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The bacteria that cause PID are usually transmitted through unprotected sexual contact with an infected person. Two common causes are gonorrhea and chlamydia. Other bacteria that can cause PID either are sexually transmitted (e.g., Mycoplasma hominis) or are vaginal bacteria that are not sexually transmitted (e.g., Gardnerella vaginalis).

Women with multiple sexual partners are at increased risk for PID. A woman who has unprotected sex with an infected partner while she is menstruating is also at higher risk, since at this time of the month the natural defenses of the cervix are less effective. Younger women may be more vulnerable because they are more likely to practice unsafe sex and may have more frequent exposure to partners who are infected with sexually transmitted bacteria.

For women who are sexually active with male partners, condoms and spermicide (nonoxynol-9) can help prevent transmission of PID-causing bacteria if they are used correctly and consistently and if the condom does not break or leak. Cervical caps and diaphragms, used with spermicide, may also help decrease the risk of infection, but they are not as effective as condoms. Whatever their sexual orientation, women who have had unprotected sexual contacts in the past and who have never been examined for sexually transmitted diseases should be tested for PID and other STDs, even if they are symptom free.

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Clearly, it is not inevitable that a person who is sexually active with a partner who has herpes will contract herpes. Some couples have been together for years, and even after years of unprotected sexual contact only one of the partners has herpes. Then there are those who are sexually intimate with a person with herpes just once or only a couple of times and acquire herpes from that contact.

A few truths seem to hold for most people regarding transmission of the herpes viruses. First, a person who has had a past infection with one type of herpes virus will not get reinfected in that area of the body with the same strain of the virus. For example, a person with genital type 2 herpes will not be repeatedly infected with genital type 2 herpes on reexposure. Therefore couples in which both partners are infected with genital type 2 herpes, for example, do not need to worry about transmission to one another. They will not reinfect one another through genital sexual contact. Furthermore, the likelihood of acquiring a new infection with type 2 herpes in another area of the body is low, because the antibody that is produced following the initial infection, which circulates through the body, offers protection at other sites.

People with type 2 herpes will almost never acquire a new type 1 infection, because the antibody to type 2 offers nearly complete protection against a new type 1 infection. Therefore, neither oral nor genital sex for this couple poses a risk of reinfection. Although type 1 herpes offers some protection against acquiring type 2 herpes, the protection is not as complete, and someone with type 1 can acquire a type 2 infection if exposed. However, as discussed later, it is unlikely that a person will acquire type 2 herpes in the same area where he or she has the type 1 infection.

Similarly, two people who are infected with oral type 1 herpes will not reinfect one another through kissing. However, there is a risk that they could infect one another through oral sex, although this risk appears to be low If only one partner has oral HSV-1, then the uninfected partner can more easily acquire genital HSV-1 through oral sex, especially if it is performed while the infected partner has a cold sore.

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There is no evidence that repeated ejaculation, such as through masturbation, will help to “clear out” the infection any sooner, nor do dietary changes affect the course of prostatitis. It is recommended that partners of a man with prostatitis, if it is suspected to be caused by sexually transmitted bacteria, be treated as contacts. If the infection is not caused by sexually transmitted bacteria, then the decision about whether or not to treat partners must be made on an individual basis. Generally, all partners should at least be examined for evidence of infection and possibly treated as well.

The conditions mentioned previously that are not treatable by antibiotics are best addressed by a urologist. Any underlying structural problem that has caused the infection of the prostate—such as benign enlargement of the prostate or obstruction of the bladder for other reasons—should be treated by a urologist. Surgery can correct these problems and prevent future infections. A stricture or scarring of the urethra can occur after urethritis, and this can make it impossible to clear an infection from the genital tract, including the prostate. In addition, there can be stones in the prostate that prevent clearance of the infection, even if the antibiotics used are the right ones.

Even for prostatitis that is not thought to have a bacterial cause, most experts recommend a short trial course (one to three weeks) of an antibiotic in case bacteria are present and causing the infection. However, if this is not successful, then repeated trials of an antibiotic are not recommended. Follow-up with a urologist is recommended to treat symptoms of these usually benign conditions. Medications are available that ease the symptoms of prostate irritation that is not caused by bacterial infection.

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What if, despite being very careful, you are diagnosed with an STD anyway? How could this happen? One possibility is that your partner has had another partner while he or she has been with you. Or, as was the case with Mandy and Alan, you or your partner may have had an infections without knowing it. When someone who is long-term relationships is diagnosed with an STD, it can lead to problems in the relationship. This is one reason why a health care provider must go over all the possibilities when you are diagnosed with an infection. Many people ask “Does this mean my partner has been with someone else?” Not always. It is occasionally difficult to tell who was infected first. The person who has been diagnosed with the infection is not always the person who brought the infection into the relationship and vice versa. In either case, the most important thing is for both parties to be treated.

If you are diagnosed with an infection, you need to talk honestly with your partner. Your health care provider can tell you whether or not your partner (or partners) must be tested and treated. Particular sexually transmitted infections—such as gonorrhea, chlamydia, and syphilis— are reportable in most states to the state health department, where a program is in place to notify and treat partners. Even if a partner does not have any symptoms of an STD, he or she could be infected and needs to be tested and possibly treated.

Do not avoid telling a partner because you are uncomfortable or embarrassed. Many sexually transmitted infections, even if they are symptom free, can progress to serious complications if left untreated.

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How common is prostate cancer? Too common. In the United States, a man is diagnosed with prostate cancer every three minutes. Every fifteen minutes, a man dies of it. A boy born today has a 13 percent chance of developing prostate cancer, and a 3 percent chance of dying of it.

Scientists don’t know precisely what causes prostate cancer, but it’s clear that a number of factors are involved. First and foremost are age and hormones. Prostate cancer hardly ever develops before age 40; it becomes more common with every decade afterward. Also, it rarely develops in men who are castrated before puberty.

Genetic factors also play a role. Does prostate cancer run in your family? If your father or brother has prostate cancer, your risk of developing it is two times greater than the average American man’s. Families with prostate cancer in three or more first-degree relatives (father or brother), or prostate cancer in three generations (grandfather, father, son) have a hereditary form of the disease. The significance of this is that, in these families, men have a 50 percent risk of developing the disease. Also, it’s more likely to strike at a younger age—when a man might not even be looking for trouble or having yearly prostate exams.

What about environment? Clinically significant prostate cancer is rare in men who live in China or Japan. But when these men move to Hawaii or California, their rate of prostate cancer escalates—to the level of an American man’s. The high-fat Western diet looms as an obvious environmental culprit, but it’s not that simple. Other factors, such as vitamin A and exposure to ultraviolet light — which increases the body’s levels of vitamin D—are important in determining which men develop prostate cancer.

As scientists learn more about what causes prostate cancer, per someday we’ll be able to turn this knowledge into positive actions— so that, maybe, one day, prostate cancer will be preventable.

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