risks. Oral medications with pseudoephedrine have less of an effect on blood pressure than those containing phenylpropanolamine, but both should be avoided by anyone with high blood pressure. Of some concern is a study indicating that phenylpropanolamine may even increase the risk for stroke in certain individuals. Although a very rare occurrence, some experts advise against anyone taking phenylpropanolamine.

Those at risk are people whose blood vessels are highly susceptible to contraction, including those with migraines and Raynaud's phenomenon, in which people are highly sensitive to cold.

Antihistamines:  Histamine is the chemical released when antibodies overreact to allergens and is the cause of many symptoms of allergic rhinitis. The antihistamines relieve itching, sneezing, and nasal discharge. Many prescription and non-prescription antihistamines are available and include short-acting and long-acting forms. They are generally categorized as first- and second-generation and are available in tablet, nasal-inhaler, eye drop, and syrup form. It should be noted that antihistamines are not generally recommended to relieve the symptoms of the common cold. Although one study has indicated that older (so-called first-generation) antihistamines may reduce cold symptoms, experts postulate that their benefits for the cold are likely to be due to the drowsiness they cause. The newer, second-generation, antihistamines do not have these effects and also appear to have no benefits against colds. People with bacterial infections in the nasal or sinus passages should not use antihistamines, even during allergy season; antihistamines thicken mucus secretions and can actually worsen bacterial infections.
Combination Cold Remedies:  Except in special circumstances, patients should avoid combination cold remedies. Some ingredients may produce side effects without even helping a cold. In some cases, the ingredients conflict (such as a cough expectorant and a cough suppressant). In other cases, a patient may wish to increase the dosage to improve one symptom, which serves to increase other ingredients that do no good and may even be harmful at higher doses.


Cough Remedies

Patients should not suppress coughs that produce mucus and phlegm; it is important to expel this substance. To loosen phlegm, patients should drink plenty of fluids and use a humidifier or steamer. For thick phlegm, patients may try cough medications that contain guaifenesin (Robitussin, Scot-Tussin Expectorant), which loosens mucus. For patients with a dry cough, a suppressant may be useful, such as one that contains dextromethorphan (Drixoral Cough, Robitussin Maximum Strength Cough Suppressant). Medications that contain both a cough suppressant and an expectorant are not useful and should be avoided. Medicated cough drops that contain dextromethorphan are not very useful. A patient is just as likely to find relief from hard candy or lozenges. Those that contain menthol and mild anesthetics, such as benzocaine, hexylrescorincol, phenol, and dyclonine (the most potent), may soothe mild sore throat.

Remedies for Sore Throat

Cough drops, throat sprays, or gargling warm salt water may help relieve sore throat and reduce coughing. One health professional suggested that people with sore throats from postnasal drip might try taking a teaspoon of liquid antacid. They shouldn't drink anything afterward, since the intention is to coat the throat and help neutralize the acid in the mucus that might be causing pain. If these home remedies don't help, or for more severe discomforts, there are many over-the-counter drug treatments available.

Medications for Mild Pain and Fever Reduction

Mild pain relievers, such as aspirin, ibuprofen (Advil), or acetaminophen (Tylenol) may help reduce fever and relieve mild sore throat and other aches and pains. Although many people take such medications for colds, one study suggested that these drugs may actually neutralize the body's immune response against the rhinovirus and even increase nasal symptoms, but the study was very small. Aspirin and aspirin-containing products are almost never recommended for children or adolescents. Reye's Syndrome, a very serious condition, has been associated with aspirin use in children who have flu symptoms or chicken pox.


Zinc:  There is evidence on the importance of zinc for maintenance of the immune system, and adequate zinc levels are important, especially in patients at high risk for serious infections, such as those with HIV or children with sickle-cell disease. In such people, supplements may be helpful. The use of zinc supplements for otherwise healthy people with colds, however, is uncertain. Some research indicates that zinc may help prevent the rhinovirus from attaching to nasal passage membranes. One analysis of studies on the use of zinc supplements, however, found no significant effect on colds. In 1999, the FDA charged the manufacturer of the zinc carbonate lozenges Cold-Eeze and Kids-Eeze Bubble-Gum with making unsubstantiated claims about their benefits against colds, allergies, and pneumonia. Of some interest, however, is Zicam, a nasal gel that contains zinc ions as the active ingredient. The zinc gel may be more effective than zinc lozenges or sprays because the zinc resides within the nasal cavity long enough to interact with the virus. More studies are underway. It should be noted, however, that no one with an adequate diet and a healthy immune system should take zinc for prevention. Some research has suggested that taking zinc for long periods, even in moderate recommended doses, may actually weaken immunity, reduce HDL (the so-called good cholesterol), and interfere with copper metabolism. In any case, zinc does not seem to reduce fever or soothe muscle aches or scratchy throats. Side effects include nausea and a bad taste, and the mineral may be toxic in large doses. More studies are needed.
Vitamins: A number of studies have found that large doses of vitamin C reduce the duration of the cold by 5% to 50%, depending on the study. Such high doses, however, may cause headaches and intestinal and urinary problems, and even kidney stones. Because ascorbic acid increases iron absorption, people with certain blood disorders, such as hemochromatosis, thalassemia, or sideroblastic anemia, should particularly avoid high doses. Large doses can also interfere with anticoagulant medications, blood tests used in diabetes, and stool tests for diagnosing colon cancer. It should further be noted that vitamin C has limited protective properties. In an examination of 60 studies, the six largest ones reported no preventive effects of vitamin C in well-nourished individuals. (It may be useful for prevention of respiratory infections in people in poor health or under heavy physical stress, however.)
Echinacea: The herbal remedy echinacea is now commonly taken to prevent onset of cold or flu and to ease symptoms. There are three species: Echinacea (E.) purpurea , E. pallida , and E. augustifolio . In some studies, people who took extracts of either E. purpurea or E. augustifolio experienced no protection against colds. Others have found benefits with various Echinacea forms, such as Echinaforce (an Echinacea purpurea-preparation) and Echinacea purpurea concentrate (same preparation at 7 times higher concentration). At this time there are no standards or quality controls available for echinacea (including what part of the plant to use) or any other herbal remedies. People with autoimmune diseases or who are allergic to plants in the daisy family should not take it. No one should take untested so-called natural remedies without a clinician's approval. No studies have confirmed the benefits of these medications and many can cause toxic side effects in large doses.



What Are the Treatments for More Severe Upper Respiratory Tract Infections?

General Guidelines Regarding Antibiotics

In spite of strong warnings by experts that colds and their symptoms never require antibiotics, many physicians feel pressured by patients into prescribing antibiotics for mild upper respiratory tract infections. In people with colds, even the presence of a persistent cough or greenish, thick mucus does not indicate the need for antibiotics if there are no other symptoms of infection. Experts estimate that outside the hospital only half of the antibiotics prescribed for sore throats, 20% of prescriptions for bronchitis, and virtually no antibiotics for colds are necessary. Antibiotics may be required in children and elderly patients with medical conditions that put them at high risk for complications of respiratory infections. They are also used for some cases of sinusitis and ear infections, which are discussed in other reports. Other possible indications for antibiotics are described below.

Prescribing antibiotics to people who do not require antibiotics is raising great concern among health professionals. Increasingly, physicians are reporting strains of common bacteria that are no longer eliminated using many standard antibiotics. As of yet, the average person is not endangered by this problem. The risk is greatest in hospitals and nursing homes, but it is still not high. Nevertheless, it is important for patients with mild upper respiratory tract infections to understand that although antibiotics may bring a sense of security, they provide no significant benefit and overuse can contribute to the growing problem of resistant bacteria.

Treatments for Acute Bronchitis or Persistent Coughing

Bronchodilators: For some patients with acute bronchitis, inhaled medications called bronchodilators may be effective. These drugs relax and open the airways and so may relieve symptoms and reduce the duration of the coughing. The most common bronchodilator used for acute bronchitis is albuterol (Proventil, Ventolin).
Antibiotics:  Acute bronchitis associated with colds is almost always caused by viruses and almost never warrants antibiotics. Exceptions possibly include pertussis (whooping cough) or coughing that lasts longer than 10 days in children with chronic lung disease (not asthma). Clinicians may also prescribe antibiotics for persistent coughing if they suspect that the conditions are caused by the organisms Mycoplasma or Chlamydia, which usually develop in older children and young adults. In such cases, antibiotics known as macrolides (erythromycin, azithromycin, clarithromycin, clindamycin) are useful for such patients older than five years old. Oral erythromycin is the first choice for young nonsmoking patients with Mycoplasma or Chlamydia infection without other medical problems. For smokers and patients who cannot take erythromycin, clarithromycin and azithromycin are good alternatives. Some clinicians believe that antibiotics may prevent bacterial infections from developing in the lungs of patients with acute bronchitis, although several studies have reported few or no benefits from antibiotics for uncomplicated bronchitis in either children or adults. Needless to say, antibiotics are warranted if the coughing is caused by bacterial pneumonia.


Treatments for Strep Throat

Sore throats associated with colds are nearly always caused by viruses and should not be treated with antibiotics. In general, only throat infections caused by group A Streptococcal bacteria (strep throat) require these medications. Penicillin is usually the antibiotic of choice unless the patient is allergic. Many clinicians will prescribe an antibiotic based on symptoms alone, although studies indicate that only about half of adults and far fewer children with even strong signs and symptoms for strep throat actually have Streptococcal infections. There is no evidence to prove that early antibiotic therapy offers any greater protection against acute rheumatic fever or recurring infections than waiting for the laboratory results. In any case, the clinician should call the patient if culture results are negative and have them discard and not take any remaining antibiotics.

Treatments for Influenza

Drugs developed to treat and prevent influenza target either influenza A, the most serious strain of the virus, or both influenza A and B. Four drugs have been approved for the treatment, prevention, or both of influenza: amantadine (Symmetrel), rimantadine (Flumadine), zanamivir (Relenza), and oseltamivir (Tamiflu).

M2 Inhibitors: Amantadine and rimantadine are called M2 inhibitors. Both offer protection against influenza A, but not B. They may shorten the duration and lessen the severity of the flu if given within 48 hours of onset of symptoms. Side effects of amantadine and, to a lesser extent, rimantadine include nervousness, anxiety, difficulty concentrating, and lightheadedness. Rarely, amantadine can cause significant mental and behavioral changes, usually in elderly people already at risk for psychiatric symptoms. Neither has proven to reduce the risk for complications including pneumonia and bronchitis.
Neuraminidase Inhibitors: Zanamivir (Relenza) and oseltamivir (Tamiflu), called neuraminidase inhibitors, are proving to be effective for treating both A and B strains of influenza. They both shorten the duration of the flu by one to three days but need to be taken within two days of onset of symptoms. Both are approved for treatment in adults patients; zanamivir is also approved for adolescents and is proving to be safe and effective in children over six. Zanamivir is administered as a nasal spray or inhaler. Side effects are minor, although people with existing asthma and other lung disorders may experience airway spasms or lung deterioration after taking the drug, and such people should use this drug with caution. Oseltamivir works similarly to zanamivir, but comes in capsule form. Side effects are also minor but patients taking the oral drug may experience more nausea and vomiting than those on zanamivir. To date, their effects on patients with serious medical conditions are not known, nor whether they have any effect on overall survival rates. There is some early evidence that they may reduce complications of influenza, although this needs to be confirmed. Neuraminidase Inhibitors are much more expensive than M2 inhibitors.
Antibiotics:  Antibiotics have no benefits against influenza


How Can Upper Respiratory Infections Be Prevented?


Healthy Lifestyle

Hygiene: The best way to prevent pneumonia is to take measures to avoid the organisms that cause the respiratory infections, including colds and flus. Everyone should always wash his or her hands before eating and after going outside. Ordinary soap is sufficient; antibacterial soaps add little protection, particularly against viruses. In fact, a recent study suggests that common liquid dish washing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV), which is known to cause pneumonia. Nasal secretions containing RSV can remain infectious for several hours. Flus and colds are not spread by touching inanimate objects, such as subway poles or toilet seats; bacteria do not thrive on such objects and of the organisms that do survive on inanimate objects, most are harmless.
Daily Habits: Daily diets should include foods such as fresh, dark-colored fruits and vegetables, which are rich in antioxidants and other important food chemicals that help boost the immune system. Supplements of vitamin C and E may be helpful, but there is no evidence to prove their benefits, and high amounts of vitamin C may cause diarrhea. Interestingly, maintaining an active social lifestyle could help prevent colds. One study found that the more social interaction a person has the less likely they are to have a cold, possibly because stress hormones, which suppress the immune system, are reduced.




Viral Influenza Vaccines. The two major influenza viruses are called A and B. Unfortunately, influenza A viruses undergo changes (antigenic drift) over time, so a vaccine that works one year may not work the next. Vaccines are then redesigned annually to match the current strain. Influenza B viruses tend to be more stable than influenza A viruses, but they too vary. The vaccines use inactivated, not live, viruses. Flu shots are given in the fall, usually between October and December.
An intranasal vaccine (FluMist) is made from weakened influenza viruses that are engineered to grow only in cooler temperatures found in the nasal passages, not in the warmer temperatures of the lungs and lower airways. The vaccine boosts the specific immune factors in the mucous membranes of the nose that fight off the actual viral infections.

The vaccines may be slightly less effective in the elderly, the very young, and patients with certain chronic diseases than in healthy young adults. Even in people with a weaker response, however, the vaccine is usually protective against serious flu complications, particularly pneumonia, although patients may still experience symptoms in the upper respiratory tract (the nose and throat). All adults 50 years and older, particularly those in nursing homes, and anyone at risk for serious complications from the flu should have an annual vaccination. Those at high risk include people with heart disease, lung problems, immune deficiencies, diabetes, kidney disease, or chronic blood disease, such as sickle cell disease. Certain other younger adults who should be vaccinated include health care workers and others who may expose high-risk people to the flu. Current studies suggest that influenza vaccinations are very effective for people with HIV. People at risk for complications of influenza and who are traveling to the tropics at any time or to the Southern Hemisphere between April and September should consider vaccination. Pregnant women who are at risk for complications of influenza should be vaccinated, usually after the first trimester unless they are in their first trimester during flu season and their risk for complications of the flu is higher than any theoretical risk to the baby from the vaccine.

Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs. Almost a third of people who receive the influenza vaccine develop redness or soreness at the injection site for one or two days afterward. Other side effects include mild fatigue and muscle aches and pains; they tend to occur between six and 12 hours after the vaccination and last up to two days. It should be noted that these symptoms are not influenza itself but an immune response to the virus proteins in the vaccine. Anyone with a fever, however, should not be vaccinated until the ailment has subsided.

Where Else Can People With Upper Respiratory Infections Get Help?

  • American College of Allergy
    Asthma & Immunology
    85 West Algonquin Road, Suite 550
    Arlington Heights, IL 60005
    Call: 847-427-1200
    Fax: 847-427-1294
    On the Internet:


This organization publishes information sheets on specific allergies and offers a number for referrals to allergists in local areas. Their web site is excellent.

  • National Jewish Center for Immunology and Respiratory Medicine
    1400 Jackson Street
    Denver, CO 80206
    Call 800-222-LUNG or 303-355-LUNG or for the recorded service Lung Facts call (800-552-LUNG)
    On the Internet: www.njc.org

  • The American Lung Association
    1740 Broadway
    New York, New York 10019-4374
    Call: 800-LUNG-USA
    On the Internet:


The association is very responsive and offers a wide range of information and services.

  • Centers for Disease Control has a National Immunization Information Hotline.
    Call (800-232-2522)

Internet Sites

Centers for Disease Control:


Flu guidelines:


Federal Agency for Health Care Policy and Research:


The Website of the Alliance for the Prudent Use of Antibiotics:


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Viral or Bacterial Conjunctivitis

Conjunctivitis is inflammation of the conjunctiva, the clear membrane that lines the eyelids and covers the white of the eye. Conjunctivitis is sometimes called pink eye.
Many things, including infection, can cause conjunctivitis by viruses or bacteria. Viruses that cause colds may lead to conjunctivitis. Some bacteria that cause conjunctivitis are chlamydia, staphylococci, and streptococci.

How does it occur?

Viral forms of conjunctivitis can be spread easily from person to person through coughing or sneezing. Bacteria or viruses can get in your eyes through contact with contaminated objects, including:

washcloths or towels
false eyelashes
contact lenses

What are the symptoms?

 Symptoms may include:

itchy or scratchy eyes
redness - sensitivity to light
swelling of eyelids
watery discharge
discharge of pus
Like a cold, viral conjunctivitis will usually go away on its own, even without treatment. However, your clinician may prescribe eye drops to help control your symptoms. Antihistamine pills may also relieve the itching and redness.

If you have bacterial conjunctivitis, your clinician will prescribe antibiotic eye drops. You can also help your eyes get better by washing them gently to remove any pus or crusts. Then dry them gently with a clean towel.

If you wear contact lenses, you will need to stop wearing them until your eyes are healed. The combination of contacts and conjunctivitis may damage your cornea (the clear outer layer on the front of your eye) and cause severe vision problems.

How long will the effects last?

Viral conjunctivitis usually gets worse 5 to 7 days after the first symptoms. It can improve in 10 days to 1 month. If only one eye is affected at first, it may take up to 2 weeks for the other eye to be affected. Usually, if both eyes are affected, the first eye has worse conjunctivitis than the second.

Bacterial conjunctivitis should improve within 2 days after you begin using antibiotics. If your eyes are not better after 3 days of antibiotics, call your clinician.

How can I prevent conjunctivitis?

To keep from getting conjunctivitis from someone who has it, or to keep from spreading it to others, follow these guidelines:

Wash your hands frequently. Do not touch or rub your eyes.
Never share eye makeup or cosmetics with anyone. Also, if you have bacterial conjunctivitis, throw out eye makeup you have been using.
Never use eye medicine that has been prescribed for someone else.
Do not share towels, washcloths, or sheets with anyone. If one of your eyes is affected but not the other, use a separate towel for each eye.
Avoid swimming in swimming pools if you have conjunctivitis.

When should I call my clinician?

Call your clinician if:

You have any severe eye pain.
Your symptoms do not improve after you have used your medicine for 3 days.
Your eyes become very sensitive to light, even up to a few weeks after the redness is gone.

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Infectious Mono:

What is infectious mononucleosis?
Infectious mononucleosis (also called mono) is a viral infection that frequently affects young people. It is a common infection, but often it causes no symptoms, especially when children have it. However, for adolescents and young adults it is a frequent cause of illness and missed school.

How does it occur?

The virus that causes infectious mono is called EBV (Epstein-Barr virus). It is spread mainly through saliva, which is why it has the nickname "kissing disease."

What are the symptoms?

After the virus enters the body it can take up to a month before symptoms begin. The first symptoms usually include tiredness, fever, headache, and muscle aches. Many people have extreme tiredness and need to sleep 12 to 16 hours a day before they have any other symptoms. After just a few days of the fever and aches, the throat becomes sore and the lymph nodes (glands) in the neck get bigger.

Other common symptoms are loss of appetite, nausea, joint aches, rash, and vague abdominal fullness or pain.

How is it diagnosed?

Your clinician will ask about your symptoms and then examine you. He or she will look for fever; a red throat with enlarged tonsils, sometimes covered with pus; and enlarged lymph nodes in the neck. You may also have a red rash, especially on the chest, and an enlarged spleen (in the upper left abdomen).

A blood sample will be taken to test for mono. The first blood test might be negative, but a complete blood count can show that a mono infection appears to be developing. Your clinician may ask you to return in a few days for another blood test. If you have mono, this second test will nearly always be positive.

How is it treated?

There is no specific drug treatment for mono. Because it is a viral illness, antibiotics are not helpful. The most important thing you can do is to get plenty of rest. Take acetaminophen for the fever and sore throat.

If your symptoms seem to be worsening rather than gradually improving after 1 to 2 weeks, tell your clinician. You could develop strep throat or a sinus infection. An uncommon complication of mono is an abscess (pocket of infection) on the tonsil. These three infections do need to be treated with antibiotics.

Sometimes the mono infection causes the tonsils to become so big that they nearly block the throat. Steroids (Prednisone) may be prescribed to try to decrease the size of the tonsils.

The virus may inflame your liver, so it is important not to drink alcohol when you have mono. Alcohol could further injure your liver.

An enlarged spleen could rupture if it were hit or strained. A rupture of the spleen causes severe bleeding and is a medical emergency. For this reason, you should avoid heavy lifting and any kind of jarring activity or contact sport. Your activities will need to be restricted until your spleen returns to a normal size. Otherwise, you will gradually be able to return to school, work, and sports.

How long will the effects last?

Your symptoms may get worse for 2 or 3 weeks after they first appear. Usually the fever, sore throat, and extreme fatigue last about 1 to 2 weeks. It can take several weeks, and in some cases several months, for the body's immune system to overcome the virus. You may continue to be infectious for many months after you recover from the infection.

The Epstein-Barr virus stays in the body even after you recover. You could have mono again, but this very rarely happens. Some experts believe that mono never recurs.

What can be done to help prevent infectious mononucleosis?

The best way to prevent others around you from getting mono is for them to avoid contact with your saliva. They can do this, for example, by avoiding kissing you and by not sharing food or eating and drinking containers and utensils until it has been several days since you had a fever.

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Cold Sores (Oral Herpes):

Oral Herpes

Oral herpes (herpes labialis) is most often caused by HSV-1 and usually affects the lips and, in some primary attacks, the mucous membranes in the mouth. A facial herpes infection on the cheeks or in the nose may occur, but this condition is very uncommon.

Primary Oral Herpes Infection. If the primary (or initial) oral HSV-1 infection causes symptoms, they can be very painful, particularly in small children.

Blisters form on the lips but may also erupt on the tongue.
The blisters eventually rupture as painful open sores, develop a yellowish membrane before healing, and disappear within three to 14 days.
Increased salivation and foul breath may be present.
Rarely, the infection may be accompanied by difficulty in swallowing, chills, muscle pain, or hearing loss.
In children, the infection usually occurs in the mouth; in adolescents, the primary infection is more apt to occur in the upper part of the throat and cause soreness.

Recurrent Oral Herpes Infection.  Between 20% and 40% of oral HSV-1 infections recur within a year. Recurrences are usually much milder than primary infections and are known commonly as cold sores or fever blisters. They usually show up on the lower lip and rarely affect the gums or throat. Reactivation can be provoked within about three days of intense dental work, particularly root canal or tooth extraction.

Treatment of Oral Herpes

Acyclovir: Acyclovir is often taken orally for a severe primary attack of HSV-1. Taken preventively, it reduces frequency and severity of recurring infections. Acyclovir ointment does not appear to be useful with HSV-1. The first antiviral cream to be approved for cold sores, penciclovir (Denavir), heals HSV-1 sores an average of one day faster than without treatment, stops viral shedding, and reduces the duration of the pain. The patient should apply the cream within the first hour of symptoms, and for four consecutive days it should be reapplied every two hours while awake.

For over-the-counter treatment of oral-facial herpes, the FDA has now approved Docosanol cream (Lidakol). Other agents are being investigated for oral herpes.

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Lower Back Pain:

What Is Lower Back Pain?

Low back pain is pain or stiffness in the lower back. Most of the time, it is caused when a muscle in your back is strained. For example, it can happen when you lift a heavy object or when you sit or stand for a long time. Health problems, such as arthritis, can also cause back pain.

Low back pain may last a day or two, several weeks, or longer. You may have pain in one spot or it may spread down the buttocks and into your legs.

You should see your clinician right away if you have back pain with these symptoms:

You cannot control your bladder or bowels.
You have a hard time moving your legs or walking.
Your arms or legs are numb or tingling.
These symptoms may mean you have hurt your spine and nerves.  When you see your clinician, he or she will:

Ask about your symptoms.
Give you an exam.
X-rays or other tests may also be done.

How is it treated?

Here are some good ideas for taking care of low back pain:

Use an electric heating pad on a low setting (or a hot water bottle wrapped in a towel) for 20 to 30 minutes. (Don't let the heating pad get too hot, and don't fall asleep with it. You could get a burn.)
Use an ice pack wrapped in a towel for 20 minutes, one to four times a day. (Don't leave it on too long. You could get frostbite. Set an alarm to remind you.)
Take aspirin, ibuprofen, or other pain medications your clinician may suggest.
Ask about exercises you can do to stretch and strengthen your back muscles.
When you sleep or lie down, keep these hints in mind:

Rest on a firm mattress. It may help to lie on your back with your knees raised or lie on your side with your knees bent.
Put a pillow under your knees when you are lying down.
Sleep without a pillow under your head.
Talk to your clinician about whether it would help to:

Wear a belt or corset to support your back.
Make visits to a physical therapist.
Have your back massaged by a trained person.
Take it easy at first. As you start to feel better, you'll be able to do more and more. But be careful. You may need to cut back on what you do:

If your symptoms come back.
If you have more pain after you start doing more or something new.
See your clinician if your pain is worse even with treatment.

How can I take care of myself?

You can lower the strain on your back. Here are some ideas that can help:

Try to get to and keep a healthy weight.
Use good posture. Stand with your head up, shoulders straight, chest forward, your weight on both feet, and your pelvis tucked in.
Sit in a straight-backed chair and hold your spine against the back of the chair.
Sit close to the pedals when you drive. Use your seat belt and a hard backrest or pillow.
Use a footrest for one foot when you stand or sit in one spot for a long time. This keeps your back straight.
Bend your knees when you bend over.
Here are tips when you need to lift or move heavy objects:

Don't push with your arms when you move a heavy object. Turn around and push backwards so your legs take the strain.
Bend your knees and hips and keep your back straight when you lift a heavy object.
Don't lift heavy objects higher than your waist.
Hold packages you carry close to your body, with your arms bent.
To rest your back, do these exercises for 5 minutes or longer:

Lie on your back, bend your knees, and put pillows under your knees.
Lie on your back, put a pillow under your neck, bend your knees to a 90-degree angle, and put your lower legs and feet on a chair.
Lie on your back, bend your knees, and bring one knee up to your chest and hold it there. Repeat with the other knee, then bring both knees to your chest. When holding your knee to your chest, grab your thigh rather than your lower leg.
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Smoking Cessation:

What Are the Risks of Smoking?

Dangers of Cigarette Smoking: Cigarette smoking kills nearly about 420,000 people a year, making it more lethal than AIDS, automobile accidents, homicides, suicides, drug overdoses, and fires combined. It reduces a smoker’s life expectancy by 15 to 25 years, and is the single most preventable cause of death. In one study only 42% of male lifelong smokers reached the age of 73 compared to 78% of nonsmokers.

On a national scale, the U.S. spends an astounding $50 billion each year on smoking-related health costs. Smoking may be even more dangerous now than 30 years ago, most likely because the lower tar and nicotine levels in most cigarette brands cause people to inhale more deeply.

People who are exposed to second-hand smoke are also at risk. Smoke that is exhaled not only contains the same dangerous contaminants as inhaled smoke, but the exhaled smoke particles are smaller, so that they can reach distant sites in the lungs of involuntary or passive smokers and do great harm.

The smoke is the most dangerous component of the cigarette. When people inhale they also bring tar into their lungs, which itself includes 4000 chemicals, some of which are carcinogenic. They are also inhaling other chemicals including cyanide, benzene, formaldehyde, methanol (wood alcohol), acetylene (the fuel used in torches), and ammonia. Smoke also contains nitrogen oxide and carbon monoxide, which are harmful gases.

Dangers of Other Forms of Tobacco: Twelve million Americans use smokeless tobacco; most are men, and 25% are teenagers. Chewing tobacco is not harmless and also contains known carcinogens. According to the Centers for Disease Control and Prevention, chewing smokeless tobacco 8 to 10 times per day may be equivalent to smoking 30 to 40 cigarettes per day. It produces a 50-fold increase in the risk of oral cancer, gingivitis, and tooth loss. Most users also become addicted.

One study reported that people who switch from cigarettes to cigars or pipes halve their risk of lung cancer, coronary artery disease, and chronic lung disease, possibly because they use less tobacco and inhale less.

Still, the risks of these diseases using “safer” forms of tobacco are 50% to almost 70% higher than nonsmokers.

Heart Disease

Smokers in their thirties and forties have a heart-attack rate that is five times higher than their nonsmoking peers. Cigarette smoking may be directly responsible for at least 20% of all deaths from heart disease or about 120,000 deaths annually. Smoking cigars may increase the risk of early death from heart disease, although evidence is much stronger for cigarette smoking.

Specific Effects on the Heart. Its damaging effects on the heart are multifold:

Smoking lowers HDL levels (the so-called good cholesterol) even in adolescents.
It causes deterioration of elastic properties in the aorta, the largest blood vessel in the body, and increases the risk for blood clots. It increases the activity of the sympathetic nervous system (which regulates the heart and blood vessels).
Tobacco smoke may increase cardiovascular disease in women through an effect on hormones that causes estrogen deficiency.
Specific Factors for a Greater Risk for Heart Disease in Smokers. Certain smokers are at even higher risk than others are for heart problems from smoking:

Current smokers. (Quitting will rapidly reduce the risk of developing heart disease, but long-term smoking may still permanently damage arteries.)
Heavy smokers.
Female smokers. (In women who smoke, the risk for a heart attack is about 50% greater than in male smokers.)
Effects of Second-Hand Smoke. Studies continue to confirm the dangers of second-hand smoke. Regular exposure to passive smoke is now estimated to increase the risk of heart disease in the nonsmoker by between 25% and 91%, causing 30,000 to 60,000 deaths each year.


Smoking accounts for about 30% of all cancer deaths in the U.S. and it has been cited as the most important factor in changes in worldwide cancer trends.

Lung Cancer. Smoking is the cause of 85% of all cases of lung cancer, which is expected to kill nearly 160,000 people in 2000, accounting for 28% of all cancer deaths. One analysis of studies suggested that exposure to second-hand tobacco smoke may increase the risk of lung cancer in the nonsmoker by about 25%, but a 2000 study suggested that this figure may be greatly overestimated, since it relied on many small and possibly biased studies. Quitting reduces the risk for lung cancer, even well into middle age. [See Table] In a British study of male smokers who quit at different ages, the risk for lung cancer by age 75 was the following:


Risk for Lung Cancer in Men at Age 75

Quitting Age   Percentage 
30   2%
 40  3%
 50  6%
 60  10%

Source: Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies, British Medical Journal. 321:323-329 ( 5 August 2000 )

Other Cancers. Smoking and smokeless tobacco also cause between 60% and 93% of cancers of the throat, mouth, and esophagus. Smokers also have higher rates of leukemia and cancers of the kidney, stomach, bladder, and pancreas. About 30% of cervical cancers have been attributed to both active and passive smoking. Lung cancer patients who survive and continue to smoke face a serious risk of developing a second tobacco-related tumor within ten years.

Specific Effects of Smoking on Cancer. Cigarette smoke contains many chemicals and cancer may develop from the accumulative effects of more than one.

Cigarette tar found in the lungs of smokers can cause specific DNA damage that is particularly difficult for the cell to repair. (Genetic damage, in fact, has been detected even in the lungs of smokers who do not have cancer.)
Cigarette smoke is a source of chemicals called polycyclic aromatic hydrocarbons (PAHs), which can lead to specific genetic mutations in the p53 tumor suppressor gene. (In its normal state, this gene is protective against cancer.) Such mutations are present in about 60% of all cases of lung cancer, in many other smoking-associated cancers.
Specific Factors for a Greater Risk for Cancer in Smokers. Certain individuals may be at even higher risk than others for cancer from smoking:

Current smokers. (Even after quitting smoking, long-term smokers may have permanent cellular changes in the lungs that cause a persistent risk for years, even decades.)
Heavy smokers.
Being female. (Some studies indicate that women are more likely to develop lung cancer from smoking than men are. In a 1999 study, the risk for older women was 2.3 times that of older men.) . Since 1987, lung cancer has ranked above breast cancer as the leading cause of cancer death among women. (Curiously, some studies suggest that smoking cigarettes may actually reduce the risk of breast cancer in women who carry BRCA1 and BRCA2 gene mutations, but smoking should by no means be used as a preventive measure.)
Smokers of low-tar cigarettes. (These smokers may have a higher risk for a particularly deadly lung cancer called adenocarcinoma, possibly because they inhale deeper, bringing particles to the smallest and most vulnerable tissues in the lungs where these cancers start.)
Smokers of mentholated cigarettes. (The higher incidence of lung cancer in these smokers may be due to deeper inhalation and smoking earlier in the day.)

Dementia and Neurologic Diseases

Stroke. People who smoke a pack a day have almost two and a half times the risk of stroke as nonsmokers. Specific factors for a greater risk for stroke in smokers include the following:

heavy smokers
current smokers (the risk for stroke may remain elevated for as long as 14 years after quitting)
women smokers who take oral contraceptives
Parkinson's Disease. Nicotine has some positive effects on the brain, including improving concentration and short-term memory. Studies suggest that cigarette smoke blocks the activity of a protein called monoamine oxidase B (MAO-B), which may play a role in Parkinson's disease. In fact, evidence is now fairly strong that smokers have a lower risk for Parkinson's disease. (This is, of course, no reason to smoke.)

Alzheimer's Disease. Some evidence also suggests that nicotine may have short-term protective actions against disease mechanisms that cause Alzheimer's. In fact nicotine is being tested in Alzheimer's patients. It should be strongly noted, however, that such effects, if protective, are short term and are most likely not applicable to smokers. In fact, the best current research suggesting that smoking makes little difference in the risk for Alzheimer's, and if it does, the risk for dementia is slightly higher in smokers. (Certainly, smoking can affect blood vessels in the brain as it does in the heart, increasing the risk for dementia from small or major strokes.)

Lung Disease

Smoking is associated with a higher risk for nearly all major lung diseases, including pneumonia, flu, bronchitis, and emphysema. There is also a link between smoking and increased asthma symptoms. Heavy smokers with asthma are also more likely to seek emergency treatment for their condition during times of heavy ozone pollution.

One study indicated that smokers who quit and start again might damage their lungs even more severely than people who have not yet made an attempt to quit. Some experts suggest that those who relapse and start smoking again are more strongly addicted than other smokers and may inhale more deeply and hold the smoke in their lungs longer. The message here is not that quitting smoking is more dangerous than not quitting; the emphasis is on not starting again.

Female Infertility and Pregnancy

Studies have now linked cigarette smoking to many reproductive problems. Women who smoke pose a greater danger not only to their own reproductive health but, if they smoke during pregnancy, to their unborn child. Some of these risks include the following:

  • Greater risk for infertility in women. (Women at greatest risk for fertility problems are those who smoke one or more packs a day and who started smoking before age 18.)

  • Greater risk for ectopic pregnancy and miscarriage.

  • Greater risk for stillbirth, prematurity, and low-birth weight. (Infant mortality rates in pregnant smokers are increased by 33%. The good news is that women who quit before becoming pregnant or even during the first trimester reduce the risk for a low birth weight baby to that of women who never smoked.)

  • Smoking reduces folate levels, a B vitamin that is important for preventing birth defects.

  • Women who smoke may pass genetic mutations that increase cancer risks to their unborn babies.

Male Sexuality and Reproduction

Men's sexual and reproductive health is not immune from the effects of smoking.

  • Heavy smoking is frequently cited as a contributory factor in impotence because it decreases the amount of blood flowing into the penis.

  • Smoking also reduces sperm density and their motility, increasing the risk for infertility.

Thyroid Conditions

Cyanidem, found in tobacco smoke, interferes with thyroid hormone production. Studies on the effects of smoking on the thyroid have been mixed. According to a 2000 study of twins, however, a smoking twin has three times the risk for thyroid diseases (either hyper or hypothyroid conditions) than their nonsmoking sibling. The risk was particularly higher for autoimmune thyroid diseases (Graves disease or autoimmune thyroiditis).

Women smokers with subclinical hypothyroidism (symptom-free condition in which the thyroid gland is mildly underactive) face an increased risk for developing full-blown hypothyroidism than their non-smoking counterparts.

Other Disorders Related to Aging

People who smoke also endanger other parts of their bodies as they age:

  • One study showed that smokers of a pack or more a day had approximately twice the risk of developing cataracts than nonsmokers. Such cataracts are also more likely to be located in the nuclear portion of the lens, which limit vision more severely than cataracts in other sites.

  • Smokers also have twice the risk for the severe age-related eye disorder, macular degeneration. They are higher risk for periodontal problems.

  • Smokers look older than nonsmokers do. Smokers are nearly five times more likely to develop more and deeper wrinkles as they age compared to nonsmokers. Smoking also appears to have a higher risk for baldness and premature gray hair.

  • One study showed that older smokers had a 70% higher incidence of suffering from hearing loss than nonsmokers.

  • One study of 600 women indicates that smokers and former smokers are twice as likely to develop incontinence than women who never smoked.

Physical Benefits After Quitting

Time After Last Cigarette  Physical Response 
 20 minutes  Blood pressure and pulse rate return to normal
 8 hours  Levels of carbon monoxide and oxygen in the blood return
to normal
 24 hours  Chance of heart attack decreases
 48 hours  Nerve endings start to regrow; ability to taste
and smell increases
 72 hours  Bronchial tubes relax; lung capacity increases
 2 weeks
to 3 months
Improved circulation; lung function increases up to 30% 
 1 to 9 months  Decreased incidence of coughing, sinus infection, fatigue, and shortness of breath; regrowth of cilia in lungs, increasing the ability to handle mucus, clean the lungs, and reduce chance of infection; overall energy level increases

Who Smokes?

According to the American Heart Association's 2000 statistics, 26.3 million men (27.6%) and 22.7 million women (22.1%) smoke. The risk varies by ethnic group and geographic location. 

Ethnicity and Gender:  In the US, smoking rates among men of different ethnic backgrounds are as follows from highest to lowest:

  • Native Americans (37.9%)

  • African American (32.1%)

  • Caucasian American (27.4%)

  • Hispanic American (26.2%)

  • Asian/Pacific Islanders (21.6%)


Among women the percentages are: 

  • Native American (31.3 %)

  • Caucasian American (23.3%)

  • African American (22.4%)

  • Hispanic American (14.3%)

  • Asian/Pacific Islanders (12.4%)


Smoking may pose the highest danger for African-Americans, who appear to metabolize nicotine differently from other ethnic groups. Nicotine uptake is as much as 30% higher in African American smokers than in Caucasian smokers. This increased absorption may further increase the risk for nicotine addiction and related health problems.

Geography:  Geography also affects smoking. In a 1998 study of U.S. smokers, people in Kentucky, Missouri, Arkansas, Nevada, and West Virginia had higher than average smoking rates. In fact, the highest lung cancer rates in the country are also in the Southeast. The lowest smoking rates were in Utah, California, Hawaii, Idaho, and Washington, D.C.

Educational Level:  Those with less education have higher smoking rates (37.5% in people educated from grades nine to 11) than those with more education (14% in people educated beyond college). (College educated smokers, however, may be more likely to suffer from depression than less educated smokers, and so may have more trouble quitting.)


Adolescence. While smoking is on the decline in adults, first use of cigarettes rose 30% among teenagers between 1988 and 1996. Each day, between 2000 and 3000 young people become regular smokers. (Discouraging 1999 and 2000 studies of high school and colleges students reported that cigarette use was at about 28%.) The incidence is highest in white teenagers. Smoking is immediately addictive: adolescents who have smoked 100 cigarettes or more, according to one report, are generally not able to quit even if they want to.
One 1998 study estimated that advertising could be responsible for a third of teenage smoking. New regulations are making it more difficult for advertisers to promote smoking to young people, but more high school students are taking up smoking now, despite stepped-up anti-smoking campaigns. The most important step for preventing smoking in children is for the parent to not smoke. One study reported that preschoolers whose parents smoke are more likely to view themselves as future smokers.

Older Adults. Older people are less likely to be smokers. Among people aged 55 to 64 years, about 24% are smokers. Between 65 and 74 years the smoking rate drops to 15%, and among those aged 75 or older, the rate is 8%.
Psychological Factors:  Psychological factors play a major role in people's susceptibility to smoking. Depression is a well-known risk factor for smoking and increases the danger of starting young. Indeed, nicotine may stimulate receptors in the brain that improve mood in certain people with genetically-induced depression. People with low self-esteem and adolescents with behavioral problems have a higher risk for smoking.

Genetic Factors:  Evidence now strongly supports genetic factors as a major risk factor for nicotine dependence, and researchers are now targeting specific genes that may be responsible. Among the findings is a common genetic vulnerability to both nicotine and alcohol dependence. (For some people who wish to stop drinking as well as smoking, a dual recovery process can be effective.)

Economic Factors:  Some studies suggest that the cheaper it is to smoke the more widespread smoking will be. For example, states that have low excise taxes on cigarettes have a high proportion of smokers. And, conversely, making it more expensive to smoke could reduce the number of smokers.


Why Do Smokers Fail To Quit?

Although over a quarter of American adults continue to smoke, about 70% of them want to quit. Unfortunately, in one study of women smokers who said they wanted to stop smoking, 80% of them were unable to. Withdrawal is a difficult process. Even after years of not smoking, about 20% of ex-smokers still have occasional cravings for cigarettes. People who keep trying, however, have a fifty-fifty chance of finally quitting. In any case, the attempts to quit are never a waste of time, since the amount of smoking is reduced during these periods. The smoker is up against an army of obstacles to quitting.

Individual Risk Factors for Failure:  Researchers have been trying to discover individual risk factors or sets of behaviors that can help predict why specific people fail to quit. Some factors include:

Being female
Being a heavy smoker
Inhaling deeply
Being a long-term smoker
Severe withdrawal symptoms
Among many studies, however, only one found a single consistent factor for failure to quit:

cheating during the first two weeks of withdrawal, even with the patch, nearly guarantees smoking again in six months. (In one study, nearly half of the people who did not cheat during the first two weeks were still not smoking after six months.)
Addictive Aspects of Nicotine:  Nicotine is a psychoactive drug, and some researchers feel it is as addictive as heroin. In fact, nicotine has actions similar to cocaine and heroin in the same area of the brain.

Depending on the amount taken in, nicotine can act as either a stimulant or a sedative. Cigarette smoking (either the nicotine or the oral process of smoking itself) has definite immediate positive effects:

It relieves minor depression.
It helps suppress little fits of anger.
It enhances concentration and short-term memory.
It produces a modest sense of well being.
The addictive process of smoking has a specific daily cycle:

Most smokers have a special fondness for the first cigarette of the day because of the way brain cells respond to the day's first nicotine rush. Nicotine, particularly taken in first few cigarettes of the day, increases the activity of dopamine, a chemical in the brain that elicits pleasurable sensations, a feeling similar to achieving a reward.
During the day, however, the nerve cells become desensitized to nicotine; smoking becomes less pleasurable, and smokers may be likely to increase their intake to get their “reward.” A smoker develops tolerance to these effects very quickly and requires increasingly higher levels of nicotine.
Withdrawal in the First Two Weeks:  Because the first two weeks are so critical in determining quitting failure rates, smokers should not be shy about seeking all the help they can during this period.

Withdrawal symptoms begin as soon as four hours after the last cigarette, generally peak in intensity at three to five days, and disappear after two weeks. They include both physical and mental symptoms.

Physical Symptoms. During the quitting process people should consider the following physical symptoms of withdrawal as if they were recuperating from a disease and treat them as they would any other physical symptoms:

Tingling in the hands and feet
Intestinal disorders (cramps, nausea)
Cold symptoms as the lungs begin to clear (sore throats, coughing, and other signs of colds and respiratory problem)
Mental and Emotional Symptoms. Tension and craving build up during periods of withdrawal, sometimes to a nearly intolerable point. One European study found that the incidence of workplace accidents increases on “No Smoking Day,” a day in which up to 2 million smokers either reduce the amount they smoke or abstain altogether.

Nearly every moderate to heavy smoker experiences more than one of the following strong emotional and mental responses to withdrawal:

Feelings of being an infant: temper tantrums, intense needs, feelings of dependency, a state of near paralysis.
Mental confusion
Depression is common in the short and long term. In the short term it may mimic the feelings of grief felt when a loved one is lost. As foolish as it sounds, a smoker should plan on a period of actual mourning in order to get through the early withdrawal depression.

Long-Term Depression

There is a significant association between cigarette smoking and a susceptibility to depression. People who are prone to depression face a 25% chance of triggering depression when they quit smoking. And, depressed smokers have a very low level of success; only about 6% remain smoke-free after a year. There are strong reasons for this:

Smoking may be masking major depression, which can become severe even after the early stages of withdrawal have passed.
For some smokers, the future physical damage incurred by smoking is an abstraction, which fails to motivate quitting when measured up against the very real emotional pain triggered by nicotine withdrawal.
Not only does the smoker suffer, but also the negative emotions often harm relationships with friends and family, who might even urge the ex-smoker to take up cigarettes again.
People who suffer from depression associated with quitting might do better using a combination of emotionally supportive therapy (as opposed to behavioral therapy), nicotine replacements, and temporary use of antidepressants, such as bupropion (Zyban). If severe depression lasts beyond withdrawal, professional help should be sought as soon as possible.

Weight Gain

The emphasis on weight loss in our society has given many people an excuse to start or continue smoking.

Effects of Smoking on Calories. Smoking does indeed use up calories, about 200 a day according to one study. A 1999 study reported that smoking increases energy expenditure in men by 3.6% at rest and by 6.3% during physical activity. (Actually, the higher level during exercise was only because the men inhaled more deeply during that time.)

Reasons for Weight Gain after Quitting. Quitting can add five or more pounds, due to the following reasons:

Obviously, the body is working better. After quitting, the body's metabolism slows down, and food is digested more efficiently.
Insulin levels increase, enabling the body to process more sugar for energy.
People snack as an oral substitution.
Long Terms Effects of Abstinence on Weight. One 1998 study reported that people who quit smoking put on more weight than expected, and although they gained most of the weight in the first year, they kept adding weight over a period of five years. This contradicts other studies that ex-smokers lost their extra weight over a year or two and that the longer they abstained from smoking the more weight they lost. Indeed, an encouraging 1999 study reported that weight gain tends to peak between two and four years after quitting and then declines to the same rate as those who never smoked.

Keeping the Weight Off. It should be noted that to use up the 200 calories gained from quitting smoking, one need only take an extra 15-minute daily walk and eliminate 100 calories a day from meals. Even a moderate increase in physical activity among middle-aged women who have quit smoking can help keep weight gain to a minimum. (Using Zyban also appears to help protect against weight gain.)

What Are Methods for Quitting Smoking?

At this time the most effective methods for quitting is a combination of nicotine replacement products and the antidepressant bupropion (Zyban) bolstered by counseling.

Cold Turkey:  After a year only about 4% of smokers who quit without any outside help succeed. Nevertheless, most people try to quit alone and many have reported activities that can help the process of withdrawal [ see Table, below]. The primary obstacle in trying to quit alone is making the behavioral changes necessary to eliminate the habits associated with smoking. Excellent books, tapes, and manuals are available and are strongly recommended to help people who want to quit without other assistance.

Nicotine Replacement:  Nicotine replacement products provide low doses of nicotine that do not contain the contaminants found in smoke. They are proving to be twice as helpful as other standard quitting methods. Replacement products include nicotine patches, gums, nasal sprays, and inhalers. A 2000 English study indicated that about 20% of people who use nicotine replacement products and have some support from health professionals will abstain for at least a year and about 10% will remain nonsmokers. (Unfortunately this rate is not much better than using placebo, although adding the antidepressant Zyban is improving this rate.) (In spite of the obvious health benefits from nicotine replacement treatments, only about a quarter of HMOs reimburse smokers for these aids.) There is no evidence yet that one product is any better than another, but individual preferences vary.

Tips for All Nicotine Replacement Products:

Not cheating on the very first day of nicotine-replacement use increases the chance of quitting permanently by tenfold.
No one should use these replacement therapies as a substitute for smoking. Any nicotine replacement therapy should be temporary and directed at quitting. In one study, use of nicotine gum for more than year was associated with insulin resistance, an abnormality that occurs in diabetes.
Adding a counseling program may boost the effect of any nicotine replacement program. (One study reported a quit rate of 30.5% after a year in patients who wore the patch and attended a smoking program.)
The antidepressant Zyban may be particularly useful in addition to nicotine replacement in ensuring long-term abstinence in people who suffer with depression because or independently of withdrawal.
No one should smoke while using nicotine replacement. It can cause nicotine to build up to toxic levels.
Nicotine replacement helps prevent weight gain while it is being used but people are still at higher risk for gaining weight when they stop all nicotine.
Side Effects: Side effects of any nicotine replacement product may include headaches, nausea, and other gastrointestinal problems. People often experience sleeplessness in the first few days, particularly with the patch, but the insomnia usually passes. Patients using very high doses are more likely to experience symptoms, and reducing the dose can prevent them.

Special Concerns: Certain individuals may need to be aware of some concerns with nicotine replacement products. Most studies have been conducted using the patch, but results may apply to other replacement products as well.

People with Heart Disease: There has been some concern that the patch might be harmful for people with heart or circulatory disease, but studies are finding that it poses no danger for these individuals. In fact, it may help reduce angina attacks brought on by exercise. Nevertheless, unhealthy cholesterol levels (lower HDL levels) caused by smoking remain abnormal with the use of nicotine replacement (at least with the use of the patch). HDL levels improve when all nicotine is stopped.

Pregnant Women: Nicotine replacement may not be completely safe in pregnant women. There is an increase in heart rates in fetuses of women who use the patch as compared with those who smoke. Because this may be an indication of fetal stress, pregnant women are cautioned to remove the patch before bedtime.

Adolescents: Nicotine replacement is safe for adolescents.

Small Children: Nicotine is a poison and all nicotine products should be kept safely away from small children. A parent should call a physician or a poison control center immediately if a child has been exposed to a nicotine replacement product, even for a short duration. Parents should also call their health practitioner if a small child has been exposed to a nicotine product and has any symptoms, including stomach upset, irritability, headache, rash, or fatigue.

Nicotine Patches:  Nicotine patches, or transdermal nicotine, can be an effective way to quit smoking. The quit rate for patch users is around 20% after six months, twice the rate of those who try to quit cold turkey. Nicotine patches are available over the counter, but it is best to consult a doctor before using them, particularly people with any medical problems. They are probably the best nicotine replacement products for people with asthma or other chronic lung problems.

The patch products available have different approaches:

NicoDerm CQ includes patches that come in three strengths (21, 14, and 7 mg), which are used in a step-down program over a period of 8 to 10 weeks. The initial set of large patches is replaced after about three weeks with a smaller, less potent set. For heavy smokers, this process is usually repeated one more time using an even smaller patch. Using these patches for 8 weeks provides the maximum benefit.
Nicotrol is a single-step patch and can be taken off after 16 hours and replaced 8 hours later. It can only be taken for six weeks.
Perigo offers two strengths and does not require tapering. The 22 mg patch is for those who smoke more than 16 cigarettes per day, and the 11 mg patch is for those smoking 15 or less each day.
The patches are all applied in similar ways:

A single patch is worn each day and replaced after 24 hours.
To avoid skin irritation it is applied to different hairless locations above the waist and below the neck each day. (Transparent patches are now available, which allows greater area for application.)
People can wear the patches for 24 hours, but some have reported odd dreams and have disliked the sensation of the patch during the night. People who wear the patch all the time, however, have less withdrawal symptoms and slightly better abstinence rates than those who take it off at night.
Patches should be stored and discarded safely, particularly in homes with small children. Small children have been poisoned (not fatally so far) from wearing, chewing, or sucking on nicotine patches.
The FDA recommends the patch for three to five months, although some studies suggest that using it for eight weeks is just as effective.
Special precautions should be made if children are exposed to the patches:

Children should not come in contact with the patches, even while the smoker is wearing them.
If the child has worn the patch, the affected skin should be washed right away.
Urgent medical care may be required if the child has eaten nicotine or worn a patch for a prolonged time. (The hazard increases if the child has been exposed to more than one patch or one that has not been used.)
Nicotine Gum:  Nicotine gum (Nicorette), available over the counter, has also been effective for a number of people. Some prefer it to the patch because they can control the nicotine dosage and chewing satisfies the oral urge. Long-term dependence may be a problem with this method. Although such dependence is probably safer than smoking, research is needed to confirm this and experts recommend chewing the gum for no more than six months.

Some tips for using the gum are as follows:

Patients starting to quit chew one to two pieces each hour. A smoker should not chew more than 20 pieces a day.
The goal is to stop using the gum by six months, but about 3% of people continue to use it long after they have quit smoking.
The gum must be chewed slowly until it develops a peppery taste. It is then tucked between the gum and cheek where it is stored so that the nicotine can be absorbed.
Coffee, tea, soft drinks, and acidic beverages may interfere with nicotine absorption, so people should wait at least 15 minutes after drinking before chewing a piece of gum.
Some people prefer other methods or cannot use the gum for the following reasons:

They find gum unpleasant tasting.
Side effects specific to the gum that may include upset stomach, mouth ulcers, hiccups, and throat irritation.
They are embarrassed chewing gum.
They wear dentures.
The Nicotine Inhaler:  The nicotine inhaler resembles a plastic cigarette holder. It comes with a number of nicotine cartridges that are inserted into the inhaler. It requires a prescription in the U.S. Four studies have reported that the inhaler triples abstinence rates (between 17% and 28%) compared with placebo (6% to 9%) for a six-month period. It has some specific advantages over other slower nicotine replacement products:

It provides varying doses of nicotine on demand (as opposed to continuously with the patch or the gum).
It satisfies the oral urges.
Most of the nicotine vapor is delivered in the mouth (although some people experience throat irritation).
The Nicotine Nasal Spray:  The nasal spray satisfies immediate cravings by providing doses of nicotine rapidly and thus may play a useful role in conjunction with slower acting nicotine replacement therapies. The spray can irritate the nose, eyes, and throat, but most people can tolerate the side effects that usually subside within the first few days. Unfortunately one small study found that at the end of the year, only 16% were still abstaining.


Reduced-Smoke Cigarette: Special Warning?:  A new cigarette (Eclipse) is a reduced-smoke cigarette. It works in the following way:

The smoker lights a carbon rod at the tip of the cigarette.
The heat passes from the carbon rod through a layer of tobacco. The carbon rod is insulated by glass fiber mat, so the tobacco is heated rather than burned.
The smoker inhales.
Nicotine and other substances in the cigarette are delivered to the lungs similar to using an aerosol device.
It should be strongly noted, unlike nicotine replacement products, this cigarette has undergone no rigorous independent studies. In spite of a massive advertising efforts, this product should not be regarded as a safer form of smoking.

To date no independent studies support manufacturer claims that Eclipse poses less risk for cancer or lung disease. One potential danger, in fact, is that the glass insulating fibers can become dislodged and inhaled into the lungs. Their carcinogenic effects in the lungs may be similar to asbestos fibers.

Even the manufacturers do not claim any lower risk for heart disease than conventional cigarettes. In fact, Eclipse may increase carbon monoxide levels, a danger to the heart.


Bupropion (Zyban):  A unique antidepressant called bupropion (Zyban) is proving to be a strong aid in the quitting process. This agent increases the effects of certain neurotransmitters, particularly dopamine, which may play a strong role in nicotine addiction.

Success Rates. Taking the drug alone produces higher smoking rates than placebo and taking it along with nicotine replacement is even more successful. In one 2000 study, after a year the following people were still not smoking:

5.6% of people on placebo.
9.8% of those on the nicotine patch.
18.4% of those treated with Zyban alone.
22.5% of those treated with Zyban and nicotine replacement.
Temporary weight loss is a possible side benefit of the drug, although people generally regain it after they stop the antidepressant. In people who are not depressed, there is no noticeable effect on mood. People who are depressed generally report better spirits and more energy.

Typical Regimen:

The smoker takes Zyban twice a day for five days before the quit date.
On the day the smoker quits, the dose is increased to three times a day.
The smoker may or may not choose to take nicotine replacement at that time.
Generally people take Zyban for about 8 weeks in total, although some researchers are investigating longer use of the antidepressant to increase the duration of abstinence and perhaps maintain weight loss.
Side Effects. Side effects include gastrointestinal problems, headache, insomnia, dry mouth, and irritation. In very rare cases, seizures have occurred, although usually in people who exceeded the recommended dose or who already had risk factors for seizure.

Outside Support:  People who have such outside help have the best record for quitting, with success rates of between 25% and 35%. (Those who are counseled and use nicotine replacement and Zyban have the best chance.) According to recent research the two most successful behavioral interventions are:

supportive care by a clinician, or
training in problem solving or coping.
Telephone hotlines offering counseling also help, especially when smokers receive follow up calls. The more intense the counseling program the better. Smokers should look for programs that include the following:

20 to 30 minute session lengths
four to seven sessions
two week program duration
Even brief advice by a clinician (three minutes or less) can help. In one study this modest intervention increased the long-term quit rate from 7.9% to 10.2%.

Alternative and Other Methods for Quitting

Scheduled Reduction. One study showed that people who used a systematic withdrawal schedule were twice as likely to quit as those who went cold turkey. The procedure involves the following steps:

Divide the number of minutes per day awake by the number of daily cigarettes; the result is the minute-long wait between smokes.
Set up a schedule with time intervals based on this result and using a timer, smoke only at those intervals; if the "cigarette appointment" is missed by more than five minutes, the smoker must skip that cigarette.
The following week, one-third fewer cigarettes are used and the smoking time is recalculated based on the lower number.
During the third week the count is again reduced by a third, and the smoker quits in the fourth week.
(Those who are unable to smoke during working hours could try calculating the intervals based on the usual smoking times of the day.)

Hypnosis. Some people report successful cessation from smoking with hypnosis in individual sessions. Group sessions appear to be worthless. The process is effective only if the subject trusts the therapist and can feel completely at ease in the vulnerable and passive state necessary for hypnotic susceptibility. A typical effective session includes the following steps:

The hypnotherapists uses various techniques (e.g., imagery, silent counting) to put the subject in a relaxed state.

When the subject is very relaxed, but not asleep, the hypnotherapist quietly suggests motivations for not smoking.

The hypnotherapist should also reinforce a positive self-image while the subject is in deep relaxation. This helps many people avoid the depression that accompanies withdrawal.

The session usually takes about an hour.

The patient is taught methods of self-hypnosis to use at home, and there is usually one follow-up reinforcing session.

Acupuncture. The acupuncture technique for quitting smoking usually uses tiny curved staples attached to three different points around the edge of the ear. The procedure is entirely painless. The patient is instructed to press each staple in sequence for a few seconds whenever the craving for a cigarette occurs. There are no side effects except for some soreness if the staple is pressed too hard. Analysis of studies indicates, however, that acupuncture is no more effective than any other method for quitting smoking.

Some Tips For Quitting

Decide on a Specific Quit Date:  For some people, choosing a particular date to quit is helpful when no or low stress is anticipated for at least the first three days afterward. Women affected by PMS should avoid quitting right before their periods. (If smokers lose their nerve on the chosen day, they must not get discouraged but should simply choose another one as soon as possible.)

Let the Body and Mind Heal during Withdrawal:  Retreat from the world when cravings become overwhelming: take naps, warm baths or showers, meditate, read novels.

Assist the body in getting rid of nicotine. Drink plenty of water, eat fresh fruits, vegetables, whole grains, and fiber-rich foods. Carrots, apples, and celery are good munching foods.

When cravings occur, hold your breath as long as possible or take a few deep rhythmic breaths.

Use meditation or relaxation and deep breathing exercises. In fact, taking deep breaths when the urge o smoke occurs is a good stop gap measure.

Get Family and Friends Involved.  Tell all your friends and family that you've already quit, so you'll be embarrassed if they catch you smoking.

Pay a family member or friend if they catch you smoking. The amount should be large enough ($5 to $20) to be a deterrent, but not too large as to be ridiculous.

If your partner smokes, try and persuade him or her to quit or at the very least not to smoke around you and others.

Exercise.  An enjoyable exercise program is a great asset. Studies continue to show that smokers who exercise, vigorously if possible, can greatly increase their ability to quit smoking, while reducing their risk for weight gain. Move the muscles when craving occurs. Dance, run, walk, jump up and down, stretch, do push-ups. Yoga is an excellent exercise program for quitting.

Maintain a Healthy Diet.  Eat plenty of fresh, crunchy fruits and vegetables. This is also a useful way of satisfying oral cravings without adding many calories.

Drink plenty of water and healthy beverages.

Weight gain is a problem in quitting. One study reported that a low-calorie diet during withdrawal and for the first few weeks helped women prevent weight gain and improved abstinence significantly compared to those on a normal diet, even when subjects went off this diet later on.

Change Daily Habits.  Change the daily schedule as much as possible. Eat at different times or eat many small meals instead of three large ones, sit in a different chair, rearrange the furniture.

Find other ways to close a meal. Play a tape or CD, eat a piece of fruit, get up and make a phone call, or take a walk (a good distraction that burns calories as well).

Substitute oral habits (eat celery, chew sugarless gum, suck on a cinnamon stick.) One small study comparing men who had quit for 10 years with those who failed found that those who substituted other types of oral behavior were more likely to succeed in quitting than those who didn't. People who simply tried to distract themselves with busy activities were typical of those who relapsed.

Go to public places and restaurants where smoking is prohibited or restricted.

Set short-term quitting goals and reward yourself when they are met, or every day put the money normally spent on cigarettes in a jar and buy something pleasurable at the end of a predetermined period of time.

Find activities that focus the hands and mind but are not taxing or fattening: computer games, solitaire, knitting, sewing, whittling, crossword puzzles.

Avoid heavy drinking of alcohol, caffeine, or other stimulants or mood altering substances.

Make an Oath.  Take an extreme "sacred" or superstitious oath. (Example: "If I smoke one more cigarette my dog will die.") Although this seems absurd, some people, even well-educated individuals, who have failed all other methods have reported that they quit completely and successfully after taking such an oath.

What Should Smokers And Former Smokers Do To Protect Themselves Against Harmful Effects Of Smoking?

It is so difficult to quit that smokers should never feel inadequate if they fail. In fact, self-recriminations and guilt only reinforce the low self-esteem and depression that helps cause smoking behavior in the first place. So the cycle continues. Everyone who smokes should simply assume that at some point they will be able to quit, even if they have relapsed many times. Whether or not smokers can stop smoking, they and former smokers should begin immediately to change any other behaviors that might be damaging their health.

Exercise:  Any smoker who is able to and is not exercising should start after discussing an appropriate program with their physician. Regular exercise reduces a smoker's risk of heart disease (although still not to the level of a nonsmoker.) Exercise does not lower a smoker's risk for lung cancer or emphysema.
Regular Check-Ups:  Smokers should be assiduous about screening programs for any disorders that are increased with smoking. They should have their cholesterol and blood pressure checked regularly. Women should have annual Pap smears. All older adults should be screened for colon cancer. Smokers might ask their physicians about recent computed tomography (CT) screening programs, which might detect lung cancer in early stages. (At this time, they are not usually covered by insurance.)
Healthy Diet:  Everyone should also maintain a healthy diet, with foods rich in whole grains and fruits and vegetables (particularly dark colored ones). Saturated fats should be avoided, and people should choose monounsaturated fats, which are contained in olive oil, or fats from oily fish. (All fats are high in calories and former smokers particularly should be careful to use even these fats in moderation.) Two studies have indicated that eating fish more than twice a week might help limit the tobacco damage in people who are not heavy smokers (more than a pack and a half a day.)
Vitamins and Supplements:  Even with a healthful diet, however, smoking reduces the levels of a number of vitamins. Some research suggests that supplements of folic acid, a B vitamin, and the antioxidants vitamins E and C and selenium may improve lung function. According to two studies, daily vitamin E supplements were associated with reduced risk for prostate cancer among smokers, and in another, higher levels of vitamin E were associated with a lower risk for lung cancer. It should be strongly noted that taking another well-known antioxidant, beta-carotene, has been associated in more than one study with higher rates of lung cancer in smokers. The best way of achieving healthy levels of important nutrients is from healthy food

Where Else Can Help Be Obtained For Quitting Smoking?

American Cancer Society
1599 Clifton Road, NE
Atlanta, GA 30329
Call: 800-ACS-2345 or 404-320-3333

On the Internet:



The ACS offers a good program that covers four one-hour sessions during over a two-week period. They claim that 20% to 30% of people remain off cigarettes. Call to find the nearest program for quitting smoking.


The American Lung Association

1740 Broadway
New York, New York 10019-4374
Call (800-LUNG-USA) , 212-315-8700 or

On the Internet:


The association is very responsive and offers a wide range of information and services.


National Cancer Institute

Building, 31, Room 10A03
31 Center Drive, MSC 2580
BETHESDA, MD 20892-2580 USA
Call: 800-422-6237 or 301-435-3848

On the Internet:


The NCI offers free information on quitting smoking.


Nicotine Anonymous World Services

Call: 415-750-0328

On the Internet:



The organization uses the same principles as Alcoholics Anonymous. It offers a directory of meeting places and times in many locations.


Agency for Health Care Policy and Research

Publications Clearinghouse
2101 E. Jefferson St., Suite 501
Rockville, MD 20852
Call: 800-358-9295

On the Internet:



The American Council on Science and Health

1995 Broadway
New York, NY 10023
On the Internet:


Offers very useful information on health consequences of smoking.


The American Society of Clinical Hypnosis

130 East Elm Court, Suite 201
Roselle, IL 60172
On the Internet:


To find a reliable hypnotherapist send a self-addressed stamped envelope to:

The Society for Clinical and Experimental Hypnosis

3905 Vincennes Rd., Suite 304
Indianapolis, IN 46268



American Academy of Medical Acupuncture

Call: 800-521-2262
On the internet:


To find an acupuncturist in ones location:




Please visit our Health Links page for some additional useful sites.

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Alcohol & Other Drugs:

How Can I Tell if a Friend or a Loved One Has a Problem With Alcohol or Other Drugs?

Sometimes it is tough to tell. Most people won't walk up to someone they're close to and ask for help. In fact, they will probably do everything possible to deny or hide the problem. But, there are certain warning signs that may indicate that a family member or friend is using drugs and drinking too much alcohol.

If your friend or loved one has one or more of the following signs, he or she may have a problem with drugs or alcohol:

Getting high on drugs or getting drunk on a regular basis
Lying about things, or the amount of drugs or alcohol they are using
Avoiding you and others in order to get high or drunk
Giving up activities they used to do such as sports, homework, or avoiding friends who don't use drugs or drink
Having to use more alcohol or other drugs to get the same effects
Constantly talking about using drugs or drinking
Believing that in order to have fun they need to drink or use other drugs
Pressuring others to use drugs or drink
Getting into trouble with the law
Taking risks, including sexual risks, and driving under the influence
Feeling run-down, hopeless, depressed, or even suicidal
Getting suspended from school for an alcohol- or drug-related incident
Missing work or poor work performance because of drinking or drug use
Many of the signs, such as sudden changes in mood, difficulty in getting along with others, poor job or school performance, irritability, and depression, might be explained by other causes. Unless you observe drug use or excessive drinking, it can be hard to determine the cause of these problems. Your first step is to contact a qualified alcohol and drug professional in your area who can give you further advice.

How Can I tell if I Have a Problem with Drugs or Alcohol?

Drug and alcohol problems can affect every one of us regardless of age, sex, race, marital status, place of residence, income level, or lifestyle.

You may have a problem with drugs or alcohol, if:

You can't predict whether or not you will use drugs or get drunk.
You believe that in order to have fun you need to drink and/or use drugs.
You turn to alcohol and/or drugs after a confrontation or argument, or to relieve uncomfortable feelings.
You drink more or use more drugs to get the same effect that you got with smaller amounts.
You drink and/or use drugs alone.
You remember how last night began, but not how it ended, so you're worried you may have a problem.
You have trouble at work or in school because of your drinking or drug use.
You make promises to yourself or others that you'll stop getting drunk or using drugs.
You feel alone, scared, miserable, and depressed.
If you have experienced any of the above problems, take heart, help is available. More than a million Americans like you have taken charge of their lives and are living healthy and drug-free.

How Can I Get Help?

You can get help for yourself or for a friend or loved one from numerous national, State, and local organizations, treatment centers, referral centers, and hotlines throughout the country. There are various kinds of treatment services and centers. For example, some may involve outpatient counseling, while others may be 3- to 5-week-long inpatient programs. While you or your friend or loved one may be hesitant to seek help, know that treatment programs offer organized and structured services with individual, group, and family therapy for people with alcohol and drug abuse problems. Research shows that when appropriate treatment is given, and when clients follow their prescribed program, treatment can work. By reducing alcohol and/or drug abuse, treatment reduces costs to society in terms of medical care, law enforcement, and crime. More importantly, treatment can help keep you and your loved ones together. Remember, some people may go through treatment a number of times before they are in full recovery. Do not give up hope.

Facts about Alcohol

Alcohol abuse is a pattern of problem drinking that results in health consequences, social, problems, or both. However, alcohol dependence, or alcoholism, refers to a disease that is characterized by abnormal alcohol-seeking behavior that leads to impaired control over drinking.
Short-term effects of alcohol use include:

Distorted vision, hearing, and coordination
Altered perceptions and emotions
Impaired judgment
Bad breath
Long-term effects of heavy alcohol use include:

Loss of appetite
Vitamin deficiencies
Stomach ailments
Skin problems
Sexual impotence
Liver damage
Heart and central nervous system damage
Memory loss

How Do I Know If I, or Someone Close, Has a Drinking Problem?

Here are some quick clues:

Inability to control drinking -- it seems that regardless of what you decide beforehand, you frequently wind up drunk
Using alcohol to escape problems
A change in personality -- turning from Dr. Jekyll to Mr. Hyde
High tolerance level -- drinking just about everybody under the table
Blackouts -- sometimes not remembering what happened while drinking
Problems at work or in school as a result of drinking
Concern shown by family and friends about drinking
If you have a drinking problem, or if you suspect you have a drinking problem, there are many others out there like you, and there is help available. Talk to school counselor, a friend, or a parent.

Facts about Benzodiazepines

Clinicians, for an array of therapeutic objectives, prescribe most benzodiazepines. However, misusing or mixing these drugs can be very dangerous.   Effects of benzodiazepines can include:
Diminished libido
Increased sensitivity to alcohol
Serious suppression of vital functions occurs when these drugs are combined with other depressants, most often alcohol.

Facts about Cocaine

Cocaine is a white powder that comes from the leaves of the South American coca plant. Cocaine is either "snorted" through the nasal passages or injected intravenously. Cocaine belongs to a class of drugs known as stimulants, which tend to give a temporary illusion of limitless power and energy that leave the user feeling depressed, edgy, and craving more. Crack is a smokable form of cocaine that has been chemically altered. Cocaine and crack are highly addictive. This addiction can erode physical and mental health and can become so strong that these drugs dominate all aspects of an addict's life.
Physical risks associated with using any amount of cocaine and crack:

Increases in blood pressure, heart rate, breathing rate, and body temperature
Heart attacks, strokes, and respiratory failure
Hepatitis or AIDS through shared needles
Brain seizures
Reduction of the body's ability to resist and combat infection
Psychological risks associated with using any amount of cocaine and crack:

Violent, erratic, or paranoid behavior
Hallucinations and "coke bugs"--a sensation of imaginary insects crawling over the skin
Confusion, anxiety and depression
Loss of interest in food or sex
“Cocaine psychosis" -- losing touch with reality, loss of interest in friends, family, sports, hobbies, and other activities Some users spend hundreds of thousands of dollars on cocaine and crack each week and will do anything to support their habit. Many turn to drug selling, prostitution, or other crimes.
Cocaine and crack use has been a contributing factor in a number of drownings, car crashes, falls, burns, and suicides. Cocaine and crack addicts often become unable to function sexually. Even first time users may experience seizures or heart attacks, which can be fatal.

Facts about Ecstasy

Ecstasy is chemically known as MDMA, or Methyline Dioximethamphetamine. Like amphetamines, it is a stimulant to the central nervous system. Sometimes MDMA is classified as a hallucinogen; this is due to its chemical makeup. Ecstasy takes the form of pills, though there are scores of different types. According to some sources, six new designs are produced every month. Some include red and black capsules, known as “Dennis the Menace;” “White Doves,” white pills with dove imprints; “hamburgers,” white or off-white tablets; and “Disco Biscuits,” large flat white tablets with brown speckles.
Short-term effects of using Ecstasy:

A “high” that masks the feelings of tiredness.
Reputation of producing a feeling of expansive well-being and a perception of heightened senses.
Potential long-term effects include:

Damage to the areas critical for thought and memory
Continued use may lead to permanent brain damage
The brain cannot immediately refuel the amount of serotonin used to create the “high”
Depression, lasting days to weeks, after coming down off the drug
Dehydration and hypertension from dancing all night and not drinking enough fluids; or from combining Ecstasy with alcohol. This combination has caused collapse and failure of body organs like the kidneys, heart and/or liver.
Internal bleeding that leads to death because Ecstasy prevents the blood from clotting.
Use has lead to heart attacks, strokes, and seizures.
The drugs effects last approximately 3 to 6 hours, though confusion, depression, sleep problems, and paranoia have been reported to occur weeks after the drug was taken.

A wide range of products has been passed off as Ecstasy, ranging from pure amphetamines, paracetamol, methadone, worming pills and fish tank oxygenating tablets. Apart from users conducting a chemical analysis on every tablet they take, they will have no guarantee as to the purity of the product.

Facts about GHB

Gamma Hydroxybutyrate (GHB) is a powerful and rapidly acting central nervous system depressant that was first synthesized in the 1960s. It is produced naturally by the body in small amounts but its physiological function is unclear. GHB was once sold in health food stores as a performance-enhancing additive in body building formulas. Currently, GHB is created in clandestine laboratories with no guarantee of quality of purity, making its effects less predictable and increasingly difficult to diagnose. GHB is commonly consumed orally, either as a grainy, white or sand-colored powder that is often dissolved in water or alcohol, or as a liquid sold in vials or small bottles.
The effects of GHB can include:

Loss of muscle tone
Reduction of inhibitions
Slowing of heart rate and respiration
Impairment of circulation, motor coordination, and balance
Severe interference with motor and speech control
A deep sleep, resembling a coma, may be induced, requiring intubation to awake user.
Nausea and vomiting
Respiratory distress
Loss of consciousness
Frequently during the clandestine production of GHB, too much of an acid solution is added to the mixture, which can cause severe esophageal erosion in users. GHB is commonly referred to as a Date Rape Drug because of its incapacitating effects. GHB is particularly dangerous when mixed with alcohol since alcohol increases its potency.

Facts about Hallucinogens

Hallucinogenic drugs are substances that distort the perception of objective reality. The most well-known hallucinogens include phencyclidine, otherwise known as PCP, angel dust, or loveboat; lysergic acid diethylamide, commonly known as LSD or acid; mescaline and peyote; and psilocybin, or "magic" mushrooms. Under the influence of hallucinogens, the senses of direction, distance, and time become disoriented. These drugs can produce unpredictable, erratic, and violent behavior in users that sometimes leads to serious injuries and death. The effect of hallucinogens can last for 12 hours. LSD produces tolerance, so that users who take the drug repeatedly must take higher and higher doses in order to achieve the same state of intoxication. This is extremely dangerous, given the unpredictability of the drug, and can result in increased risk of convulsions, coma, heart and lung failure, and even death.
Physical risks associated with using hallucinogens:

Increased heart rate and blood pressure
Sleeplessness and tremors
Lack of muscular coordination
Sparse, mangled, and incoherent speech
Decreased awareness of touch and pain that can result in self-inflicted injuries
Coma, heart and lung failure

Psychological risks associated with using hallucinogens:

A sense of distance and estrangement
Depression, anxiety, and paranoia
Violent behavior
Confusion, suspicion, and loss of control
Behavior similar to schizophrenic psychosis
Catatonic syndrome whereby the user becomes mute, lethargic, disoriented, and makes meaningless repetitive movements
Everyone reacts differently to hallucinogens -- there's no way to predict if you can avoid a "bad trip."

Facts about Heroin

The drug heroin itself is a semi-synthetic narcotic that’s been around just a little longer than the 20th century’s been around. Today, the U.S. government recognizes heroin as having no legitimate medical uses. As a result of the federal ban, all heroin available in the United States is illicitly made and distributed, which poses a double threat – in the form of questionable quality and unknown contaminants – that can seriously affect the health and lives of users. Users take heroin either by injecting, snorting, or smoking. Tolerance and addiction can occur from using. Addiction to heroin is physiological, involving the central nervous system and other body systems affected by the drug. It also involves a strong psychological component, which can continue to make life difficult for an ex-user months or years after the physical craving for the drug has gone.
Effects of heroin can include:

Respiratory depression (which can progress until breathing stops)
Constricted pupils
Withdrawal symptoms include:

Watery eyes
Runny nose
Loss of appetite
Muscle cramps
Elevations in blood pressure, pulse, respiratory rate, and temperature occur as withdrawal progresses. Symptoms of a heroin overdose include shallow breathing, pinpoint pupils, clammy skin, convulsion, and coma. Variability in the quality of street heroin can range from zero to 90%, greatly raising the risk of accidental overdose and death. Dangers linked to shooting heroin involve the same risk to the brain, lungs, liver, and eyes associated with shooting other drugs. And sharing needles is one of the primary routes for the spread of AIDS. Heroin’s potent pain-relieving properties may actually conceal symptoms of real physical illness or such diseases as pneumonia, and delay treatment.

Facts about Inhalants

Inhalants refer to substances that are sniffed or huffed to give the user an immediate head rush or high. They include a diverse group of chemicals that are found in consumer products such as aerosols and cleaning solvents. Inhalant use can cause a number of physical and emotional problems, and even one-time use can result in death.
Using inhalants even one time can put you at risk for:

Sudden death
Visual hallucinations and severe mood swings
Numbness and tingling of the hands and feet
Prolonged use can result in:

Muscle weakness
Abdominal pain
Decrease or loss of sense of smell
Nausea and nosebleeds
Violent behaviors
Irregular heartbeat
Liver, lung, and kidney impairment
Irreversible brain damage
Nervous system damage
Dangerous chemical imbalances in the body
Involuntary passing of urine and feces
Short-term effects of inhalants include:

Heart palpitations
Breathing difficulty
Remember, using inhalants even one time can kill you.  According to medical experts, death can occur in at least five ways:

Asphyxia--solvent gases can significantly limit available oxygen in the air, causing breathing to stop
Suffocation--typically seen with inhalant users who use bags
Choking on vomit
Careless behaviors in potentially dangerous settings
Sudden sniffing death syndrome, presumably from cardiac arrest.

Facts about LSD

LSD (lysergic acid diethlamide) is one of the major drugs making up the hallucinogen class. LSD was discovered in 1938 and is one of the most potent mood-changing chemicals. It is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains. LSD, commonly referred to as “acid,” is sold on the streets in tablets, capsules, and occasionally, in liquid form. It is odorless, colorless, and has a slightly bitter taste and is usually taken by the mouth. Often LSD is added to absorbent paper, such as blotter paper, and divided into small decorated squares, with each square representing one dose.
Sensations and psychological risks associated with LSD:

Sensations “cross over,” giving the user the feeling of hearing colors and seeing sounds.
Severe, terrifying thoughts and feelings; fear of losing control; fear of insanity or death; and despair.

Facts about Marijuana

The physical effects of marijuana use, particularly on developing adolescents, can be acute.
Short-term effects of using marijuana:

Difficulty keeping track of time, impaired or reduced short-term memory
Reduced ability to perform tasks requiring concentration and coordination, such as driving a car
Increased heart rate
Potential cardiac dangers for those with preexisting heart disease
Bloodshot eyes
Dry mouth and throat
Decreased social inhibitions
Paranoia, hallucinations
Long-term effects of using marijuana:

Enhanced cancer risk
Decrease in testosterone levels for men; also lower sperm counts and decreased fertility
Increase in testosterone levels for women; also increased risk of infertility
Diminished or extinguished sexual pleasure
Psychological dependence requiring more of the drug to get the same effect
Marijuana blocks the messages going to your brain and alters your perceptions and emotions, vision, hearing, and coordination. A recent study of 1,023 trauma patients admitted to a shock trauma unit found that one-third had marijuana in their blood.

Facts about Methamphetamine

Methamphetamine is a stimulant drug chemically related to amphetamine but with stronger effects on the central nervous system. Street names for the drug include "speed,""meth," and "crank." Methamphetamine is used in pill or powdered form for snorting or injecting. Crystallized methamphetamine known as "ice," "crystal," or "glass," is a smokable and more powerful form of the drug.
The effects of methamphetamine use include:

Increased heart rate and blood pressure
Increased wakefulness; insomnia
Increased physical activity
Memory loss
Psychotic behavior
Decreased appetite
Respiratory problems
Extreme anorexia
Convulsions and cardiovascular problems, both of which can lead to death
Violent behavior
Can cause irreversible damage to blood vessels in the brain, producing strokes
Methamphetamine users who inject the drug and share needles are at risk for acquiring HIV/AIDS. Researchers continue to study the long-term effects of this class of drugs.

Facts about Rohypnol

Rohypnol is the brand name for flunitrazepam, a benzodiazepine drug. It is in the same family of medications as Valium and Xanax. But, unlike these other drugs, Rohypnol has never been approved for any medical use in the United States. It is illegal to manufacture, distribute, or possess Rohypnol in this country. Rohypnol is most commonly found in tablet form. It is usually smuggled into this country in its original packaging. Sometimes, the packages are opened and the pills are put into vitamin jars or other medication bottles. Or, the pills may be ground into a powder. Rohypnol is occasionally found in liquid form. Impairments can last from 8 to 12 hours with a 1-mg. dose.
In 1998, Hoffman-LaRoche, the manufacturer of Rohypnol made several changes to these tablets to assist in decreasing the potential for its use in rape. The following changes have been made:

The new formulation emits blue dye as it dissolves in liquid.
Tablet coating makes it dissolve slowly in beverages.
The 2-mg. tablet was withdrawn from the market in 1996 – 1997. Introduction of new tablet will be coordinated with the removal of the round white 1-mg. tablet from the market in each country.
These changes only effect the pills bought legally in this country. Obviously, there are still illegal and homemade versions that will be odorless, colorless, and very potent.


The effects of Rohypnol use can include:

Impaired judgment
Reduced levels of consciousness
Partial amnesia
The combination of Rohypnol and alcohol can produce the following effects:

Extremely low blood pressure
Respiratory depression
Difficulty breathing
If you suspect you have been slipped Rohypnol or GHB, please get to a hospital or to the Health Center within 72 hours to have a urinalysis conducted.

Facts about Ritalin

Ritalin, referred to as Vitamin R or R-Ball on the street, is a stimulant medication commonly prescribed by clinicians to treat attention deficit hyperactivity disorder (ADHD). It is becoming one of the most frequently abused drugs across college campuses. Students use it as a study aid and to treat a hangover. Because it is a prescribed medication, Ritalin is often viewed as less dangerous than street drugs, such as cocaine. This is a misconception, however. Prescription drugs, including Ritalin, are potentially just as harmful, when misused, as illegal substances.

Ritalin, is a stimulant that in street use is crushed and inhaled; smoked; mixed with liquids; or swallowed. It is often obtained as a prescription and then shared. Large doses of this drug can lead to an elevated heart rate and blood pressure, increasing one’s risk of stroke or heart attack. Misuse can also cause a loss of appetite, tremors, muscle twitching, fevers, convulsions and headaches, paranoia, hallucinations, delusions, mania, impulsivity, and extreme agitation. A “crash,” or depressive phase, can occur after the initial high.

The individual sharing or selling the Ritalin can face charges of selling a controlled substance, possession of a controlled substance with intent to sell, and any of the other several laws that pertain to the distribution of a prescription medication. The user of an illegally obtained prescription can be charged with possession of a controlled substance.

Messages for Students

Know the law. Methamphetamines, marijuana, hallucinogens, crack, cocaine, and many other drugs are illegal. Depending on where you are caught, you could face high fines and jail time. Alcohol is illegal to buy or possess if you are under 21.
Be aware of the risks. Drinking or using drugs increases the risk of injury. Car crashes, falls, burns, drowning, and suicide are all linked to drug use.

Keep your edge. Drug use can ruin your looks, make you depressed, and contribute to slipping grades.

Play it safe. One incident of drug use could make you do something that you will regret for a lifetime.

Do the smart thing. Using drugs puts your health, education, family ties, and social life at risk.

Get with the program. Doing drugs isn't "in" anymore.

Think twice about what you're advertising when you buy and wear T-shirts, hats, pins, or jewelry with a pot leaf, joint, blunt, beer can, or other drug paraphernalia on them.

Face your problems. Using drugs won't help you escape your problems, it will only create more.

Be a real friend. If you know someone with a drug problem, be part of the

Remember, you DON'T NEED drugs or alcohol. If you think "everybody's doing it," you're wrong! Doing drugs won't make you happy or popular or help you to learn the skills you need. In fact, doing drugs can cause you to fail at all of these things.


Center for Substance Abuse Treatment
National Drug and Alcohol Treatment Referral Service

Referrals to:




Children of Alcoholics Foundation, Inc.
555 Madison Avenue, 20th Floor
New York, NY 10022
212-754-0656 or 1-800-359-COAF


Cocaine Anonymous
World Service Office
3740 Overland Avenue, Ste. C
Los Angeles, CA 90034


Narcotics Anonymous
World Service Office
P.O. Box 9999
Van Nuys, CA 91409


National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345



National Council on Alcoholism and Dependence
12 West 21st Street, 7th Floor
New York, NY 10010
1-800-NCA- CALL (will refer you to local treatment information center)


On Campus

Counseling Services: Ext. 2415
Dean of Students Office: Ext. 2156
Health Center: Ext. 2018
Chaplain Office: Ext. 2012
Residence Life: Ext. 2305
TCERT: Ext. 2222
Campus Safety: Ext. 2222
Health Education Services: Ext. 2531
Chaplain Ext. 2012

Local Assistance
Institute of Living Alcohol and Drug Treatment
400 Washington Street
Hartford, CT 06106


Anne Parente, LCSW
West Hartford Counseling Center


Alcoholics Anonymous (In Connecticut)



(Meetings on campus on Sundays)




(A support group for those who have been affected by another person’s drinking)

Meetings on campus on Sundays

Narcotics Anonymous



1-800-DRUGHELP (24-hour confidential information and how to get help for yourself or a friend)



The following agencies were sources for this webpage:

The National Clearinghouse for Alcohol and Drug Information (NCADI), a service of The Substance Abuse and Mental Health Services Administration (SAMHSA).
The American Cancer Society
The Rape Treatment Center, Santa Monica – UCLA Medical Center (Do It Now publications by Jim Parker)
DC Rape Crisis Center

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