Women’s Health:

A Guide to Preventing Infections

Infection: Don’t Pass It On Campaign

Office of Public Health

Veterans Health Administration
Women’s Health:

A Guide to Preventing Infections

Infection: Don’t Pass It On (IDPIO) 

Campaign Contributing Team

Office of Public Health 

 Clinical Public Health

 Occupational Health

Employee Education System

Office of Patient Care Services

 VA Infection Control Professionals 

 National Center for Health Promotion and 

Disease Prevention

 National Infectious Diseases Service

 Women Veterans Health Strategic Health Care Group 

National Center for Patient Safety

Veterans Health Administration

U.S. Department of Veterans Affairs

Internet site: www.publichealth.va.gov/InfectionDontPassItOn
Women’s Health: A Guide to Preventing Infections

Foreword

Victoria Davey

I was delighted to see that Clinical Public Health collaborated with so many other 

offices within the Veterans Health Administration (VHA) in the development of this 

book. These included our Infection: Don’t Pass It On campaign whose membership 

represents about 13 VHA program offices and disciplines, including the Women 

Veterans Health Strategic Health Care Group. I am even more impressed by the wealth 

of talent and expertise that contributed to its content – doctors, nurses, educators, 

infection control professionals, and so many others who believe in the mission of 

keeping our women Veterans healthy. It contains so much important information, some 

basic – as we all could use reminders – and some very specific. There is no doubt that 

this resource will help all of our women Veterans learn more about these topics and the 

skills to address their own health. 

So much of what we do as individuals influences those around us. This is how I think of public health. That’s why I 

was excited after reading the resource information within this book. Providing this type of education to our women 

Veterans is just one step toward public health. Think about it. Learning more about how germs and infections 

are spread empowers us as women to take personal steps toward more healthy behaviors. Let’s not forget the 

influence we have on those around us – pass this information along and help your children and other family and 

friends to reduce the spread of infections. Never underestimate your own personal contribution to those around 

you. Public health truly begins with personal health.

I invite you to peruse the pages within this book. I have every confidence that you’ll be as pleased as I was with 

this as a reliable and informative resource for women.

Victoria Davey, PhD, MPH, RN

Chief Officer, Office of Public Health

VHA Central Office

U.S. Department of Veterans Affairs

Washington, DC

Veterans Health Administration
i

Women’s Health: A Guide to Preventing Infections

Introduction

Flu infects up to one out of every five people in the 

United States each year. The U.S. also counts over one 

billion colds and 19 million new sexually transmitted 

disease (STD) infections among the infections 

occurring each year. Flu, colds, STDs, and other 

illnesses are caused by infections. Chances are that 

you or someone you know had an infection last year. 

Infections are usually spread by passing germs 

from person to person. Infections can put a whole 

community at risk. Some illnesses caused by infections 

can be mild, like a cold, while others are more severe 

and can even lead to death. 

The Office of Public Health and the Infection: Don’t 

Pass It On (IDPIO) campaign are committed to 

preventing the spread of infection and improving 

the health of Veterans and their families. IDPIO and 

the Office of Public Health are pleased to provide 

Women’s Health: A Guide to Preventing Infections to 

women Veterans. IDPIO has developed this booklet to 

provide educational materials to the VA community to 

prevent the spread of infection and promote the health 

of women Veterans. 

This booklet describes the most common infections in 

women, from colds and flu to STDs such as chlamydia 

and HIV. Topics such as how to prevent the spread of 

germs and women-specific issues such as pregnancy 

and breastfeeding are covered in this book. Use this 

information to learn how to reduce your risk of getting 

sick. If you are sick, this booklet can teach you how to 

avoid spreading the infection to your family and friends. 

Veterans Health Administration
Women’s Health: Introduction

Each section has information on:

u How the infection is spread.

u What the signs of infection are.

u How the infection is treated.

u How to avoid infection.

u What you should do if you are infected.

u How the infection might affect your pregnancy.

u Links to more online information. 

If you have specific concerns or think you have an 

infection, see your health care provider. He or she will 

be able to personally advise you on treatments and 

develop a health plan to keep you healthy and free 

from infection. 

Remember that everyone can help stop the spread of 

infection. Use this book to learn to clean your hands, 

get vaccinated, handle food safely, and practice safer 

sex. All of these steps will help prevent infection and 

keep you and your family healthy. 

Patricia Hayes, PhD 

Chief Consultant 

Women Veterans Health Strategic Health Care Group 

Veterans Health Administration

Richard Martinello, MD 

Chief Consultant

Clinical Public Health

Veterans Health Administration

ii www.publichealth.va.gov/InfectionDontPassItOn
iii

Women’s Health: A Guide to Preventing Infections

Acknowledgements

Completion of this book would not have been possible without the interest and dedication of so many people 

within the Veterans Health Administration. First and foremost, special acknowledgement goes to Judith 

Anderson, MD, who conceived this book as a much-needed tool for our women Veterans. She spent countless 

hours researching and drafting the contents of this book. Without her, this book would not be a reality. Special 

thanks go to Dana Christofferson, PhD, for her commitment in editing and revising contents of this book. Sincere 

thanks and acknowledgement to Troy Knighton, MEd, EdS, LPC, National Seasonal Influenza and IDPIO Program 

Manager, whose leadership has taken this book from concept to completion. 

Veterans Health Administration
iv www.publichealth.va.gov/InfectionDontPassItOn

Women’s Health: Acknowledgements

Finally, many significant contributions, small and large alike, have been made to the overall effort of this book. 

Special recognition goes to colleagues listed below from the Women Veterans Health Strategic Health Care 

Group and members of the Infection: Don’t Pass It On (IDPIO) campaign and others who represent the following 

services and offices:

Office of Public Health 

 Clinical Public Health

 Occupational Health

Employee Education System

Office of Patient Care Services

 VA Infection Control Professionals 

 National Center for Health Promotion and Disease Prevention

 National Infectious Diseases Service

 Women Veterans Health Strategic Health Care Group 

National Center for Patient Safety

Thanks to all who managed to find extra time among their day to day responsibilities to participate in the writing, 

revision, and review of sections of this book.

• Lorraine Bem, EdD, MSHA, MSN, FACHE, National Project Manager/ANCC Nurse Planner, Birmingham Employee 

Education Resource Center

• Jonna Brenton, RN, Women Veteran Program Manager, VA Montana Health Care System

• Marla Clifton, RN, MSN, CIC, MDRO Clinical Program Coordinator, National Infectious Diseases Service, VHA 

Central Office

• Maggie Czarnogorski, MD, Deputy Director, Clinical Public Health Programs, VHA Central Office

• Linda H. Danko, RN, MSN, Clinical Program Coordinator, National Infectious Diseases Service, VHA Central Office 

• Pamela Del Monte, MS, RN-BC, ACNS, Associate Chief Nurse, Ambulatory Care, Durham VAMC

• Kathleen De Roos, APRN, MSN, CIC, VISN 23 Infection Prevention Coordinator

• Janet Durfee, RN, MSN, APRN, Deputy Chief Consultant, Clinical Public Health, VHA Central Office. 

• Karen B. Feibus, MD, Deputy Director, Reproductive Health, Women Veterans Health Strategic Health Care 

Group, VHA Central Office

• S tacy Garrett-Ray, MD, MPH, MBA, Deputy Director, Comprehensive Women’s Health, Women Veterans Health 

Strategic Health Care Group, VHA Central Office
Veterans Health Administration v

Women’s Health: Acknowledgements

• Sally G. Haskell, MD, Acting Director, Comprehensive Women’s Health, Women Veterans Health Strategic Health 

Care Group, VHA Central Office

• Patricia Hayes, PhD, Chief Consultant, Women Veterans Health Strategic Health Care Group, VHA 

Central Office 

• Pamela Hirsch, NP-C, BS, MEd, MS, Director of Occupational Health, VHA Central Office 

• Amanda M. Johnson, MD, FACOG, Senior Medical Consultant, Women Veterans Health Strategic Health Care 

Group, VHA Central Office

• Vicki Macks, RN, BSN, CNOR, CIC, MDRO Prevention Coordinator, Memphis VAMC

• Scott E. Mambourg, PharmD, BCPS; Clinical Pharmacy Coordinator, Reno VAMCS 

• Rick Martinello, MD, Chief Consultant, Clinical Public Health, VHA Central Office

• Phyllis Ogletree, CRNP, COHN-S, Nurse Practitioner/Occupational Health, Biloxi VAMC 

• Jacqueline Parker, RN, MS, MPH, Patient Safety Officer, VISN3 – NY/NJ HCS 

• Kathleen Pittman, RN, MPH, Program Manager, Prevention Practice, National Center for Health Promotion and 

Disease Prevention, Office of Patient Care Services

• Barbara Polak, RN, MSN, Deputy Director, Women’s Health Education, Women Veterans Health Strategic Health 

Care Group, VHA Central Office

• Connie Raab, BA, Director, Public Health Communications, Office of Public Health, VHA Central Office

• Marian Rodgers, RN, MSN, MPH, CIC, Community Living Center MRSA Prevention Coordinator, Dayton VAMC

• Mary Standridge, RN, MSN, CIC, Infection Control Nurse, Memphis VAMC

• Beverly F. Van Metre, RN, BSN, MS, CHES, Clinical Programs Coordinator for HIV & Hepatitis C, 

Martinsburg VAMC

• Laure Veet, MD, Director, Women’s Health Education, Women Veterans Health Strategic Health Care Group, 

VHA Central Office

• Michael Williams, Public Health Intern, Clinical Public Health, VHA Central Office

• Laurie C. Zephyrin, MD, MPH, MBA, FACOG, Director, Reproductive Health, Women Veterans Health Strategic 

Health Care Group, VHA Central Office
1

Women’s Health: A Guide to Preventing Infections

Contents

Sexually Transmitted Diseases (STDs). . . . . . . . .3

u Chlamydia. . . . . . . . . . . . . . . . . . . . . .7

u Genital Herpes. . . . . . . . . . . . . . . . . . . 11

u Genital Warts. . . . . . . . . . . . . . . . . . . . 17

u Gonorrhea. . . . . . . . . . . . . . . . . . . . . 21

u Human Immunodeficiency Virus (HIV). . . . . .25

u Human Papillomavirus (HPV). . . . . . . . . . . 31

u Syphilis. . . . . . . . . . . . . . . . . . . . . . . 37

u Trichomoniasis. . . . . . . . . . . . . . . . . . . 41

Hepatitis . . . . . . . . . . . . . . . . . . . . . . . 43

u Hepatitis A. . . . . . . . . . . . . . . . . . . . .45

u Hepatitis B. . . . . . . . . . . . . . . . . . . . . 51

u Hepatitis C. . . . . . . . . . . . . . . . . . . . .59

Bacterial Vaginosis (BV). . . . . . . . . . . . . . . .65

Vaginal Yeast Infections. . . . . . . . . . . . . . . .69

Urinary Tract Infections (UTIs) . . . . . . . . . . . 73

Safer Sex. . . . . . . . . . . . . . . . . . . . . . . . 77

Colds. . . . . . . . . . . . . . . . . . . . . . . . . . 81

Influenza (Flu) . . . . . . . . . . . . . . . . . . . . 83

Pneumonia. . . . . . . . . . . . . . . . . . . . . . .89

Vaccines . . . . . . . . . . . . . . . . . . . . . . . 93

Vaccines and Pregnancy. . . . . . . . . . . . . . .97

Food Safety . . . . . . . . . . . . . . . . . . . . . 101

Food-borne Illness During Pregnancy. . . . . . . 107

u Listeriosis . . . . . . . . . . . . . . . . . . . . 113

u Toxoplasmosis. . . . . . . . . . . . . . . . . . .115

Clean Hands. . . . . . . . . . . . . . . . . . . . . .119

Contact Lens Safety. . . . . . . . . . . . . . . . . 123

Definition of Terms . . . . . . . . . . . . . . . . . 127

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Women’s Health: A Guide to Preventing Infections

Sexually transmitted diseases (STDs) are infections 

that are spread by sexual contact with someone who 

has an STD. STDs are mostly spread through vaginal, 

anal, or oral sex, and genital touching.

Sexually Transmitted 

Diseases (STDs)

There are about 19 million new STD infections each 

year in the United States. There are over 20 types of 

STDs. STDs may be caused by bacteria, parasites, or 

viruses. STD infection may show a range of signs, or no 

signs at all. Sometimes people have an STD and don’t 

know it. The only way to know if you have an 

STD is by a medical exam and testing by your health 

care provider. 

Common STDs caused by bacteria that can be 

treated and cured with antibiotics include:

u Chlamydia.

u Gonorrhea.

u Syphilis. 

Common STDs caused by viruses that can be 

controlled with treatment include:

u Hepatitis.

u Herpes.

u HIV.

u HPV.

If you have an STD, 

tell current and 

recent sex partners 

of the infection.

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Women’s Health: Sexually Transmitted Diseases

How do you know if you have an STD?

Your health care provider can examine and test you for 

STDs. Some women are at a higher risk for STDs. They 

should have regular exams and testing. Higher risk 

women include those who:

u Have had a previous STD.

u Have new or multiple sexual partners.

u Use condoms only some of the time. 

u Have sex for drugs or money.

u Use needles for illegal drugs.

How can women avoid STDs?

u Avoid sexual contact.

 Including vaginal, anal, or oral sex, or 

genital touching.

 This is the only way to be absolutely sure of 

avoiding STDs.

u Have safer sex:

 Reduce the number of sexual partners.

 Use barriers, including:

 Male condom.

 Female condom.

 Condoms, when used correctly, can 

reduce the risk of getting an STD. Each 

time you have sex use a condom (male or 

female type):

 Before vaginal sex.

 Before anal sex.

 Before oral sex.

 Dental dam.

 Plastic wrap, if other barriers are not available.

 Have sex with only one partner who does not 

have sex with others and does not have an STD.

Using condoms or not having 

sex are the best options to 

protect yourself from STDs.

For more 

information, 

see Safer Sex

on page 77.

www.publichealth.va.gov/InfectionDontPassItOn
5

Women’s Health: Sexually Transmitted Diseases

u Know that washing the vagina or douching after sex 

will not prevent it.

 The American Congress of Obstetricians and 

Gynecologists (ACOG) recommend that women 

do not douche.

 Douching can change the balance of germs and 

acidity in a healthy vagina.

 Any changes in that balance can cause an over 

growth of bad bacteria. This can lead to a yeast 

infection or bacterial vaginosis.

 If you have a vaginal infection, douching can push 

infection-causing bacteria up into the uterus, 

fallopian tubes, and ovaries. This can cause more 

serious problems.

What about pregnancy?

Some STDs can also be passed on to the baby during 

pregnancy, birth, or breastfeeding.

It is important for all pregnant women to be tested for 

STDs. Treatment of STDs can prevent the effects of the 

STD on the baby. If you are pregnant or breastfeeding 

and have an STD, you should talk to your health care 

provider about the risk of passing the STD to your baby. 

Some STDs can cause:

u Early birth.

u Low birth weights.

u Other severe problems in the newborn baby.

For more on STDs see:

Centers for Disease Control and Prevention (CDC):

STD Prevention Today

www.cdcnpin.org/scripts/std/prevent.asp

Condom Fact Sheet In Brief

www.cdc.gov/condomeffectiveness/brief.html

Pelvic Inflammatory Disease (PID) – CDC Fact Sheet

www.cdc.gov/std/pid/stdfact-pid.htm

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Sexually transmitted infections (STI) fact sheet

www.womenshealth.gov/publications/our-publications/fact-sheet/

sexually-transmitted-infections.cfm

HIV/AIDS: Preventing HIV infection

www.womenshealth.gov/hiv/prevention/

Douching fact sheet

www.womenshealth.gov/faq/douching.cfm

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Women’s Health: A Guide to Preventing Infections

Chlamydia is an infection caused by bacteria. 

It is the most commonly reported sexually 

transmitted disease (STD) in the United States.

Chlamydia

How is it spread?

Women get chlamydia through vaginal, oral, or anal 

sexual contact with an infected person. 

What are signs of chlamydia in women?

75% of infected women and 50% of infected men have 

no signs. Signs in women include: 

u Increased or unusual vaginal discharge. 

u Burning with urination. 

u Pain in the back or abdomen.

u Nausea. 

u Fever.

u Discomfort during sex. 

u Bleeding between periods. 

u Rectal pain, bleeding, or discharge.

u Sore throat.

Most women with 

chlamydia do not show 

any signs of infection.

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Women’s Health: Chlamydia

How do you know if you have chlamydia?

The only way to know if you have chlamydia is by a 

medical exam. Most women with chlamydia do not 

have any signs of infection. See your health care 

provider to be tested for chlamydia each year if you: 

u Are age 25 or younger and are sexually active.

u Are older than 25 with new or multiple sex partners.

u Do not practice safe sex.

u Are having sex with someone who might be having 

sex with others.

u Are pregnant. 

How is it treated?

Chlamydia can be treated and cured with antibiotics. 

Always finish antibiotic treatment, even if signs of 

chlamydia go away. Do not have sex until after 

treatment and signs of it are gone. See your health 

care provider if your signs do not go away after 

finishing treatment. 

What can happen if you have chlamydia 

for a long time?

u Problems getting pregnant.

u Pregnancy outside of the uterus.

u Swelling in the anus.

u Eye and joint redness and pain.

u More likely to get HIV from a partner who is infected 

with HIV.

If you have chlamydia:

u Always finish all antibiotic treatment.

u Do not have sex with someone who has chlamydia 

or has not finished treatment (to prevent re-infection).

u Tell current and recent sex partners of the infection 

so they can get checked. 

u Know that it can raise the risk of getting and 

spreading HIV.

www.publichealth.va.gov/InfectionDontPassItOn
9

Women’s Health: Chlamydia

How can you avoid chlamydia?

u Avoid sexual contact.

u Have safer sex:

 Reduce the number of sexual partners.

 Condoms, when used correctly, can reduce the 

risk of getting chlamydia. Each time you have sex 

use a condom (male or female type):

 Before vaginal sex.

 Before anal sex.

 Before oral sex.

 Have sex with only 

one partner who 

does not have sex 

with others and does 

not have chlamydia.

u Know that other forms of birth control do not protect 

against chlamydia.

What about pregnancy?

All pregnant women should be tested for chlamydia. 

If you are pregnant and have chlamydia, you should 

discuss your pregnancy and infection with your health 

care provider. Pregnant women with chlamydia can 

have early births or babies with eye and lung infections.

For more on chlamydia see:

Centers for Disease Control and Prevention (CDC): 

Chlamydia – CDC Fact Sheet

www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm

U.S. Department of Health and Human Services (HHS), Office on Women’s Health: 

Chlamydia fact sheet

www.womenshealth.gov/faq/chlamydia.cfm 

U.S. National Library of Medicine:

Chlamydia infections in women

www.nlm.nih.gov/medlineplus/ency/article/000660.htm

For more 

information, 

see Safer Sex

on page 77.

Pregnant women 

with chlamydia 

can pass it to their 

babies during 

childbirth.

Veterans Health Administration
Veterans Health Administration 11

Women’s Health: A Guide to Preventing Infections

Genital herpes is a sexually transmitted disease (STD) 

caused by herpes simplex viruses. Many people with 

herpes have no signs of infection and do not know 

they have it.

Genital Herpes

There are 2 herpes simplex viruses that 

can cause infection: 

u One causes most genital herpes. 

u The other virus can also cause genital herpes but 

more often causes blisters of the mouth and lips 

(e.g., cold sores or fever blisters).

The U.S. Centers for Disease Control and Prevention 

(CDC) states that about 1 out of 6 people ages 14 to 49 

have genital herpes. 

How is it spread?

The herpes virus is spread by skin-to-skin contact with 

a person who has the herpes virus:

u Most often, from herpes sores or blisters. 

u Less often, from normal looking skin where the virus 

first entered the body.

u During vaginal, anal, or oral sexual contact, or skinto-skin contact. This may happen even without 

visible sores. 

u The herpes virus enters the body through the:

 Lining of the mouth. 

 Vagina. 

 Labia. 

 Regular skin that has small cracks or cuts. 

Women are more 

easily infected with 

herpes than men. 
12

Women’s Health: Genital Herpes

People with a weak immune system can get a herpes 

infection more easily. A weak immune system is caused 

by some diseases (e.g., cancer, HIV/AIDS) and by some 

medicines used to treat serious diseases. 

People who don’t know they 

have herpes can still spread 

the virus to others.

What are signs of genital herpes 

in women?

Women who have the herpes virus may have no 

outbreaks or signs of infection. Many do not know they 

have the virus. Once you are infected, the virus stays 

in your nerve cells for life. When the virus is not active, 

there is no sign of infection. When the virus becomes 

active, a herpes outbreak occurs. Some women 

may not have any outbreaks or may have only one 

outbreak, while others may have multiple outbreaks. 

First Outbreak

The first herpes outbreak often occurs within the 2 

weeks after contracting the virus from an infected 

person. The first signs may include:

u Itching, tingling, or burning feeling in the vaginal or 

anal area. 

u Flu-like symptoms, including fever. 

u Swollen glands. 

u Pain in the legs, buttocks, or vaginal area. 

u A change in vaginal discharge. 

u Headache.

u Painful or difficult urination.

u A feeling of pressure in the area below the 

stomach.

After a few days, painful sores, blisters, or ulcers may 

develop where the virus entered the body. These 

areas include: 

u The vaginal or anal area.

u The mouth.

u Inside the vagina .

u On the cervix.

u In the urinary tract.

u On the buttocks or thighs. 

u On other parts of your body where the virus has 

entered. 

Sometimes the first outbreak will not occur until months 

or years after infection. 

Other Outbreaks

After the first outbreak, you may have more outbreaks. 

For most, these outbreaks occur less often over time. 

The signs of herpes infection are usually milder than 

during the first outbreak, and they go away faster.

For people with a weak immune system, outbreaks can 

be severe and long-lasting.

See your health 

care provider to 

be tested if you 

have signs of 

herpes.

www.publichealth.va.gov/InfectionDontPassItOn
13

Women’s Health: Genital Herpes

How do you know if you have 

genital herpes?

The only way to know if you have genital herpes is by a 

medical exam. Your health care provider can examine 

you and test for it. Lab samples are taken from a sore, 

blister, or blood. Your health care provider may ask to 

test you for other infections at the same time.

Tell current and most recent sex 

partners of your herpes infection.

How is it treated?

Genital herpes can be treated, but it cannot be cured. 

Anti-viral medicines can make outbreaks:

u Shorter.

u Less severe.

u Less frequent.

Living with genital herpes causes some people to: 

u Feel embarrassed or ashamed. 

u Worry about infecting a sexual partner.

u Worry that having herpes will affect relationships with 

sexual partners. 

u Avoid dating or sexual relationships. 

Most people with herpes are able to live with the virus 

and manage their outbreaks. Talking to trusted health 

care providers and friends can help. Your health care 

provider can talk to you about medicines that treat 

outbreaks and about ways to reduce the chance of 

passing the virus on to a sexual partner.

Medicines can 

help lower the 

chance that you 

will pass the 

virus to others.

Veterans Health Administration
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Women’s Health: Genital Herpes

If you have genital herpes, during 

outbreaks you should:

u Keep the infected area clean and dry. 

u Avoid touching the sores or blisters. 

u Clean hands after contact with the infected area. 

u Avoid skin-to-skin contact from the time you first 

notice signs of herpes until the sores have healed.

How can you avoid genital herpes?

Most women get genital herpes through sexual contact 

with a person who has herpes sores. You can get the 

virus without having sex. To avoid infection:

u Avoid skin-to-skin and sexual contact.

u Have safer sex:

 Reduce the number of sexual partners.

 Condoms, when used correctly, can reduce the 

risk of getting genital herpes. But, condoms may 

not cover all infected areas. Each time you have 

sex use a condom (male or female type):

 Before vaginal 

sex.

 Before anal sex.

 Before oral sex.

 Have sex with only 

one partner who 

does not have sex 

with others and does not have herpes.

u Know that other forms of birth control do not protect 

against herpes infection.

For more on how 

to clean hands, 

see Clean Hands

on page 119.

For more 

information, 

see Safer Sex

on page 77.

www.publichealth.va.gov/InfectionDontPassItOn
15

Women’s Health: Genital Herpes

What about pregnancy?

A pregnant woman who has genital herpes can pass 

the virus to her baby. A baby born with herpes might:

u Be born early. 

u Have brain, skin, or eye problems.

u Not survive.

If you are pregnant, you should tell your health care 

provider if you have herpes. If you show any signs of 

herpes during pregnancy, tell your provider. Pregnancy 

can be managed safely if your health care provider 

knows about your herpes. Medicines can help babies 

born with herpes if they are treated right away.

For more on genital herpes see:

Department of Veterans Affairs (VA):

Herpes simplex virus

www.hiv.va.gov/patient/diagnosis/OI-herpes-simplex.asp

Centers for Disease Control and Prevention (CDC):

Genital Herpes – CDC Fact Sheet

www.cdc.gov/std/Herpes/STDFact-Herpes.htm

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

Genital Herpes

www.niaid.nih.gov/topics/genitalherpes/pages/default.aspx

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Genital herpes fact sheet

www.womenshealth.gov/faq/genital-herpes.cfm

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Women’s Health: A Guide to Preventing Infections

Genital warts are caused by low-risk types of human 

papillomavirus (HPV). These viruses may not cause 

warts in everyone. 

Genital Warts

How are they spread?

Women can get genital warts from sexual contact 

with someone who has HPV. Genital warts are spread 

by skin-to-skin contact, usually from contact with the 

warts. It can be spread by vaginal, anal, oral, or handgenital sexual contact. Genital warts will spread HPV 

while visible, and after recent treatment. Long-term 

sexual partners usually have the same type of 

wart-causing HPV. 

What are signs of genital warts 

in women?

Genital warts can grow anywhere in the genital area:

u In the vagina.

u Around the vaginal opening.

u On the cervix (the opening to the womb).

u On the groin.

u In or around the anus.

u In the mouth or throat (rare).

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Women’s Health: Genital Warts

Genital warts:

u Can be any size – from so small they can’t be seen, 

to big clusters and lumps.

u Can be smooth with a “mosaic” pattern or bumpy like 

a cauliflower.

u Are soft, moist and flesh-colored.

u Can cause itching, burning or pain.

Not all HPV infections cause genital warts. HPV 

infections often do not have any signs that you can see 

or feel. Some HPV infections can be more serious, see 

HPV, page 31. 

Even if you can’t see any genital warts, 

you could still have an HPV infection.

How do you know if you have 

genital warts?

Genital warts can be detected by:

u Yourself.

u A sexual partner.

u A health care provider.

The only way to confirm HPV infection is if your health 

care provider does an HPV test. 

How is it treated?

See your health care provider to discuss treatment. 

Even when genital warts are treated, the HPV 

infection may remain. Warts may also return after 

treatment. Over-the-counter treatments for other types 

of warts should not be used. Treatments for genital 

warts include:

u Watch and wait to see if the warts stay the same, get 

bigger, or go away.

u Medicines applied directly to the warts. These can 

include prescribed creams.

u Burning off the warts.

u Freezing off the warts.

u Cutting the warts out.

u Using special lights or lasers to destroy the warts.

www.publichealth.va.gov/InfectionDontPassItOn
19

Women’s Health:Genital Warts

What can happen if you have genital 

warts for a long time?

The immune system fights HPV infection. The types 

of HPV that cause genital warts do not cause cancer. 

Without any treatment, genital warts may:

u Go away.

u Remain unchanged.

u Increase in size or number.

If you have genital warts:

u Discuss treatment for genital warts with your health 

care provider.

u Know that it you may never know when you got HPV 

or who gave it to you.

u Know that partners that have been together for a 

while often share the same HPV types, even if both 

have no symptoms.

How can you avoid genital warts?

u Get vaccinated against HPV. 

 Certain types of HPV vaccines protect against the 

low-risk HPV that causes 90% of genital warts.

 HPV vaccine is safe for all females 9 to 26 

years old.

 The Centers for Disease Control and Prevention 

(CDC) recommends all 11-12 year old girls get the 

HPV vaccine.

u Avoid sexual contact.

u Have safer sex:

 Reduce the number 

of sexual partners.

 Condoms, when used 

correctly, can reduce 

the risk of getting 

HPV. 

But, condoms may not cover all infected areas. 

Each time you have sex use a condom (male or 

female type):

 Before vaginal sex.

 Before anal sex.

 Before oral sex.

 Have sex with only one partner who does not 

have sex with others and does not have HPV.

u Know that other forms of birth control do not protect 

against HPV.

Condoms may not fully 

protect against HPV since 

HPV can infect areas not 

covered by a condom.

For more 

information, 

see Safer Sex

on page 77.

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Women’s Health: Genital Warts

What about pregnancy?

Genital warts rarely cause problems during pregnancy 

and birth. Most women who no longer have visible 

genital warts do not have problems with pregnancy 

or birth. If you are pregnant, you should discuss 

treatment options with your health care provider as 

the warts may:

u Grow larger and bleed.

u Make it difficult to urinate if growing in the urinary 

tract (rare).

u Make the vagina less elastic during birth if the warts 

are in the vagina (rare).

u Cause a need for a cesarean section (C-section) birth 

if the warts block the birth canal (rare).

u Be passed to the baby during birth (rare). 

For more on genital warts see:

Centers for Disease Control and Prevention (CDC):

Human Papillomavirus (HPV)

www.cdc.gov/hpv/index.html

Genital HPV Infection – Fact Sheet

www.cdc.gov/std/HPV/STDFact-HPV.htm

HPV Vaccination

www.cdc.gov/vaccines/vpd-vac/hpv/default.htm

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

Human Papillomavirus (HPV) and Genital Warts

www.niaid.nih.gov/topics/genitalWarts/Pages/default.aspx

U.S. Department of Health and Human Services (HHS), Office on Women’s Health: 

Human papillomavirus (HPV) and genital warts fact sheet

www.womenshealth.gov/publications/our-publications/fact-sheet/human-papillomavirus.cfm

www.publichealth.va.gov/InfectionDontPassItOn
Women’s Health: A Guide to Preventing Infections

21

Gonorrhea is an infection spread by bacteria. Also 

known as “the clap” or “the drip”, it affects both 

women and men. Women can get it in moist, warm 

areas such as the vagina, reproductive organs, anus, 

mouth, throat, and eyes.

Gonorrhea

How is it spread?

Women get gonorrhea from sexual contact 

with someone who is infected. Anyone who has 

gonorrhea can spread it to others. Gonorrhea can 

be spread through oral, vaginal, and sexual contact 

between:

u Men and women.

u Women and women.

u Men and men.

What are signs of gonorrhea in women?

Some women and men can have gonorrhea without 

any signs. For women, signs include:

u Painful or burning urination.

u Increased vaginal discharge.

u Bleeding between periods or after sex.

u Vaginal itching and irritation.

u Discomfort or pain during sex.

See your health care provider to be 

tested if you have signs of gonorrhea.

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Women’s Health: Gonorrhea

u Urgent or increased need to urinate.

u Anal discharge, pain, bleeding or itching. 

u Fever, abdominal pain, rashes, and swelling or pain 

in joints over time. 

u Sore throat.

u Red or itchy eyes.

u Eye discharge.

Women can get or 

spread HIV more easily if 

they have gonorrhea.

How do you know if you have gonorrhea?

The only way to know if you have gonorrhea is by a 

medical exam. Your health care provider can examine 

you and test for it. Lab samples may be taken from the 

vagina, bladder, bowels, throat, urine, or eyes. Your 

health care provider may ask to test you for other 

infections at the same time. See your health care 

provider to be tested for gonorrhea each year if you: 

u Are age 25 or younger and are sexually active.

u Are older than 25 with new or multiple sex partners.

u Do not practice safe sex.

u Are having sex with someone who might be having 

sex with others.

u Are pregnant. 

Get tested for gonorrhea if 

your sex partner has it.

How is it treated?

Gonorrhea can be treated and cured with antibiotics. 

Always finish antibiotic treatment, even if signs of 

gonorrhea go away. Do not have sex until after 

treatment and signs of it are gone. See your health 

care provider if your signs do not go away after 

finishing treatment.

What can happen if you have gonorrhea 

for a long time?

Some women have no signs of gonorrhea until they are 

very sick and have permanent damage to their health. 

If untreated, gonorrhea can cause severe problems 

that include:

u Problems getting pregnant.

u Pregnancy outside of the uterus.

u Pain and infections in the abdomen.

u The spread of gonorrhea to the blood, heart 

and joints.

Tell current and most recent 

sex partners of the infection.

If you have gonorrhea:

u Always finish all antibiotic treatment.

u Do not have sex with someone who has 

gonorrhea or has not finished treatment (to prevent 

re-infection).

u Tell current and recent sex partners of the infection 

so they can get checked. 

u Know that it can raise the risk of getting and 

spreading HIV.

www.publichealth.va.gov/InfectionDontPassItOn
23

Women’s Health: Gonorrhea

How can you avoid gonorrhea?

u Avoid sexual contact.

u Have safer sex:

 Reduce the number of sexual partners.

 Condoms, when used correctly, can reduce the 

risk of getting gonorrhea. Each time you have sex 

use a condom (male or female type):

 Before vaginal sex.

 Before anal sex.

 Before oral sex.

 Have sex with only 

one partner who 

does not have sex 

with others and does 

not have gonorrhea.

u Know that other forms of birth control do not protect 

against gonorrhea.

What about pregnancy?

Gonorrhea can cause miscarriages or early labor 

in pregnant women. If you are pregnant and have 

gonorrhea, you can pass the infection to your baby 

during birth. Your baby can have:

u Blindness.

u Joint infections.

u Blood infections.

All pregnant women should be tested for gonorrhea. If 

treated, most problems in pregnancy and birth can be 

avoided.

For more 

information, 

see Safer Sex

on page 77.

Mothers who have gonorrhea 

can spread it to their own 

newborn babies.

For more on gonorrhea see:

Centers for Disease Control and Prevention (CDC):

Gonorrhea – CDC Fact Sheet

www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm 

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

Gonorrhea

www.niaid.nih.gov/topics/gonorrhea/Pages/default.aspx

U.S. National Library of Medicine:

Gonorrhea

www.nlm.nih.gov/medlineplus/gonorrhea.html

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Gonorrhea fact sheet

www.womenshealth.gov/faq/gonorrhea.cf

Veterans Health Administration
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Women’s Health: A Guide to Preventing Infections

HIV stands for human immunodeficiency virus. 

HIV is a virus that attacks and weakens the immune 

system. The immune system is the body’s defense 

against infections.

Human Immunodeficiency 

Virus (HIV)

If you are infected with HIV, you are said to be “HIVpositive.” Over time as HIV weakens your immune 

system, you are more likely to get other infections. 

The late stage of HIV infection is known as acquired 

immune deficiency syndrome (AIDS). 

HIV is NOT spread by:

• Tears

• Sweat

• Feces

• Urine

How is it spread?

Each year in the United States about 40,000 people 

get infected with HIV. The HIV virus is found only in 

certain body fluids: 

u Blood.

u Vaginal fluid. 

u Semen. 

u Breast milk.

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Women’s Health: Human Immunodeficiency Virus (HIV)

Contact with infected body fluids can spread HIV. 

HIV is mostly spread by:

u Sexual contact:

 Vaginal and anal sex.

 Sharing unclean sex toys.

 Oral sex, very rarely.

 Body fluids with HIV can enter tiny breaks or 

rips in the linings of the vagina, vulva, rectum, 

or mouth. Rips and tears in these areas can be 

common and often unnoticed.

u Needle sharing: 

 Used or unclean needles. 

 During illegal drug use. 

u Breastfeeding:

 HIV can be spread to babies and others who drink 

breast milk from a woman who is HIV positive. 

u Pregnancy and birth: 

 HIV-positive women can spread the virus to their 

babies during pregnancy and birth. 

HIV is rarely spread from a blood transfusion because:

u All donated blood is tested and screened for HIV. 

u Blood and blood products that test positive for HIV 

are safely destroyed. None are used for transfusions. 

u There is no risk of getting HIV when donating or 

giving blood. 

VA offers HIV testing 

and treatment to all 

enrolled Veterans.

You can't tell if a person 

is HIV infected by looking 

at them.

What are signs of HIV?

Most people with HIV will not show signs of HIV until 

years after infection. People who have been recently 

infected with HIV may have: 

u Fever. 

u Chills. 

u Night sweats. 

u Headache. 

u Sore throat. 

u Swollen lymph nodes, usually on the neck. 

u Tiredness. 

u Rash. 

u Sores or infections in the mouth. 

u Body aches.

How do you know if you have HIV?

The only way to know you have HIV is by getting 

an HIV test. Routine HIV testing is recommended 

for all adults. HIV tests are offered by health care 

providers in doctor's offices, hospitals, local public 

health departments, and in community clinics. Most 

HIV tests use either blood or saliva. HIV tests are very 

accurate but may not show HIV from a recent infection. 

It is important to always discuss your test result and 

retesting with your test provider. 

www.publichealth.va.gov/InfectionDontPassItOn
27

Women’s Health: Human Immunodeficiency Virus (HIV)

How is it treated?

There is no cure for HIV. But there are very effective 

treatments that help your body fight HIV. Your health 

care provider can help you decide when to start 

treatment and which medicines to take. Treatment is 

lifelong and can: 

u Reduce the amount of virus in your body. 

u Reduce the spread of HIV to others.

u Help most people with HIV live longer and 

healthier lives. 

The sooner you know if you have HIV, 

the sooner your provider can know if 

you need treatment.

Image courtesy of the Centers for Disease Control and Prevention’s Public Health Image Library (PHIL)

Picture of microscopic HIV virus particles (small, round, green 

objects) growing from an infected immune cell (large red object). 

What can happen if you have HIV for a 

long time?

If HIV infection is not diagnosed and treated, it 

can progress into AIDS. AIDS stands for acquired 

immune deficiency syndrome. AIDS is the late stage 

of HIV infection. When you have AIDS, the virus has 

severely weakened your immune system. If HIV is not 

treated, other life-threatening infections can occur. 

The only way to know if you have AIDS is through a 

medical exam and testing by your health care provider. 

Common signs of AIDS are:

u Rapid weight loss. 

u Fevers. 

u Night sweats. 

u Extreme tiredness. 

u Swelling of the lymph nodes in the armpits, groin, or 

neck which doesn’t go away. 

u Diarrhea that lasts for more than a week. 

u Sores of the mouth, anus, or genitals. 

u Infections such as pneumonia, tuberculosis, and 

certain cancers. 

u Red, brown, pink, or purplish blotches on or under 

the skin or inside the mouth, nose, or eyelids. 

u Depression. 

u Memory loss and other brain or nerve problems.

If you have HIV:

u See a health care provider regularly.

u If on treatment, be sure to take medicines as 

prescribed.

u Tell current and recent sex partners that you have 

HIV.

u Avoid spreading HIV to others by:

 Using condoms during all sexual contact. 

 Not sharing used or unclean needles and 

sex toys.

 Not breastfeeding.

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Women’s Health: Human Immunodeficiency Virus (HIV)

How can you avoid HIV?

The best ways to avoid HIV are:

u Avoiding sexual 

contact.

u Using condoms during 

all sexual contact.

u Not using or injecting 

illegal drugs. If you do 

use injection drugs, use 

a new sterile needle and clean drug equipment each 

time you prepare and inject drugs.

Other ways to reduce the risk of getting HIV include:

u Reducing the number of sex partners.

u Have sex with only one partner who does not have 

sex with others and does not have HIV.

u Knowing that douching or washing the vagina or 

anus after sex will not prevent HIV.

u Knowing that other forms of birth control do not 

protect against HIV.

u Not reusing or sharing needles, or drug equipment 

(works). If unused (new) needles and sterile drug 

equipment are not used, then all of it should be 

boiled in water or disinfected with a bleach solution, 

then rinsed with water before each use.

Ask your sex partners to test 

for HIV and other STDs. 

For more 

information, 

see Safer Sex

on page 77.

www.publichealth.va.gov/InfectionDontPassItOn
29

Women’s Health: Human Immunodeficiency Virus (HIV)

What about pregnancy?

A woman who has HIV can pass the virus to her baby 

during:

u Pregnancy.

u Birth.

u Breastfeeding.

A woman with HIV who is not treated for HIV during 

pregnancy or labor has a 25% chance (1 in 4) of giving 

the virus to her baby. If the mother is treated, the 

chance of passing the virus to the baby is less than 2% 

(fewer than 2 out of 100 times). Babies born to HIVpositive mothers should be treated with anti-HIV drugs 

after birth.

If you are pregnant or want to get pregnant, you 

should:

u Get tested for HIV.

u Have your sexual partner tested. 

u Discuss your HIV status with your health care 

provider. 

u Talk to your health care provider about starting HIV 

treatment if you are HIV-positive. 

u Take steps to avoid HIV by:

 Having safe sex. Each time you have sex use a 

condom.

 Not injecting illegal drugs.

u Not breastfeeding your infant if you have HIV. 

If you are pregnant and HIV-positive, you should talk to your health 

care provider about starting treatment with anti-HIV drugs to prevent 

passing HIV to your baby.

For more on HIV/AIDS see:

Department of Veterans Affairs (VA):

VA National HIV/AIDS Website; for Veterans and the Public

www.hiv.va.gov/patient/

U.S. Department of Health and Human Services (HHS):

HIV/AIDS Basics

www.aids.gov/hiv-aids-basics/

Centers for Disease Control and Prevention (CDC):

HIV/AIDS Basics

www.cdc.gov/hiv/resources/qa/definitions.htm

Pregnancy and Childbirth; What Women Can Do

www.cdc.gov/hiv/topics/perinatal/protection.htm

Oral Sex and HIV Risk

www.cdc.gov/hiv/resources/factsheets/pdf/oralsex.pdf

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

What are HIV and AIDS?

www.niaid.nih.gov/topics/HIVAIDS/Understanding/Pages/whatAreHIVAIDS.aspx

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Women’s Health: A Guide to Preventing Infections

Human papillomavirus or HPV is the most common 

viral sexually transmitted disease (STD) in the United 

States. According to the Centers for Disease Control 

and Prevention (CDC), at least one out of every two 

sexually active people will have HPV at some point in 

their life.

Human Papillomavirus 

(HPV)

There are over 100 known types of HPV.

About 40 types can infect female and male genital 

areas. Genital HPV are grouped into two types:

u Low-risk types of HPV can cause genital warts or 

may be completely harmless.

u High-risk types of HPV increase the chances for 

some types of cancer, like cervical cancer.

How is it spread?

HPV is spread by skin-to-skin contact. Women get 

HPV from sexual contact with someone who has it. 

HPV can be spread by vaginal, anal, oral or handgenital sexual contact. Someone who is infected but 

has no visible signs can still spread HPV to others. 

People can be infected with more than one type of 

HPV. Long-term sexual partners with HPV often have 

the same HPV types. 

Most sexually active men and 

women get genital HPV at 

some time in their lives.

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Women’s Health: Human Papillomavirus (HPV)

There is an increased risk of genital HPV infection 

if you:

u Become sexually active at an earlier age.

u Have multiple sexual partners.

u Smoke.

u Have an immune system that does not work well 

due to a medical condition (e.g., cancer, HIV/AIDS) or 

from a medicine that weakens the immune system.

What are signs of HPV in women?

Most HPV infections have no signs that can been seen 

or felt. You can have HPV even if years have passed 

since you had sexual contact with an infected person. 

You may never know which sexual partner gave you 

HPV. HPV infection may cause:

u Genital warts (infection with low-risk viruses). 

 See Genital Warts (page 17) for more information.

u Cancer (infection with high-risk viruses). 

 Cervical cancer (more common).

 Cancers of the vagina, vulva, anus, throat, tongue 

or tonsils (less common).

How do you know if you have HPV?

Most women with HPV have no signs of infection. 

Since most HPV infections go away on their own within 

two years, many women never know they had an 

infection. Some HPV infections cause genital warts that 

can be seen or felt. The only way to know if you have 

HPV is to ask your health care provider to do an HPV 

test. Your health care provider may also examine you 

for other infections. 

High-risk types of HPV infection can cause cervical 

cancer. To detect changes in the cervix caused by HPV, 

all women should get regular Pap tests. You should talk 

to your health care provider about when to start, how 

often, and when to stop having Pap tests. 

Pap tests:

u Screen for cervical cancer and changes in the cervix 

that might turn into cancer.

u Are done by a health care provider who collects a 

cell sample from the cervix with a small brush.

u Can find abnormal cells on the cervix caused 

by HPV.

u Can be done with an HPV test if:

 You are age 30 or older.

 You have had an abnormal Pap test result. This will 

show if HPV caused the changes.

u Should be done within three years of first sexual 

contact or starting at age 21.

u Are important, as treating pre-cancer changes on the 

cervix can prevent cervical cancer.

All women, aged 21 and older, should 

have regular Pap tests.

How is it treated?

Although genital HPV infections are very common, 

most show no signs and go away without treatment 

within a few years. If HPV does not go away, treatments 

are different for low risk HPV and high-risk HPV:

u Low-Risk HPV (Genital warts) – Even when genital 

warts are treated, HPV infection may remain. Warts 

can also come back after treatment. Over-thecounter treatments for other types of warts should 

not be used. Treatments for genital warts include: 

 Watch and wait to see if the warts stay the same, 

get bigger, or go away.

 Medicines put directly on the warts. 

 Burning off the warts.

 Freezing off the warts. 

 Cutting the warts out.

 Using special lights or lasers to destroy the warts.

www.publichealth.va.gov/InfectionDontPassItOn
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Women’s Health: Human Papillomavirus (HPV)

u High-Risk HPV – Pap tests can find pre-cancer 

changes in the cervix and other abnormal cells. 

Removing the abnormal cells is the best way to 

prevent cervical cancer.

 Abnormal cells can be surgically removed without 

removing the uterus or damaging the cervix. After, 

women can still have normal pregnancies.

What can happen if you have HPV for a 

long time?

Certain types of low-risk HPV can cause genital warts. 

Without treatment genital warts may:

u Go away.

u Remain unchanged.

u Increase in size or number.

See Genital Warts, page 17 for more information.

High-risk HPV can cause abnormal cells in the cervix 

and cancer if not treated. Almost all cervical cancers 

are thought to be caused by HPV infections. While 

there are often no signs of early cervical cancer, some 

signs may include:

u Increased vaginal discharge, which may be pale, 

watery, pink, brown, bloody, or foul-smelling.

u Abnormal vaginal bleeding between menstrual 

periods, after sex, douching or a pelvic exam.

u Longer or heavier menstrual periods. 

u Bleeding after menopause.

u Pelvic pain.

u Pain during sex.

Almost all cervical cancers 

are caused by high-risk 

HPV infection.

If you have high-risk HPV the risk of cervical cancer is 

further increased if you:

u Smoke.

u Have had more than three children.

u Have used a birth control pill for more than 

five years.

u Have a family history of cervical cancer.

u Have limited access to medical testing and care.

u Have a suppressed immune system.

Model of human papillomavirus (HPV) particles.

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Women’s Health: Human Papillomavirus (HPV)

If you have HPV:

u Get regular Pap tests. 

u Discuss treatment and follow-up care with your 

health care provider.

u Know that partners that have been together for a 

while often share the same HPV types, even if both 

have no symptoms.

How can you avoid HPV?

u Get vaccinated against HPV.

 HPV vaccines can protect against 70% of cervical 

cancers.

 One type of HPV vaccine can protect against the 

low-risk HPV that causes 90% of genital warts.

 HPV vaccine is recommended for all females 9 to 

26 years old.

 The Centers for Disease Control and Prevention 

(CDC) recommends all 11-12 year old girls and boys 

get the HPV vaccine.

u Avoid sexual contact.

u Have safer sex:

 Reduce the number of sexual partners.

Condoms may not fully 

protect against HPV since 

HPV can infect areas not 

covered by a condom.

 Condoms, when used correctly, can reduce the 

risk of getting HPV. But, condoms may not cover 

all infected areas. Each time you have sex use a 

condom (male or female type):

 Before vaginal sex.

 Before anal sex.

 Before oral sex.

 Have sex with only one partner who does not 

have sex with others and does not have HPV.

u Know that other forms of birth control do not protect 

against HPV.

For more 

information, 

see Safer Sex

on page 77.

www.publichealth.va.gov/InfectionDontPassItOn
35

Women’s Health: Human Papillomavirus (HPV)

What about pregnancy?

Genital warts rarely cause problems during pregnancy 

and birth. Most women who no longer have visible 

genital warts do not have problems with pregnancy 

or birth. If you are pregnant, you should discuss 

treatment options with your health care provider as the 

warts may:

u Grow larger and bleed.

u Make it difficult to urinate if growing in the urinary 

tract (rare).

u Make the vagina less elastic during birth if the warts 

are in the vagina (rare).

u Cause a need for a cesarean section (C-section) birth 

if the warts block the birth canal (rare).

u Be passed on to the baby during birth (rare).

If you are pregnant and have a HPV infection and an 

abnormal Pap test, you should discuss your pregnancy 

with your health care provider.

For more on HPV see:

Department of Veterans Affairs (VA):

Cervical Cancer: The Power of Early Detection

www.va.gov/health/NewsFeatures/20110113a.asp

Centers for Disease Control and Prevention (CDC):

Human Papillomavirus (HPV)

www.cdc.gov/hpv/index.html

Genital HPV Infection – Fact Sheet

www.cdc.gov/std/HPV/STDFact-HPV.htm

HPV Vaccination

www.cdc.gov/vaccines/vpd-vac/hpv/default.htm

National Cancer Institute (NCI/NIH):

Understanding Cervical Changes: A Health Guide for Women

www.cancer.gov/cancertopics/understandingcervicalchanges/allpages

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

Human Papillomavirus (HPV) and Genital Warts

www.niaid.nih.gov/topics/genitalWarts/Pages/default.aspx

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Human papillomavirus (HPV) and genital warts fact sheet

www.womenshealth.gov/publications/our-publications/fact-sheet/human-papillomavirus.cfm

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Women’s Health: A Guide to Preventing Infections

Syphilis is a sexually transmitted disease (STD) 

caused by bacteria. It has often been called 

“the great imitator” as so many of the signs and 

symptoms are like those from other infections.

Syphilis

How is it spread?

Women get syphilis from sexual contact with someone 

who has it. Anyone who has it can spread it to others. 

Sometimes sores or infection may not be visible and 

the person may not know that they have it. Syphilis can 

be spread between: 

u Men and women.

u Women and women.

u Men and men.

Contact with a syphilis sore can spread the infection. It 

can get into your body through the vagina, anus, mouth 

and throat, or broken skin. Pregnant women can pass 

the infection to their babies before they are born.

What are signs of syphilis in women?

There are four stages of syphilis. Each is defined 

by how long the person has had it. Signs vary in 

each stage.

1. Primary Stage: The first sign of syphilis is often a 

small, round, firm, sore. These appear at the place 

where it entered the body such as the vulva, vagina, 

tongue, or lips. These signs may be inside the 

vagina. Most do not cause pain. There can also be 

more than one sore. Signs of syphilis often go away 

in about 3 to 6 weeks even without treatment. 

If not treated in this stage, it will progress into the 

other stages.

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Women’s Health: Syphilis

2. Secondary Stage: This stage can start with a rash 

over one or more areas of the body. These appear 

mostly on the palms of the hands and the bottoms of 

the feet. Other signs may be:

u Sore throat.

u Swollen glands.

u Fever.

u Hair loss in patches.

u Head and muscle aches.

u Weight loss. 

u Tiredness.

If not treated in this stage, signs will still go away. 

However, the syphilis bacteria are still in the body. 

The infection will progress into the latent stage.

3. Latent Stage: This stage is also called the hidden 

stage. It can last many years. Syphilis remains in the 

body with no signs of infection. After 10 to 20 years 

without treatment, syphilis can progress to the late 

stage.

4. Late Stage: Syphilis in this stage can cause: 

u Numbness.

u Problems with blood vessels.

u Damage to bones and joints.

u Difficulty walking. 

u Blindness.

u Paralysis.

u Brain damage.

u Dementia.

u Heart disease.

u Death.

How do you know if you have syphilis?

Your health care provider can examine and test you for 

syphilis. Blood or fluid from a sore can be tested.

How is it treated? 

Syphilis can be cured with antibiotics in all stages of the 

disease. Always finish antibiotic treatment. Do not have 

sex until after treatment and all signs are gone. See 

your health care provider if your signs do not go away 

after finishing treatment. Some damage to your body 

caused by the disease may remain. 

If you have syphilis:

u Always finish all antibiotic treatment.

u Do not have sex with someone who has syphilis or 

has not finished treatment (to prevent re-infection).

u Tell current and recent sex partners of the infection 

so they can get checked. 

u Know that it can raise the risk of getting and 

spreading HIV.

u Get tested again after 6 and 12 months. Only a 

health care provider can tell you when you no 

longer have it.

www.publichealth.va.gov/InfectionDontPassItOn
39

Women’s Health: Syphilis

How can you avoid syphilis?

u Avoid sexual contact.

u Have safer sex:

 Reduce the number of sexual partners.

 Condoms, when used correctly, can reduce the 

risk of getting syphilis. Each time you have sex 

use a condom (male or female type):

 Before vaginal sex.

 Before anal sex.

 Before oral sex.

 Have sex with only 

one partner who 

does not have sex 

with others and does not have syphilis.

u Know that other forms of birth control do not protect 

against syphilis.

What about pregnancy?

All pregnant women should be tested for syphilis. 

If you are pregnant and have syphilis, you can pass 

the infection to your baby during pregnancy or birth. 

Syphilis during pregnancy can cause:

u Babies with skin sores, blood, liver and other 

problems.

u Miscarriage. 

u Early birth.

u A baby born dead.

u A baby that dies soon after birth. 

Pregnant women and babies born to infected mothers 

must be treated to avoid problems.

For more 

information, 

see Safer Sex

on page 77.

For more on syphilis see:

Centers for Disease Control and Prevention (CDC):

Syphilis – CDC Fact Sheet

www.cdc.gov/std/Syphilis/STDFact-syphilis.htm

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

Syphilis

www.niaid.nih.gov/topics/syphilis/Pages/default.aspx

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Syphilis fact sheet

www.womenshealth.gov/faq/syphilis.cfm

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Women’s Health: A Guide to Preventing Infections

Trichomoniasis is an infection caused by a tiny 

parasite. It affects both men and women. It is also 

known as “trich”.

Trichomoniasis

How is it spread? 

Women get trichomoniasis from sexual contact with 

someone who has it. Anyone who has it can spread it 

to others. It can be spread between:

u Men and women.

u Women and women.

u Men and men.

See your health care provider to be 

tested if you have signs of “trich”.

Most infected men have no signs 

of trichomoniasis. Anyone who 

has “trich” can spread it even if 

they have no signs of it.

What are signs of trichomoniasis 

in women?

Some women can have “trich” without having signs. 

Others have signs that include:

u Increased vaginal discharge that can be foamy, 

yellow, or yellow-green.

u Strong vaginal odor.

u Vaginal itching and irritation.

u Discomfort during sex or urination.

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Women’s Health: Trichomoniasis

How do you know if you have 

trichomoniasis?

The only way to know if you have trichomoniasis is by 

a medical exam. Your health care provider can use a 

simple vaginal swab to test for it. Your provider may 

also ask to test you for other infections at the same 

time. See your health care provider to be tested for 

trichomoniasis each year if you: 

u Are age 25 or younger and are sexually active.

u Are older than 25 with new or multiple sex partners.

u Do not practice safe sex.

u Are having sex with someone who might be having 

sex with others.

u Are pregnant. 

How is it treated? 

Trichomoniasis can be treated and cured with 

prescription pills. Always finish treatment. Do not have 

sex until after treatment and all signs are gone. See 

your health care provider if your signs do not go away 

after finishing treatment. 

If you have trichomoniasis:

u Always finish all treatment.

u Do not have sex with someone who has 

trichomoniasis or has not finished treatment (to 

prevent re-infection).

u Tell current and recent sex partners of the infection 

so they can get checked. 

u Know that it can raise the risk of getting and 

spreading HIV.

How can you avoid trichomoniasis?

u Avoid sexual contact.

u Have safer sex:

 Reduce the number 

of sexual partners.

 Condoms, when used 

correctly, can reduce 

the risk of getting trichomoniasis. Each time you 

have sex use a condom (male or female type):

 Before vaginal sex.

 Before anal sex.

 Before oral sex.

 Have sex with only one partner who does 

not have sex with others and does not have 

trichomoniasis.

u Know that other forms of birth control do not protect 

against trichomoniasis.

What about pregnancy?

Trichomoniasis, if not treated, can increase the risk of 

low birth weight babies or early birth. Tell your health 

care provider if you have any signs of “trich” so you can 

be tested. Discuss treatment options with your health 

care provider. 

For more on trichomoniasis see:

Centers for Disease Control and Prevention (CDC):

Trichomoniasis – CDC Fact Sheet

www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Trichomoniasis fact sheet

www.womenshealth.gov/faq/trichomoniasis.cfm

For more 

information, 

see Safer Sex

on page 77.

www.publichealth.va.gov/InfectionDontPassItOn
43

Women’s Health: A Guide to Preventing Infections

Hepatitis means that the liver is inflamed. This 

inflammation (swelling) can be caused by germs, 

viruses, some medicines, some diseases, or heavy 

alcohol use.

Hepatitis

Three common types of hepatitis are 

caused by viruses: 

u Hepatitis A virus causes hepatitis A.

u Hepatitis B virus causes hepatitis B. 

u Hepatitis C virus causes hepatitis C.

These three kinds of hepatitis can be acute. Hepatitis B 

and C can become chronic.

Acute viral hepatitis:

u Is caused by hepatitis A, hepatitis B, and 

hepatitis C viruses. 

u Usually occurs within a few weeks after you first 

get infected with the virus. 

u Can be mild, severe or even life-threatening.

u Hepatitis B or C can sometimes lead to long-term 

(chronic) infection.

Chronic hepatitis B and C are 

serious health problems.

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Women’s Health: Hepatitis

Chronic viral hepatitis: 

u Is caused only by hepatitis B and hepatitis C viruses. 

u May be lifelong.

u Can cause liver damage, cirrhosis (scarring of the 

liver), and liver cancer.

What are the signs of hepatitis?

You may not have any sign of hepatitis. Or, you may 

have:

u Yellow skin or eyes (jaundice).

u Tiredness.

u Fever.

u Nausea. 

u Vomiting.

u Loss of appetite.

u Stomach pain.

u Light stools.

u Dark urine.

Symptoms can appear 

anywhere from 2 to 6 

weeks after contact 

with the virus.

Model of the human liver.

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45

Women’s Health: A Guide to Preventing Infections

Hepatitis A is a disease of the liver caused by hepatitis 

A virus. It may make you sick for a few weeks to a few 

months. Most recover with no lasting liver damage. 

Hepatitis A

How is it spread?

Hepatitis A is spread by coming in contact with the 

hepatitis A virus. This includes:

u Contact with any person infected with the hepatitis A 

virus.

u Sexual contact with an infected person.

u Touching contaminated surfaces and then placing 

your hands near or in your mouth.

u Sharing eating utensils that have virus on them.

u Eating food or drinking water that has been 

contaminated by feces that contain the virus. The 

food and drinks most likely to be contaminated are: 

 Fruits.

 Vegetables. 

 Shellfish.

 Ice. 

 Water.

In the United States, chlorine in the water kills hepatitis 

A virus. But infected food workers can still spread 

hepatitis A directly to food. This occurs when hands are 

not washed or cleaned before food is handled.

Infected people can spread the virus 

to others a few weeks before they 

begin to feel bad.

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Women’s Health: Hepatitis A

Who is at risk of hepatitis A?

Anyone can get hepatitis A if they have not been 

vaccinated. In the U.S., you are at a higher risk if you:

u Use illegal drugs, whether injected or not.

u Live with someone who has hepatitis A.

u Have bleeding problems and take clotting factors.

u Have oral-anal sexual contact with someone who 

has hepatitis A.

u Travel to areas that have high rates of hepatitis A.

Travel to Africa, Asia, Eastern Europe, 

or Central and South America, 

including Mexico, increases the risk 

of getting hepatitis A.

What are signs of hepatitis A?

Hepatitis A does not always cause people to feel bad. 

It may make you sick for a few weeks to a few months. 

Older people can get sicker when they have hepatitis 

A. Young children with hepatitis A usually do not show 

any signs. Signs of hepatitis A include:

u Yellow skin or eyes (jaundice).

u Tiredness.

u Fever.

u Nausea.

u Vomiting.

u Loss of appetite.

u Stomach pain.

u Light stools.

u Dark urine.

u Diarrhea.

How do you know if you have 

hepatitis A?

The only way to know if you have hepatitis A is by a 

medical exam. Your health care provider can examine 

and test you for hepatitis A. 

How is it treated?

There are no medicines for treating hepatitis A. If 

you have been exposed to hepatitis A virus, tell your 

health care provider. They may be able to give you a 

protein that fights hepatitis A virus to help keep you 

from getting sick. Most people with hepatitis A recover 

without treatment in a few months. A few people will 

need to be hospitalized for hepatitis A.

What can happen if you have hepatitis A 

for a long time?

People with hepatitis A usually improve without 

treatment and have no lasting liver damage. Symptoms 

usually last less than 2 months. A few people can be 

ill for as long as 6 months. Hepatitis A can sometimes 

cause liver failure and death. This is usually occurs in:

u People 50 years of age or older.

u People with other liver diseases, such as 

hepatitis B or C.

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Women’s Health: Hepatitis A

If you have hepatitis A: 

u Get plenty of rest.

u Eat healthy foods. 

u Drink plenty of fluids. 

u Avoid drinking any alcohol. 

u Check with your health care provider before taking:

 Medicines.

 Supplements and herbal medicines. 

 Over-the-counter drugs.

u Clean hands often, especially after using the 

bathroom.

u Avoid preparing 

food, if possible, 

while you are sick.

u Talk to those 

listed below 

about having 

hepatitis A 

so they can 

get more 

information 

to protect 

themselves:

 Household contacts.

 Sexual contacts.

 Playmates/attendees at childcare centers.

 Persons sharing illegal drugs.

 Persons sharing food or drink.

 Coworkers and/or restaurant patrons where there 

is an infected food worker.

If you have hepatitis A, 

avoid drinking alcohol. For more on how 

to clean hands, 

see Clean Hands

on page 119.

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Women’s Health: Hepatitis A

How can you avoid hepatitis A?

The best way to prevent hepatitis A is to be 

vaccinated. People with certain risk factors and 

health problems need this vaccine. Ask your doctor if 

the vaccine is right for you. You cannot get hepatitis 

A from the vaccine. Hepatitis A vaccination is 

recommended for:

u All children at age 1 year.

u People who use injection and non-injection 

illegal drugs.

u People with chronic (lifelong) liver diseases, such 

as hepatitis B or hepatitis C.

u People with bleeding problems who take clotting 

factors.

u People whose work has a risk for hepatitis A 

infection.

u People who live in areas with high rates of 

hepatitis A infection.

u Travelers to countries that have high rates of 

hepatitis A. These include:

 Africa. 

 Asia. 

 Latin America.

 South America. 

 Eastern Europe.

CDC’s Travelers’ Health site has information about 

hepatitis A and other vaccines at: wwwnc.cdc.gov/

travel/yellowbook/2012/chapter-3-infectiousdiseases-related-to-travel/hepatitis-a.htm

Getting vaccinated 

is the best way to 

prevent hepatitis A.

Other ways to avoid hepatitis A:

u Boil water or drink bottled water in places where the 

water may not be clean.

u Eat cooked foods and fruits that you can peel. Avoid 

eating uncooked vegetables or fruits that could have 

been washed with dirty water, such as lettuce.

u Avoid eating raw or steamed shellfish such as 

oysters. Shellfish may live in dirty water.

u Use condoms correctly and every time you have 

sex.

u Clean hands often.

www.publichealth.va.gov/InfectionDontPassItOn
49

Women’s Health: Hepatitis A

What about pregnancy?

Hepatitis A vaccine does not contain live virus, so the risk to 

the baby is expected to be low. However, the safety of hepatitis 

A vaccination during pregnancy is not known. The risk of the 

vaccination should be weighed against the risk for hepatitis A in 

pregnant women. Ask your health care provider if the vaccine is 

right for you.

For more on hepatitis A see:

Department of Veterans Affairs (VA):

Hepatitis A Basics

www.hepatitis.va.gov/patient/basics/hepatitisA-index.asp

Centers for Disease Control and Prevention (CDC):

Hepatitis A Information for the Public

www.cdc.gov/hepatitis/A/

Guidelines for Vaccinating Pregnant Women; Hepatitis A

www.cdc.gov/vaccines/pubs/preg-guide.htm#hepa

National Institute for Allergy and Infectious Diseases (NIAID/NIH):

Hepatitis A

www.niaid.nih.gov/topics/hepatitis/hepatitisa/Pages/Default.aspx

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Viral hepatitis fact sheet

www.womenshealth.gov/faq/viral-hepatitis.cfm

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Women’s Health: A Guide to Preventing Infections

Hepatitis B is a disease of the liver caused by 

hepatitis B virus. Most adults who have hepatitis B 

will recover on their own. However, children and some 

adults can develop chronic (lifelong) hepatitis B.

Hepatitis B

How is it spread?

Hepatitis B virus is spread by contact with body fluids 

that carry the virus, such as: 

u Blood. 

u Semen. 

u Vaginal fluids. 

u Other body fluids. 

Hepatitis B is spread by contact with infected body 

fluids, mostly by:

u Sexual contact: (This is the most common way it is 

spread in the U.S.).

 Vaginal and anal sex.

 Sharing unclean sex toys.

 Body fluids with hepatitis B can enter tiny breaks 

or rips in the linings of the vagina, vulva, rectum, 

or mouth. Rips and tears in these areas can be 

common and often unnoticed.

u Needle sharing: 

 Used or unclean needles. 

 During illegal drug or drug equipment use. 

Infected mothers 

can pass hepatitis 

B to their babies 

during childbirth.

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Women’s Health: Hepatitis B

u Contact with blood:

 Open sores of an infected person. 

 Sharing items such as razors or toothbrushes with 

an infected person.

 Being tattooed or pierced with tools that were not 

properly cleaned.

u Pregnancy and birth: 

 Hepatitis B can spread to babies during 

pregnancy and birth. 

Hepatitis B is rarely spread from a blood transfusion 

because:

u Hepatitis B tests are done on all donated blood. 

u Blood and blood products that test positive for 

hepatitis B are safely destroyed. None are used for 

transfusions. 

u There is no risk of getting hepatitis B when donating

or giving blood. 

Who is at risk of hepatitis B?

Anyone can get hepatitis B if not vaccinated. However, 

in the U.S., you may be at a higher risk if you:

u Have sex partners that have hepatitis B.

u Have HIV or another STD.

u Inject drugs or share needles, syringes, or other 

drug-injection equipment.

u Live with someone who has hepatitis B. 

u Are undergoing dialysis.

u Have diabetes.

u Travel to areas that have moderate to high rates 

of hepatitis B (see: wwwnc.cdc.gov/travel/

yellowbook/2010/chapter-2/hepatitis-b.

aspx#363). 

u Work in health care or public safety and are exposed 

to blood or body fluids on the job.

u Are an infant born to an infected mother.

What are signs of hepatitis B?

When you first get hepatitis B, it is called acute

hepatitis B. Most adults who have hepatitis B will 

recover on their own. However, children and some 

adults can develop chronic (lifelong) hepatitis B. 

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53

Women’s Health: Hepatitis B

Acute hepatitis B: Signs of acute hepatitis B can 

appear within 3 months after you get the virus. 

These signs may last from several weeks to 6 months. 

Up to 50% of adults have signs of acute hepatitis B 

virus infection. Many young children do not show any 

signs. Signs include:

u Yellow skin or eyes (jaundice).

u Tiredness.

u Fever.

u Nausea. 

u Vomiting.

u Loss of appetite.

u Stomach pain.

u Light stools.

u Dark urine.

u Joint pain.

Chronic hepatitis B: Hepatitis B is chronic when the 

body can’t get rid of the virus. Children, mostly infants, 

are more likely to get chronic hepatitis B than adults. 

People with chronic hepatitis B may have no signs 

for as long as 20 or 30 years. Signs may be the same 

as acute hepatitis B. There may also be signs of liver 

damage and cirrhosis such as:

u Weakness.

u Weight loss. 

u Small, red, spider-like blood vessels on the skin. 

u Confusion or problems thinking. 

u Loss of interest in sex. 

u Swollen stomach or ankles.

u A longer than normal amount of time for bleeding 

to stop.

How do you know if you have 

hepatitis B?

The only way to know if you have hepatitis B is by 

a medical exam. There are several blood tests your 

health care provider can use to diagnose hepatitis B. 

These tests can tell you: 

u If it is an acute or a chronic infection.

u If you have recovered from infection.

u If you are immune to hepatitis B.

u If you could benefit from vaccination.

How is it treated?

Acute hepatitis B: There are no drugs to treat acute 

hepatitis B. Doctors usually suggest rest, good 

nutrition, and fluids. Some people may need to be in 

the hospital.

Chronic hepatitis B: People with chronic hepatitis B 

virus infection should receive care from a provider who 

has experience treating hepatitis B. These providers 

can be: 

u Some internists or family medicine providers. 

u Infection specialists. 

u Gastroenterologists (digestive system specialists).

u Hepatologists (liver specialists).

If you have chronic hepatitis B, get checked regularly 

for signs of liver disease. Discuss treatment with your 

health care provider. Not every person with chronic 

hepatitis B needs treatment. If you show no signs of 

liver damage, your provider will continue to check you 

for liver disease. 

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Women’s Health: Hepatitis B

What can happen if chronic hepatitis B is 

not treated?

Chronic hepatitis B is a serious disease that can result 

in long-term health problems. Up to 1 in 4 people with 

chronic hepatitis B develop serious liver problems. 

These include: 

u Liver damage and scarring (cirrhosis). 

u Liver failure. 

u Liver cancer.

u Death.

If you have hepatitis B: 

u See your health care provider regularly.

u Tell current and recent sex partners that you have 

hepatitis B. 

u Get plenty of rest.

u Eat healthy foods. 

u Drink plenty of fluids.

u Avoid drinking any alcohol. There are ways to help 

you stop drinking alcohol at: www.hepatitis.va.gov/

patient/alcohol/what-you-can-do.asp.

u Check with your health care provider before taking:

 Prescription medicines.

 Supplements or herbal medicines. 

 Over-the-counter drugs.

u Avoid spreading hepatitis B to others by:

 Having safer sex and using condoms during all 

sexual contact. 

 Not sharing used or unclean needles and sex 

toys.

 Not donating blood, blood products, or organs. 

 Cleaning all blood spills – even those that have 

already dried. Use a mixture of bleach and water 

(one part household bleach to 10 parts water). 

Even dried blood is a risk to others.

 Not sharing personal care items like razors, 

toothbrushes, nail clippers or earrings.

 Not sharing glucose-monitoring equipment.

 Asking sexual partner(s) and people living in close 

contact with you to be tested and vaccinated.

Model of hepatitis B virus particles.

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55

Women’s Health: Hepatitis B

How can you avoid hepatitis B?

Getting the vaccine for hepatitis B is the best way to 

prevent hepatitis B. The hepatitis B vaccine is safe and 

effective. It is usually given as 3-4 shots over a 6-month 

period. You will not get hepatitis B from the vaccine. 

Ask your health care provider if you should get this 

vaccine. It is recommended for:

u All infants, starting with the first dose of hepatitis B 

vaccine at birth.

u Everyone under the age of 19 who has not 

been vaccinated.

u People whose sex partners have hepatitis B.

u Sexually active people who are not in a long-term, 

faithful relationship.

u People with a sexually transmitted disease. 

u People who share needles, syringes, or other druginjection equipment. 

u People who have close household contact with 

someone infected with the hepatitis B virus. 

u Health care and public safety workers at risk for 

exposure to blood or body fluids on the job.

u People with kidney disease. This includes all those 

on dialysis and those being considered for dialysis. 

u Adults with diabetes.

u Residents and staff of facilities for disabled persons.

u People with chronic liver disease.

u People with HIV infection.

u Travelers to regions with moderate or high rates 

of hepatitis B (see: wwwnc.cdc.gov/travel/

yellowbook/2010/chapter-2/hepatitis-b.

aspx#363). 

Travelers at increased risk for infection include:

 Adventure travelers.

 Peace Corps volunteers. 

 Missionaries. 

 Military personnel. 

Certain events may increase the risk for hepatitis B 

for travelers:

 An injury or illness that requires certain types of 

treatment. These include anything that breaks the 

skin such as shots, fluids in the vein, transfusion, 

stitches, and surgery.

 Dental treatment.

 Unprotected sexual contact.

 Sharing drug injection equipment.

 Tattooing, ear piercing, acupuncture and other 

practices that break the skin.

 Practices with risk for breaking the skin such as 

manicures and pedicures.

 Sharing certain items such as earrings, razors, 

toothbrushes and nail clippers.

Other ways to avoid hepatitis B:

u Avoid sexual contact.

u Have safer sex:

 Reduce the number 

of sexual partners.

 Condoms, when used 

correctly, can reduce 

the risk of getting hepatitis B. Each time you have 

sex use a condom (male or female type):

 Before vaginal sex.

 Before anal sex.

 Before oral sex.

 Have sex with only one partner who does 

not have sex with others and does not have 

hepatitis B.

For more 

information, 

see Safer Sex

on page 77.

The hepatitis B vaccine is the 

best way to prevent hepatitis B.

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Women’s Health: Hepatitis B

u Know that other forms of birth control do not protect 

against hepatitis B.

u Not using or injecting drugs. 

u Not reusing or sharing syringes, or drug equipment 

(works).

u Wear gloves if you have to touch another person’s 

blood.

u Do not use another person’s toothbrush, razor, nail 

clippers or any other item that might have even a tiny 

bit of blood on it. 

u Make sure any tattoos or body piercings are done 

under good conditions, using:

 Sterile tools

 Clean hands and gloves

 Disinfected work surfaces 

What about pregnancy?

If you have hepatitis B, your baby has a very high 

chance of getting it. Pregnant women should be 

checked for hepatitis B by a health care provider. If 

you are at risk for hepatitis B, ask your provider about 

getting vaccinated. The hepatitis B vaccine is safe for 

pregnant women and their baby. The vaccine can help 

your baby if:

u It is given to the baby within 12 hours of birth. 

u The baby finishes the vaccine series. Note: babies 

should be tested after the last vaccine shot to make 

sure they are protected from the disease. 

Don’t breastfeed until you have discussed it with 

your health care provider. Avoid breastfeeding if your 

nipples are cracking or bleeding until the sores heal. 

Until they heal, you can pump your milk to keep up 

your milk supply. Do not feed this milk to your baby. 

Throw it away.

Hepatitis B is a very serious 

disease for babies. 9 out of 

10 babies infected develop 

chronic hepatitis B.

For more on how 

to clean hands, 

see Clean Hands

on page 119.

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Women’s Health: Hepatitis B

For more on hepatitis B see:

Department of Veterans Affairs (VA):

Hepatitis B Basics

www.hepatitis.va.gov/patient/basics/hepatitisB-index.asp

Centers for Disease Control and Prevention (CDC):

Hepatitis B Information for the Public

www.cdc.gov/hepatitis/B/

Infectious Diseases Related to Travel; Hepatitis B

wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/hepatitis-b.aspx#363

Protect Your Baby for Life; When a Pregnant Woman Has Hepatitis B

www.cdc.gov/hepatitis/HBV/PDFs/HepBPerinatal-ProtectWhenPregnant-BW.pdf

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

Hepatitis B

www.niaid.nih.gov/topics/hepatitis/hepatitisb/Pages/Default.aspx

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH):

What I need to know about Hepatitis B

digestive.niddk.nih.gov/ddiseases/pubs/hepb_ez/

U.S. National Library of Medicine:

Cirrhosis

www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001301/

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Viral hepatitis fact sheet

www.womenshealth.gov/faq/viral-hepatitis.cfm

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Women’s Health: A Guide to Preventing Infections

Hepatitis C is a disease of the liver caused by 

hepatitis C virus. Hepatitis C infection can lead to 

chronic viral hepatitis, including liver damage, cirrhosis 

(scarring of the liver), and liver cancer. 

Hepatitis C

How is it spread?

Hepatitis C virus is mostly spread by blood from an 

infected person when:

u Sharing needles or other equipment to inject drugs. 

This is the most common way people get hepatitis C 

in the U.S. 

u Getting a needle stick with a needle that was used 

on an infected person.

u Sharing items that may have come in contact with 

another person’s blood, such as razors, nail clippers, 

pierced earrings, toothbrushes. 

u Being tattooed or pierced with tools that were used 

on an infected person.

u Having sexual contact with a person infected with 

the hepatitis C virus. The risk of getting hepatitis C 

from sexual contact is thought to be low. 

Hepatitis C is rarely spread from a blood 

transfusion because:

u Hepatitis C tests are done on all donated blood. 

u Blood and blood products that test positive for 

hepatitis C are safely destroyed. None are used for 

transfusions. 

u There is no risk of getting hepatitis C when donating

or giving blood. 

Hepatitis C is not spread by kissing, 

hugging, coughing, or sharing food 

and eating utensils.

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Women’s Health: Hepatitis C

Who is at risk of hepatitis C?

Anyone can get hepatitis C. It is important for people 

at high risk of infection to be tested and treated for 

hepatitis C. In the U.S., you are at a higher risk if you:

u Have ever used a needle to inject drugs, even if 

once and long ago. 

u Had a blood transfusion or organ transplant before 

1992. 

u Are a health care worker who had blood exposure 

to mucous membranes or to non-intact skin, or a 

needlestick injury. 

u Have ever been on kidney dialysis. 

u Were born of a mother who had hepatitis C at 

the time. 

u Are a Vietnam-era Veteran. 

u Had contact with hepatitis-C-positive blood to nonintact skin or to mucous membranes.

u Received tattoos or body piercings in non-regulated 

settings. 

u Have ever snorted drugs or shared drug equipment.

u Have liver disease.

u Have abnormal liver tests. 

u Have a history of alcohol abuse.

u Have hemophilia and received clotting factor 

before 1987.

u Have had a sexual partner with hepatitis C, now or 

in the past.

u Have had 10 or more lifetime sexual partners.

u Have HIV infection.

What are signs of hepatitis C?

When you first get hepatitis C, it is called acute

hepatitis C. About 15% of people who have acute

hepatitis C infection clear the virus from their bodies. 

The other 85% of people develop a chronic (lifelong) 

hepatitis C infection. Of these, 50 to 80%, if treated, 

may be cured.

The only way to know if you have 

Hepatitis C is to be tested. VA offers 

hepatitis C testing and treatment to 

enrolled Veterans.

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Women’s Health: Hepatitis C

Acute hepatitis C: Most people with acute

hepatitis C do not have any signs. If signs occur, the 

average time is 6–7 weeks after exposure, but can be 

less or more. Some people can have mild to severe 

signs including: 

u Yellow skin or eyes (jaundice).

u Tiredness.

u Fever.

u Nausea. 

u Vomiting.

u Loss of appetite.

u Stomach pain.

u Light stools.

u Dark urine.

Chronic hepatitis C: 3-5 million persons in the United 

States have chronic hepatitis C infection. Most people 

do not know they are infected. They don’t look or feel 

sick until the virus causes liver damage. This can take 

10 years or more to happen. Signs may be the same 

as acute hepatitis C. There may also be signs of liver 

damage and cirrhosis such as:

u Weakness. 

u Weight loss. 

u Small, red, spider-like blood vessels on the skin. 

u Confusion or problems thinking. 

u Loss of interest in sex. 

u Swollen stomach or ankles.

u A longer than normal amount of time for bleeding 

to stop.

How do you know if you have 

hepatitis C?

The only way to know if you have hepatitis C is by 

a medical exam. There are several blood tests your 

health care provider can use to diagnose hepatitis C. 

These tests can tell you: 

u If it is acute or chronic infection.

u If you have recovered from infection.

u If you could benefit from vaccination for 

hepatitis A and B.

In some cases, your health care provider may suggest 

a liver biopsy. A liver biopsy is a test for liver damage. A 

needle is used to remove a tiny piece of liver, which is 

then sent for tests.

How is it treated?

If you have chronic hepatitis C infection, your health 

care provider will examine you for liver problems and 

may prescribe drugs to help control the disease. 

Hepatitis C drugs can help to:

u Clear the virus from the body.

u Slow down or prevent liver damage.

u Lower the chance of getting cirrhosis and 

liver cancer.

Before starting treatment it is important to discuss your 

options with your health care provider. Treatment for 

hepatitis C may not be for everyone. Some patients 

might not need treatment. Other patients might not be 

able to be treated due to other medical problems. 

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Women’s Health: Hepatitis C

What can happen if hepatitis C is 

not treated?

For every 100 people infected with hepatitis C: 

u About 15 will clear the virus from their bodies.

u About 85 will develop chronic (long-term) infection. 

Of these 85 people: 

 66 will get only minor liver damage.

 17 will develop cirrhosis and may have symptoms 

of severe liver disease.

 2 will develop liver cancer.

Chronic hepatitis C infection is the leading cause 

of liver cancer and cirrhosis in the U.S. Cirrhosis 

is scarring of the liver which causes it to not work 

properly. Both liver cancer and cirrhosis can be fatal. A 

liver transplant may be necessary if chronic hepatitis C 

causes the liver to fail.

If you have hepatitis C: 

u See your health care provider regularly.

u Tell current and recent sex partners that you have 

hepatitis C. 

u Get vaccinated against hepatitis A and 

hepatitis B.

u Get plenty of rest.

u Eat healthy foods. 

u Drink plenty of fluids. 

u Avoid drinking any alcohol. Alcohol use speeds up 

the damage hepatitis C causes in your liver. Drinking 

alcohol before starting hepatitis C treatment makes 

treatment less likely to work. There are ways to help 

you stop drinking alcohol at: www.hepatitis.va.gov/

patient/alcohol/what-you-can-do.asp.

u Check with your health care provider before taking:

 Prescription medicines.

 Supplements. 

 Over-the-counter drugs.

u Avoid spreading hepatitis C to others by:

 Having safer sex and using condoms during all 

sexual contact. 

 Not sharing used or unclean needles and 

sex toys.

 Not donating blood, blood products, or organs. 

 Cleaning all blood spills – even those that have 

already dried. Use a mixture of bleach and water 

(one part household bleach to 10 parts water). 

Even dried blood is a risk to others.

 Not sharing personal care items like razors, 

toothbrushes, nail clippers or earrings.

 Not sharing glucose-monitoring equipment.

 Asking your sexual partner(s) to be tested for 

hepatitis C (and perhaps other infections). 

If you have hepatitis C, you 

can prevent liver damage 

by not drinking alcohol and 

by getting vaccinated for 

hepatitis A and hepatitis B.

How can you avoid hepatitis C? 

Right now there is no vaccination to protect you against 

hepatitis C. However, you can take steps to protect 

yourself from becoming infected:

u Don’t use injectable drugs.

u If you use drugs, get vaccinated against hepatitis A 

and hepatitis B and enter a treatment program.

Liver with cirrhosis.

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Women’s Health: Hepatitis C

u Never share needles, syringes, water, or “works” 

for intravenous drug use, to inject steroids, or 

cosmetic substances. 

u Handle needles and other sharp objects safely.

u Do not use personal items that may have come into 

contact with an infected person’s blood.

u Do not get tattoos or body piercings from an 

unlicensed facility or in an informal setting.

u Wear gloves if you have to touch another person’s 

blood. Always clean hands after removing gloves.

u Have safer sex. Each time you have sex use 

a condom.

What about pregnancy?

It is possible to get pregnant if you or your partner 

has hepatitis C. If you are a pregnant woman who 

already has hepatitis C (or gets hepatitis C during the 

pregnancy), the chance of passing the virus to your 

baby is 4 out of 100. The risk becomes greater if the 

mother has both hepatitis C and HIV. With good 

prenatal care, babies born to mothers or fathers with 

hepatitis C are usually quite healthy. The chance of 

your baby being infected with hepatitis C is the same 

whether your baby is born by vaginal delivery or 

C-section. Before breastfeeding, talk to your health 

care provider.

For more on hepatitis C see:

Department of Veterans Affairs (VA):

Hepatitis C Basics

www.hepatitis.va.gov/patient/basics/hepatitisC-index.asp

Hepatitis C medications: A review and update for patients

www.hepatitis.va.gov/products/patient/treatment-update.asp

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

Hepatitis C

www.niaid.nih.gov/topics/hepatitis/hepatitisC/Pages/Default.aspx

Centers for Disease Control and Prevention (CDC):

Hepatitis C Information for the Public

www.cdc.gov/hepatitis/C/

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH):

What I need to know about Hepatitis C

digestive.niddk.nih.gov/ddiseases/pubs/hepc_ez/

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Viral hepatitis fact sheet

www.womenshealth.gov/faq/viral-hepatitis.cfm

For more 

information, 

see Safer Sex

on page 77.

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Women’s Health: A Guide to Preventing Infections

Bacterial vaginosis, or BV, is a common vaginal 

infection in women. It is the most common vaginal 

infection in women of childbearing age, including 

pregnant women. 

Bacterial Vaginosis (BV)

While it is not a sexually transmitted disease (STD), 

some sexual behaviors increase the chances for BV. 

Women who have never had sex can also have BV.

How is it spread? 

The vagina contains many different types of bacteria. 

Normally, there are large numbers of “good” bacteria 

that keep the number of “harmful” bacteria very low. 

Bacterial vaginosis occurs when this balance is upset 

and there are more “harmful” bacteria than “good” 

bacteria. The cause of BV is not fully understood.

The risk of BV is higher if you:

u Have a new sex partner or multiple sex partners.

u Douche.

u Do not use condoms.

u Have a female sexual partner with BV.

BV is more common in lesbian 

and bisexual women than in 

other women. The reason for 

this is unknown.

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Women’s Health: Bacterial Vaginosis (BV)

What are signs of BV in women?

Women with BV may have few or no signs of infection. 

Some women with BV have: 

u Increased vaginal discharge: 

 Often watery.

 Gray or white in color. 

 Sometimes has an unpleasant, fish-like odor, 

especially after sex.

u Itching or irritation in the vaginal area.

u Burning during urination.

How do you know if you have BV?

BV can be diagnosed during a medical exam. To 

check for BV, your health care provider looks for signs 

of infection and collects a sample of vaginal fluid for 

lab tests. 

How is it treated?

BV is treated with antibiotics. These can be in pill form, 

creams, gels, or ovules. Sometimes BV goes away 

without treatment.

What can happen if you have BV for a 

long time?

Most often, BV does not cause other health problems. 

However, if left untreated, BV may increase your 

risk for:

u Sexually transmitted diseases (STDs) like herpes, 

chlamydia, gonorrhea, and HIV.

u Pelvic inflammatory disease where BV bacteria infect 

the uterus or fallopian tubes. Pelvic inflammatory 

disease can cause infertility and increase the risk of 

ectopic (tubal) pregnancy.

u An infection after a procedure on the female organs. 

This includes cesarean section, abortion, and 

surgery on the cervix or uterus.

u Early labor or birth, if pregnant. 

If you have BV:

u Always finish antibiotic treatment, even if the signs of 

BV go away.

u Talk to female sex partners about getting BV 

treatment.

Female partners of women 

with BV may need treatment. 

Male sexual partners do not 

need treatment.

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Women’s Health: Bacterial Vaginosis (BV)

How can you avoid BV?

Protect the normal balance of bacteria in the vagina by: 

u Not douching.

u Asking your sex partners to be examined for BV.

u Having sex with only one person who only has sex 

with you.

u Using condoms during sex.

u Reducing the number of sex partners.

u Washing the genital area daily with mild soap 

and water.

What about pregnancy?

BV is common in pregnant women. Treatment is very 

important. BV can increase the risk for:

u Low birth weight babies. 

u Early labor and birth. 

If you are pregnant and have BV, see your health care 

provider one month after finishing treatment. 

For more on BV see:

Centers for Disease Control and Prevention (CDC): 

Bacterial Vaginosis – CDC Fact Sheet

www.cdc.gov/std/bv/STDFact-Bacterial-Vaginosis.htm

U.S. Department of Health and Human Services (HHS), Office on Women’s Health: 

Bacterial vaginosis fact sheet 

www.womenshealth.gov/faq/bacterial-vaginosis.cfm

Douching fact sheet

www.womenshealth.gov/faq/douching.cfm

For more 

information, 

see Safer Sex

on page 77.

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Women’s Health: A Guide to Preventing Infections

A vaginal yeast infection is an infection of the 

vagina and vaginal area. It is caused by a type of 

fungus called yeast. When this yeast increases it 

can cause an infection.

Vaginal Yeast Infections

Three out of four women will get a vaginal yeast 

infection during their life. Some women will have it 

more than once. A vaginal yeast infection is NOT a 

sexually transmitted disease (STD). 

How is it spread?

Yeast is not spread from person to person. Small 

amounts of yeast can be found in the normal vagina. 

Infection occurs when too much yeast begins to grow. 

Vaginal yeast infections can increase with: 

u Pregnancy.

u Illness such as HIV disease or diabetes.

u Some medicines such as:

 Antibiotics.

 Birth control pills.

 Cortisone-type drugs.

 Some chemotherapy drugs.

u Stress.

u Lack of sleep.

u Having your period.

Having many vaginal yeast 

infections may be a sign of 

other health problems. 

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Women’s Health: Vaginal Yeast Infections

What are signs of vaginal yeast 

infections?

u Itching in the vaginal area.

u Vaginal discharge. This is mostly white. It can be 

watery to thick, and even chunky. It does not have a 

bad smell.

u Redness, swelling, and burning in the vaginal area.

u Pain with urination or during sex.

How do you know if you have 

an infection?

Yeast infections can be diagnosed during a medical 

exam. To check for a vaginal yeast infection, your 

health care provider looks for signs of infection and 

collects a sample of vaginal fluid for lab tests.

How is it treated?

Vaginal yeast infections can be treated with medicines 

such as pills or creams, ovules, or ointments. Treatment 

may take from 1 to 7 days days. Women with weak 

immune systems or other medical problems may need 

longer treatment. Always finish treatment, even if the 

signs of a yeast infection go away. Yeast infections 

can come back if not treated correctly. Infection is 

more likely to return if some health problems, such as 

diabetes, are not under control. 

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Women’s Health: Vaginal Yeast Infections

What can happen if you don’t get treated 

for a yeast infection?

Signs of infection may get worse without treatment. 

Scratching the vaginal area can leave open or raw 

areas. These can become infected with other germs.

How can you avoid vaginal 

yeast infections?

u Do not douche.

u Avoid scented products such as bubble baths, 

feminine hygiene sprays, pads or tampons.

u Change pads and tampons often during your period.

u Do not wear tight clothing. This can cause irritation 

and sweating in the vaginal area.

u Wear cotton underwear.

u Wear pantyhose with a cotton crotch.

u Change out of wet clothing and swimsuits right away.

u Keep blood sugar under control if you 

have diabetes.

What about pregnancy?

Pregnancy can increase the risk of vaginal yeast 

infections. Ask your health care provider about safe 

and effective treatments. Babies born to a mother 

with a vaginal yeast infection can get a mouth 

infection (thrush). 

For more on vaginal yeast infections see:

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Vaginal yeast infections fact sheet

www.womenshealth.gov/faq/vaginal-yeast-infections.cfm

U.S. National Library of Medicine:

Vaginal yeast infection

www.nlm.nih.gov/medlineplus/ency/article/001511.htm

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Women’s Health: A Guide to Preventing Infections

A urinary tract infection (UTI) occurs when bacteria 

grow in the urinary tract. The urinary tract system 

makes and stores urine and carries it out of the body. 

Urinary Tract Infections 

(UTIs)

The organs that can be infected include:

u Bladder (common) – Stores urine. 

u Urethra (common) – The tube that carries urine from 

the bladder out of the body. 

u Kidneys – Collect waste from blood to make urine.

u Ureters – Move urine from the kidneys to 

the bladder.

How is it spread? 

Women get UTIs more often than men. The risk for 

UTIs can be increased by: 

u Sexual intercourse.

u Using a diaphragm. 

u Conditions that cause urine to stay in the bladder 

too long.

u Problems emptying the bladder completely.

u Loss of hormones (after menopause).

u Diabetes.

u Kidney stones. 

u Having a tube that drains urine from the bladder. 

u Obesity.

u Having had several children.

UTIs cannot be spread 

between people. 

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Women’s Health: Urinary Tract Infections

What are signs of UTIs in women?

UTIs in the bladder and urethra may cause:

u Frequent urge to urinate, but not much urine 

comes out. 

u Burning, stinging or pain with urination.

u Heavy feeling in the lower belly.

u Waking in the night to urinate.

Other signs of UTI may include:

u Pain or pressure in the lower back or sides.

u Urine that smells bad or looks dark, cloudy, or red.

u Tiredness, fever, and chills.

How do you know if you have a UTI?

A health care provider can examine you for UTIs. A 

urine sample will be tested. Other tests may be done if 

your provider thinks the infection has spread, or if you 

have had many UTIs. You may be asked about:

u Signs of your UTI.

u Past UTIs.

u Sexual contact.

u Birth control methods. 

u Pregnancy. 

u Other health conditions, such as diabetes.

How is it treated?

UTIs are treated and cured with antibiotics. Always 

finish antibiotic treatment. If treated quickly, UTIs 

usually do not cause serious problems. You may need 

longer treatment or a different antibiotic if you:

u Are pregnant.

u Have frequent UTIs.

u Have diabetes. 

u Have a UTI that has 

spread to your kidneys.

UTIs in the bladder and urethra that 

are not treated can spread to the 

kidneys and cause serious illness.

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Women’s Health: Urinary Tract Infections

If you have a UTI:

u Always finish antibiotic treatment.

u Return to your health care provider if:

 Signs don’t go away.

 Signs come back.

 Signs get worse.

 You have more or different signs of UTI.

How can you avoid UTIs?

u Urinate when you have the urge. 

u Don’t hold in urine for a long time.

u Urinate before and after having sex. 

u Drink plenty of fluids.

u Clean your genital area every day.

u Avoid the use of douches and perfumed 

sprays for the genital area.

What about pregnancy?

It is important to notify your health care provider right 

away if you are pregnant and think you may have a UTI. 

In pregnant women, UTIs: 

u May result in early labor or early birth.

u May cause harm to the baby, or even death. 

u Are more likely to spread to the kidneys. 

Some doctors suggest 

showers instead of baths, 

and sanitary pads instead 

of tampons. 

For more on UTIs see:

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH):

Urinary Tract Infections in Adults

www.kidney.niddk.nih.gov/kudiseases/pubs/utiadult/

U.S. National Library of Medicine:

Urinary tract infection – adults

www.nlm.nih.gov/medlineplus/ency/article/000521.htm

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Urinary tract infection fact sheet

www.womenshealth.gov/faq/urinary-tract-infection.cfm

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Women’s Health: A Guide to Preventing Infections

Safer sex can help you reduce your risk for 

exposure to sexually transmitted diseases (STDs). 

STDs are spread by sexual contact with an infected 

person. This occurs through vaginal, anal, or oral 

sex, and genital touching.

Safer Sex

What is safer sex?

The only way to be absolutely sure of avoiding STDs is 

to not have any sexual contact. Having safer sex is one 

of the best ways to protect yourself from STDs. Safer 

sex uses barriers to reduce the risk of blood or body 

fluids entering the body. The most common barrier 

used is the male condom. Barriers should be used 

during all sexual contact. Barriers include:

u Male condoms.

u Female condoms.

u Other barriers.

How are barriers used?

u Each time you have sex use a barrier to prevent the 

spread of STDs, including HIV. Barriers can be made 

of plastic or latex and protect against viral STDs. Use 

barriers for:

 Vaginal sex.

 Anal sex.

 Oral sex.

u Talk to your partner about using barriers:

 Before sex. 

 Decide on sexual limits that you are both 

comfortable with.

 Remember that alcohol and drugs can alter your 

judgment about if, when, or how to use barriers.

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Women’s Health: Safer Sex

 Decide what type of barrier to use: male or female 

condoms, or other barriers.

 Make sure to have barriers on hand if there is a 

possibility that you will have sex.

Condoms kept in a wallet, 

stored somewhere warm, 

or that have been washed 

in the washer should 

not be used.

Male Condoms 

u Use for oral, anal or vaginal sex

u Choose lubricated latex condoms:

 “Lambskin” or natural condoms do not block HIV 

or other STDs.

 If you have allergies to latex, choose polyurethane 

(plastic) condoms.

u Use before the expiration date.

u Store in a cool, dry place.

u Use a new condom for each sex act, from start to 

finish.

u Always follow manufacturer’s directions for use.

u Carefully open the package, make sure there are no 

holes in the package.

u Check the condom for rips or signs of damage like 

brittleness or stickiness.

u Place the condom on an erect penis.

u Partially unroll the condom to find the right side, 

then hold onto the tip of the condom as it is placed 

on the penis.

u Use a water-soluble lubricant (e.g., ID Glide, 

K-Y Jelly, Slippery Stuff, Foreplay, Wet, Astroglide) 

after the condom is put on to prevent the condom 

from breaking.

 Do not use petroleum jelly, massage oils, mineral 

oil, cooking oil, body lotions, butter, grease, or 

hand creams as lubricant. These can weaken 

condoms.

u Remove the condom after ejaculation, but before the 

penis gets soft.

u If the condom breaks at any point during the sex act 

remove it and put on a new one.

u Use on sex toys such as dildos or vibrators that 

are shared: 

 Use new condoms for each partner.

 Clean sex toys after each use.

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Women’s Health: Safer Sex

Both male and female condoms 

are available without co-pay at the 

VA pharmacy. 

Female Condoms 

u Use for vaginal sex.

u Different shape than the male condom.

u Made of a plastic called polyurethane.

u Use before the expiration date.

u Store in a cool, dry place.

u Use a new condom for each sex act, from start 

to finish.

u Carefully open the package, make sure there are no 

holes in the package.

u Check the condom for rips or signs of damage like 

brittleness or stickiness.

u Always follow manufacturer’s instructions for use.

u Lubricate the vagina before inserting the condom.

 Female condoms are made of polyurethane and 

are already lubricated.

 Water or oil-based lubricants can be used.

 Put lubricant on the inside and outside of 

the condom.

u Put the condom on up to eight hours before having 

sex and before beginning any sexual contact.

u Squeeze the ring of the closed end and insert into 

the back of the vagina. Keep the open end outside 

of the vagina, partially covering the lip area.

u If the outer ring slips into the vagina, or if the penis is 

inserted outside of the condom pouch, remove and 

replace the condom.

u After sex, remove the condom by twisting the 

outside ring to trap any fluid before standing up. 

Throw the condom in the trash.

Other Barriers

Other barriers listed below can also be used to 

make oral sex safer. These work by reducing contact 

between blood or fluids and the mouth. Place over the 

opening to the vagina or anus before oral sex. 

u Natural latex sheet.

u Cut open condom.

u Dental Dam

 A piece of latex rubber found at surgical supply 

stores.

u Plastic cling wrap 

 Can offer some protection if nothing else 

is available. Scientific research on this is 

questionable.

For more on safer sex see:

Centers for Disease Control and Prevention (CDC):

Condom Fact Sheet In Brief

www.cdc.gov/condomeffectiveness/brief.html

U.S. Department of Health and Human Services (HHS), Office on Women’s Health:

Sexually transmitted infections (STI) fact sheet

www.womenshealth.gov/publications/our-publications/fact-sheet/sexually-transmitted-infections.cfm

HIV/AIDS: Practice safer sex

www.womenshealth.gov/hiv-aids/preventing-hiv-infection/practice-safer-sex.cfm

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Women’s Health: A Guide to Preventing Infections

A cold is an infection of the nose, sinuses, and/or 

throat almost always caused by a virus. A virus is a 

type of germ that causes infections. There are more 

than 200 types of viruses that can cause a cold. 

Colds

How are colds spread?

The most common way to get a cold is by contact with 

a person who has a cold. A cold virus spreads easily. 

For example: when a person with a cold sneezes, 

coughs, talks, or laughs, the virus can spread into 

the air as droplets from their mouth or nose. These 

droplets can spread to people as they breathe and to 

surfaces within 6 feet. Cold viruses can spread to your 

hands if you touch anything that has the virus on it. If 

you then touch your eyes, nose, or mouth, you can get 

infected with cold virus. 

What are signs of a cold?

u Stuffy or runny nose.

u Sneezing.

u Sore throat.

u Coughing.

u Headache (mild).

u Muscle aches and pains (mild).

u Chest discomfort (sometimes).

u Tiredness (sometimes).

u Fever (rare).

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Women’s Health: Colds

How can you feel better if you have 

a cold?

u Get plenty of rest. 

u Consider the use of over-the-counter drugs. 

Note: not all over-the-counter drugs are safe for 

children. Find more on drugs safe to give children at:

www.cdc.gov/getsmart/antibiotic-use/symptomrelief.html#d.

u Use a clean humidifier to help relieve congestion.

u Soothe a sore throat with ice chips, throat spray, or 

lozenges (do not give lozenges to young children).

u Gargle with warm salt water. 

u Do not smoke.

u Avoid second-hand smoke.

If you have a cold:

u Clean hands 

often with soap 

and water or 

alcohol hand 

rub.

u Cough or sneeze 

into a tissue or into your sleeve.

u Do not share eating or drinking utensils, hand towels, 

or toothpaste.

u Stay at home if possible.

u Drink plenty of non-caffeinated fluids, such as water, 

teas, broths, and sports drinks. 

u See your health care provider if: 

 Your temperature goes over 100.4°F. 

 Your signs last over 10 days.

How can you avoid a cold?

u Limit or avoid contact with people who 

are sick.

u Clean hands often.

u Stay healthy. Eat the right foods and get 

enough sleep. 

What about pregnancy?

Pregnant women should not take any over-thecounter drugs for a cold without consulting with their 

health care provider. If you are pregnant, you may be 

more likely to get a cold because pregnancy slightly 

weakens the immune system.

For more on colds see:

Centers for Disease Control and Prevention (CDC): 

Common Cold and Runny Nose

www.cdc.gov/getsmart/antibiotic-use/URI/colds.html

Get Smart: Know When Antibiotics Work – Symptom Relief

www.cdc.gov/getsmart/antibiotic-use/symptom-relief.html

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

Common Cold

www.niaid.nih.gov/topics/commonCold/Pages/default.aspx

For more on how 

to clean hands, 

see Clean Hands

on page 119.

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Women’s Health: A Guide to Preventing Infections

Influenza or “flu” is a respiratory illness caused 

by a flu virus. Flu viruses spread each fall, winter, 

and spring. 

Influenza (Flu)

Young (infants) and the very old are most at risk for 

severe illness from seasonal flu. In the U.S., about 

3,000 to 49,000 people die yearly from seasonal flu. 

The Centers for Disease Control and Prevention (CDC) 

recommends that everyone age 6 months and older 

get a flu shot each year. 

How is it spread?

The flu virus spreads easily. For example, when a 

person with the flu sneezes, coughs, talks, or laughs, 

the flu virus can spread into the air as droplets from 

their mouth or nose. These droplets can spread to 

people and surfaces within 6 feet.

The flu virus can spread to your hands if you touch 

anything that has the virus on it. If you then touch your 

eyes, nose, or mouth, you can get the flu. 

The flu virus can live on surfaces, such as countertops 

and door knobs, for 24 to 48 hours.

Seasonal flu is contagious from 1 day before any signs 

appear to up to 5 days after you get sick.

Flu spreads easily between people and 

can live for up to 2 days on surfaces such 

as doorknobs, tabletops, and counters.

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What are signs of flu?

u Fever (usually 102oF or higher).

u Chills.

u Cough.

u Runny or stuffy nose.

u Sore throat.

u Tiredness. 

u Headache. 

u Muscle or body aches. 

u Stomach symptoms (mostly in children).

How do you know if you the flu?

Your health care provider can examine and test you for 

the flu virus.

How is it treated?

Your health care provider may treat you with antiviral 

drugs. Antiviral drugs are most effective if taken within 

the first two days of being sick. 

If you have the flu, how can you 

feel better?

u Get plenty of rest.

u Take over-the-counter drugs. Note: not all overthe-counter drugs are safe for children. Find more 

on drugs safe to give children at: www.cdc.gov/

getsmart/antibiotic-use/symptom-relief.html#d.

u Use a clean humidifier to help a dry, scratchy throat.

u Soothe a sore throat with ice chips, sore throat spray, 

or lozenges (do not give lozenges to young children).

u Gargle with warm salt water.

u Eat plain foods that are easy on the stomach.

People with severe illness from the 

flu should talk to their health care 

provider about taking antiviral drugs if 

they get the flu.

Model of flu virus particles.

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Women’s Health: Influenza

What can happen if the flu gets worse?

Most people with the flu will not need medical care 

or antiviral drugs. Most will recover in less than two 

weeks. Even healthy people can have severe illness 

from the flu. Adults should get medical help right away 

if they develop: 

u Difficulty breathing, shortness of breath, or blueish 

skin color. 

u Pain or pressure in the chest or abdomen. 

u Sudden dizziness. 

u Confusion. 

u Difficulty waking up.

u Severe or continued vomiting. 

u Flu–like symptoms that improve but then return with 

fever and worse cough.

Over time, flu can lead to: 

u Pneumonia.

u Bronchitis. 

u Sinus and ear infections.

Illness from flu can also make other health problems 

worse. People with asthma may have more asthma 

attacks. People with heart problems may get worse. Flu 

can cause severe illness and even death in:

u Children younger than 5, especially those younger 

than age 2.

u Adults 65 years of age and older.

u Pregnant women.

u People who have medical conditions including: 

 Asthma.

 Diseases of the brain or muscles such as brain 

injury, muscular dystrophy, cerebral palsy, 

and stroke. 

 Chronic lung disease, such as emphysema 

(COPD) and cystic fibrosis.

 Heart disease. 

 Blood diseases such as sickle cell disease.

 Gland diseases such as diabetes.

 Kidney diseases.

 Liver diseases.

 Weak immune systems due to disease or 

medicines, such as people with HIV/ AIDS, cancer, 

or those on chronic steroids.

 People younger than 19 years of age who are 

taking aspirin pills long-term.

u People who are obese.

u American Indians and Alaskan Natives. 

These people should alert their health care provider 

if they get signs of the flu. They may need early 

treatment.

Use this flow-chart to help decide how to best handle 

the flu: www.publichealth.va.gov/docs/flu/flu_

selfassess_flowchart.pdf

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Women’s Health: Influenza

If you have the flu:

u Clean your hands 

often with soap 

and water or 

alcohol hand rub.

u Cough or sneeze 

into a tissue or 

into your sleeve.

u Do not share eating or drinking utensils, hand towels, 

or toothpaste.

u Stay home until 24 hours after their fever is gone 

except to get medical care or for other necessities. 

u Avoid contact with others.

u Drink plenty of fluids, such as water, herbal teas, 

broths, and sports drinks.

How can you avoid the flu?

u GET A FLU SHOT each year. Everyone 6 months of 

age and older should get a flu shot each year because 

flu virus can change from one year to the next.

u Clean hands and surfaces often.

u Limit or avoid contact with people who are sick.

The best way to avoid 

the flu is to get a flu 

shot each year.

For more on how 

to clean hands, 

see Clean Hands

on page 119.

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Women’s Health: Influenza

What about pregnancy?

Flu can be severe in pregnant women. Get your flu 

shot. Pregnant women should let their health care 

provider know if they have any signs of flu. Pregnant 

women should not take over-the-counter drugs without 

asking their provider first. The flu shot is safe for 

pregnant women at any stage of pregnancy.

The flu shot is safe for 

pregnant women at any 

stage of pregnancy.

For more on the flu see:

Department of Veterans Affairs (VA):

Seasonal Flu

www.publichealth.va.gov/flu

Centers for Disease Control and Prevention (CDC):

Seasonal Influenza (Flu)

www.cdc.gov/flu

2009 H1N1 Flu (“Swine Flu”) and You

www.cdc.gov/h1n1flu/qa.htm

U.S. Department of Health and Human Services (HHS):

What You Should Know about Flu Antiviral Drugs 

www.flu.gov/news/blogs/blog20110211.html

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

Flu (Influenza)

www.niaid.nih.gov/topics/Flu/understandingFlu/Pages/default.aspx

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Women’s Health: A Guide to Preventing Infections

Pneumonia is an infection of the lungs. Most cases of 

pneumonia are caused by bacteria (pneumococcal) or 

viruses (influenza). Rarely, it can be caused by fungi 

or parasites.

Pneumonia

How is it spread?

Pneumonia-causing germs can be spread the same 

way colds and the flu are spread: into the air as 

droplets by sneezing, coughing, talking, or laughing. 

These droplets can spread to people as they breathe 

and to surfaces within 6 feet.

The germs can spread to your hands if you touch 

anything that has the germ on it. If you then touch your 

eyes, nose, or mouth, you can get infected. 

Certain people are at a higher risk for pneumonia, 

including: 

u Adults 65 and older. 

u Children less than 5 years old. 

u People who smoke. 

u Alcoholics.

u People with lung diseases. 

u People with a recent cold or the flu.

u People who are now or were recently in 

the hospital.

u People who have just had surgery.

u People with chronic diseases such as heart disease, 

liver damage, or diabetes.

u People with weak immune systems such as people 

with HIV/AIDS or certain types of cancer.

u People taking drugs which weaken the 

immune system.

u People with problems swallowing, coughing or 

taking deep breaths. 

u People with renal failure.

u People with sickle cell disease.

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Women’s Health: Pneumonia

u People who have had their spleen removed.

u People who are living in nursing homes.

What are signs of pneumonia?

u Cough (sometimes with thick, creamy, or 

bloody mucus).

u Fever. 

u Chills.

u Tiredness.

u Rapid breathing or shortness of breath. 

u Chest pain. 

u Loss of appetite.

u Headache.

u Nausea and vomiting. 

How do you know you have pneumonia? 

A health care provider can examine you for 

pneumonia by:

u Asking questions about your symptoms. 

u Listening to your lungs.

u Taking a chest X-ray.

u Taking a blood or mucus sample.

More tests may be done if the pneumonia is severe or 

if you have other health problems.

How is it treated?

u Bacterial pneumonia is treated with antibiotics. 

u Viral pneumonia can be treated with antiviral drugs. 

Mild cases of pneumonia can be treated at home 

with medicine and rest. Most severe cases are treated 

in a hospital. In addition to medicine, oxygen and 

other methods are used to support breathing and 

body functions. 

What can happen if pneumonia 

gets worse?

u The lungs cannot send enough oxygen to 

the body.

u Pus pockets and fluid can form around the lung. 

u Infection can spread to other areas of the body.

u In severe cases, pneumonia can cause death. 

There are at least 4 million cases of pneumonia every 

year in the U.S. One out of four will be sick enough to 

be admitted to a hospital. Adults 65 and older are more 

likely to be sicker and admitted to a hospital. One out 

of every 20 cases of pneumonia will be fatal.

Model of human lungs

Pneumonia causes more 

deaths than HIV/AIDS. 

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Women’s Health: Pneumonia

If you have pneumonia:

u Always finish all antibiotic or anti-viral treatment.

u Clean your hands often with soap and water or 

alcohol hand rub.

u Cough or sneeze into a tissue or into your sleeve.

u Do not share eating or drinking utensils, hand towels, 

or toothpaste.

u Clean surfaces often such as countertops, 

refrigerator and freezer handles, doorknobs, and 

light switches.

u Do not smoke.

How can you avoid pneumonia?

u Get vaccinated – there are several vaccines (like the 

flu shot) that can help prevent infection that leads to 

pneumonia. Talk to your health care provider to see 

if any of these vaccines are right for you. 

u Keep your hands clean with soap and water or 

alcohol hand rub.

u Limit or avoid contact with people who are sick.

u Keep healthy. Eat the right foods and get 

enough sleep.

What about pregnancy? 

Pneumonia can be more severe if you are pregnant. 

Tell your health care provider if you have signs of 

pneumonia during pregnancy. If you are pregnant, 

check with your health care provider before taking any 

medicine. Ask your provider which vaccinations you 

need before you get pregnant, or ones that you need 

during pregnancy.

For more on pneumonia see:

Centers for Disease Control and Prevention (CDC):

Pneumonia Can Be Prevented – Vaccines Can Help 

www.cdc.gov/Features/Pneumonia/

Pneumococcal Vaccination

www.cdc.gov/vaccines/vpd-vac/pneumo/default.htm

Podcasts at CDC: Preventing Pneumonia

www2c.cdc.gov/podcasts/player.asp?f=268703

National Institute of Allergy and Infectious Diseases (NIAID/NIH):

Pneumococcal Pneumonia

www.niaid.nih.gov/topics/pneumonia/Pages/Default.aspx

U.S. National Library of Medicine:

Pneumonia

www.nlm.nih.gov/medlineplus/ency/article/000145.htm

For more on how 

to clean hands, 

see Clean Hands

on page 119.

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Women’s Health: A Guide to Preventing Infections

Vaccines are medical preparations given to help the 

body produce immunity or to fight disease. Vaccines 

can prevent outbreaks of disease and save lives. 

Some diseases are rare in the U.S. as a result of safe 

and effective vaccines. 

Vaccines

You can get vaccinnated for many 

common infections such as:

u Influenza.

u Hepatitis A.

u Hepatitis B.

u Human papillomavirus (HPV).

u Streptococcus pneumococcal pneumonia. 

u Pertussis (whooping cough).

Are vaccines safe?

Vaccines are some of the safest medical products. But, 

like any other medical product, there may be risks. 

Talk to your health care provider about the value of 

vaccines as well as their side-effects. Vaccines are held 

to a high standard of safety. In the U.S.:

u Vaccine supplies in the U.S. are the safest, most 

effective in history.

u Vaccines are monitored for safety and effectiveness.

u Vaccines undergo rigorous and extensive testing. 

u Vaccine manufacturers must follow strict 

production standards. 

To see which vaccinations you 

should get, see Vaccinations 

for Adults on page 96.

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Women’s Health: Vaccines

u The Department of Health and Human Services 

(HHS) and three federal agencies primarily work on 

vaccine safety:

 Centers for Disease Control and Prevention (CDC). 

 National Institutes of Health (NIH). 

 Food and Drug Administration (FDA).

u Scientists from FDA and CDC work closely to monitor 

reports of vaccine side effects (adverse events). The 

Veterans Health Administration monitors vaccine 

side effects within its facilities as well.

u Everyone getting a vaccine should receive a Vaccine 

Information Statement (VIS) that:

 Explains vaccine benefits and risks.

 Is handed out before each dose of 

some vaccines.

 Is available in Spanish and other languages at: 

www.cdc.gov/vaccines/pubs/vis.

Vaccines are the most 

effective tool we have to 

prevent infectious diseases.

Are vaccines effective?

Most childhood vaccines produce immunity about 

90 - 100% of the time. No medicine is perfect, so each 

vaccine has its own degree of effectiveness. History 

shows that the number of cases of disease starts to 

drop when a new vaccine starts to be given. 

How do vaccines work with your immune 

system to prevent disease?

u Vaccines help your body’s immune system prepare 

to fight germs and infection. 

u When vaccinated, your immune system attacks 

the harmless vaccine and prepares for future 

“infections”. 

u When the infection comes along, your body will 

know how to stop it.

How do vaccines protect you and 

your community?

Vaccines can prevent disease and save lives. If enough 

people get vaccinated, large outbreaks of disease 

can be avoided. Even those not vaccinated get some 

protection when the spread of contagious disease is 

contained. This is known as “community” or “herd” 

immunity. This is true for many diseases, including:

u Influenza.

u Measles.

u Mumps.

u Rotavirus. 

u Pneumococcal disease. 

u Pertussis.

u Polio.

u Rubella.

Your health care provider should have 

a record of all the vaccines have been 

given. You should also keep a record.

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95

Women’s Health: Vaccines

A community in which no one is immunized and 

an outbreak occurs.

Some are immunized but not enough for 

herd immunity.

Herd immunity – enough people are immunized, 

protecting most in the community.

Image Source: The National Institute of Allergy and Infectious Diseases (NIAID) at: www.vaccines.gov

For more on vaccines see:

Centers for Disease Control and Prevention (CDC):

Key Facts About Seasonal Flu Vaccine

www.cdc.gov/flu/protect/keyfacts.htm

Immunizations for Infants and Toddlers

www.cdc.gov/vaccines/parents/infants-toddlers.html

Pregnant Women and Vaccines

www.cdc.gov/vaccines/parents/pregnant.html

U.S. Department of Health and Human Services (HHS):

Flu Vaccination & Vaccine Safety

www.flu.gov/prevention-vaccination/vaccination/index.html

Vaccines, Who & When: Adults 

www.vaccines.gov/who_and_when/adults/index.html

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96

Vaccinations for Adults

You’re NEVER too old to get immunized!

Getting immunized is a lifelong, life-protecting job. Don’t leave your healthcare 

provider’s office without making sure you’ve had all the vaccinations you need.

You need 1 dose at age 65 (or older) 

if you’ve never been vaccinated. 

Be sure to get a 1-time dose of “Tdap” vaccine (the adult whooping cough vaccine) if you are younger than age 

65 years, are 65+ and have contact with an infant, are a healthcare worker, or simply want to be protected from 

whooping cough. You need a Td booster dose every 10 years. Consult your healthcare provider if you haven’t had 

at least 3 tetanus- and diphtheria-containing shots sometime in your life or have a deep or dirty wound.

You need this vaccine if you have a specific risk factor for hepatitis B virus infection* or you simply wish to 

be protected from this disease. The vaccine is given in 3 doses, usually over 6 months.

You need at least 1 dose of MMR if 

you were born in 1957 or later. You 

may also need a 2nd dose.*

* Consult your healthcare provider to determine your level of risk for infection and your need for this vaccine.

Do you travel outside the United States? If so, you may need additional vaccines. The Centers for Disease Control and Prevention 

(CDC) provides information to assist travelers and their healthcare providers in deciding the vaccines, medications, and other measures 

necessary to prevent illness and injury during international travel. Visit CDC’s website at www.cdc.gov/travel or call (800) CDC-INFO 

([800] 232-4636). You may also consult a travel clinic or your healthcare provider.

www.immunize.org/catg.d/p4030.pdf • Item #P4030 (12/10)

Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.vaccineinformation.org • www.immunize.org

19–49 years 50–64 years 65 years & older 

Vaccine ▲

Pneumococcal

Meningococcal

Hepatitis B 

(HepB)

Influenza

Tetanus,

diphtheria, 

pertussis 

(whooping cough)

(Td, Tdap)

Measles, 

mumps, rubella 

(MMR)

Varicella 

(Chickenpox)

Hepatitis A 

(HepA)

▲

 Age

Human 

papillomavirus

(HPV)

Zoster (shingles)

You need a dose every fall (or winter) for your protection and for the protection of others around you.

You need 1–2 doses if you smoke cigarettes or if you have certain chronic 

medical conditions.*

You need this vaccine if you have a specific risk factor for hepatitis A virus infection* or you simply wish to 

be protected from this disease. The vaccine is usually given as 2 doses, 6–18 months apart. 

You need this vaccine if you are a 

woman who is age 26 years or 

younger. One brand, Gardasil, can be 

given to men age 26 years or younger 

to prevent genital warts. The vaccine 

is given in 3 doses over 6 months.

If you are age 60 years or older, you should 

get this vaccine now.

If you’ve never had chickenpox or you were vaccinated but received only 1 dose, talk to your healthcare provider 

to find out if you need this vaccine.* 

Technical content reviewed by the Centers for Disease Control and Prevention, December 2010.

If you are going to college and plan to live in a dormitory, or have one of several medical conditions*, you need 

to get vaccinated against meningococcal disease. You may also need additional booster doses.*

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Women’s Health: A Guide to Preventing Infections

Discuss vaccinations before, during, and after 

pregnancy with your health care provider. Many 

vaccines are beneficial to the health of your baby 

and yourself.

Vaccines and Pregnancy

Vaccination BEFORE pregnancy:

Before becoming pregnant, you should be up-to-date 

on routine adult vaccines. This will help protect you 

and your child. Discuss vaccines with your health care 

provider. In general:

u Live vaccines should not be given within a month 

before getting pregnant or during pregnancy. 

u Inactivated (killed) vaccines may be given at any time 

before or during pregnancy, if needed.

Vaccination DURING pregnancy:

If you are pregnant, your health care provider will help 

you decide which vaccinations you need based on:

u Your age.

u Lifestyle. 

u High-risk conditions.

u Type and locations of travel.

u Previous vaccinations.

To see recommended vaccines 

for pregnant women, see 

Immunization & Pregnancy 

on pages 99 and 100.

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Women’s Health: Vaccines and Pregnancy

Vaccination AFTER pregnancy:

It is safe for a woman to receive vaccines right after 

giving birth and when breastfeeding. Vaccines can help 

protect mothers, including:

u Tetanus, diphtheria and pertussis (Tdap) – if not 

received during pregnancy.

u Measles, mumps and rubella (MMR).

u Varicella (chickenpox). 

u Influenza – if not received during pregnancy.

While you are pregnant and a short time after the 

baby is born, your baby has the same immunity and 

protection from disease that you do. This is temporary. 

The baby must be vaccinated to develop his/her 

own immunity. 

Pregnant Women and 

International Travel:

Many diseases, rarely seen in the United States, are 

common in other parts of the world. A pregnant woman 

planning international travel should talk to her health 

care provider about vaccines. 

Your health care provider should have a 

record of all the vaccines you have been 

given. You should also keep a record.

For more on vaccines and pregnancy see:

Centers for Disease Control and Prevention (CDC):

Pregnant Women and Vaccines

www.cdc.gov/vaccines/parents/pregnant.html

Pregnant Travelers

wwwnc.cdc.gov/travel/yellowbook/2012/chapter-8-advising-travelerswith-specific-needs/pregnant-travelers.htm

Immunizations for Infants and Toddlers

www.cdc.gov/vaccines/parents/infants-toddlers.html

U.S. Department of Health and Human Services (HHS):

Flu Vaccination & Vaccine Safety

www.flu.gov/prevention-vaccination/vaccination/index.html

Vaccines, Who & When: Adults 

www.vaccines.gov/who_and_when/adults/index.html

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Women’s Health: Vaccines and Pregnancy

Tie Consenit Amolakis Immunization & Pregnancy

Vaccines help keep a pregnant woman and her growing family healthy.

Before

pregnancy

Before becoming pregnant, a woman should be up-to-date on routine adult vaccines. 

This will help protect her and her child. Live vaccines should be given a month or more 

before pregnancy. Inactivated vaccines can be given before or during pregnancy, if 

needed.

During pregnancy

Flu Vaccine

It is safe, and very important, for a pregnant woman to receive the inactivated flu 

vaccine. A pregnant woman who gets the flu is at risk for serious complications and 

hospitalization. To learn more about preventing the flu, visit the CDC website 

www.cdc.gov/flu.

Tdap Vaccine 

A pregnant woman should receive the adult tetanus, toxoid reduced diphtheria toxoid, 

 acellular pertussis vaccine (Tdap) after 20 weeks gestational age if she has not already 

 received the vaccine. Vaccinating at this gestational age will help prevent pertussis in 

 mom and in the newborn infant.

Travel

Many vaccine-preventable diseases, rarely seen in the United States, are still common 

in other parts of the world. A pregnant woman planning international travel should 

talk to her health professional about vaccines. Information about travel vaccines can 

be found at CDC’s traveler’s health website at www.cdc.gov/travel.

Childhood Vaccines

Pregnancy is a good time to learn about childhood vaccines. Parents-to-be can learn 

more about childhood vaccines from the CDC parents guide and from the child and 

adolescent vaccination schedules. This information can be downloaded and printed at 

www.cdc.gov/vaccines. 

Did you know that a 

mother’s immunity is 

passed along to her 

baby during pregnancy? 

This will protect the 

baby from some 

diseases during the 

first few months of life 

until the baby can get 

vaccinated.

After

pregnancy

It is safe for a woman to receive vaccines right after giving birth, even while she is 

breastfeeding. A woman who has not received the new vaccine for the prevention 

of tetanus, diphtheria and pertussis (Tdap) should be vaccinated right after delivery. 

Vaccinating a new mother against pertussis (whooping cough) reduces the risk to her 

infant too. Also, a woman who is not immune to measles, mumps and rubella and/or 

varicella (chicken pox) should be vaccinated before leaving the hospital. If inactivated 

influenza vaccine was not given during pregnancy, a woman should receive it now 

because it will protect her infant. LAIV may be an option.

Visit CDC’s website at www.cdc.gov for more information. Or get an answer to 

your specific question by e-mailing cdcinfo@cdc.gov or calling 

800-CDC-INFO (232-4636) · English or Spanish

Center Name Goes Here

Division, Program, or Office Name Goes Here

CS226523A 10/2011

National Center for Immunization and Respiratory Diseases

Immunization Services Division

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Women’s Health: Vaccines and Pregnancy

CS226523B 10/2011

Immunization & Pregnancy

Vaccines help keep a pregnant woman 

and her growing family healthy.

Vaccine Before

pregnancy

During 

pregnancy

After

pregnancy

Type of 

Vaccine Route

Hepatitis A Yes, if at risk Yes, if at risk Yes, if at risk Inactivated IM

Hepatitis B Yes, if at risk Yes, if at risk Yes, if at risk Inactivated IM

Human Papillomavirus 

(HPV)

Yes, if 9 through 26 

years of age No, under study Yes, if 9 through 26 years of age Inactivated IM

Influenza TIV Yes Yes Yes Inactivated IM, ID 

(18-64 years)

Influenza LAIV

Yes, if less than 50 years 

of age and healthy; avoid 

conception for 4 weeks

No

Yes, if less than 50 years 

of age and healthy; avoid 

conception for 4 weeks

Live Nasal spray

MMR Yes, avoid conception 

for 4 weeks No

Yes, give immediately 

postpartum if susceptible 

to rubella

Live SC

Meningococcal:

• polysaccharide

• conjugate

If indicated If indicated If indicated Inactivated

Inactivated

SC

IM

Pneumococcal

Polysaccharide If indicated If indicated If indicated Inactivated IM or 

SC

Tetanus/Diphtheria Td Yes, Tdap preferred

Yes, Tdap preferred if 

20 weeks gestational 

age or more

Yes, Tdap preferred Toxoid IM

Tdap, one dose only Yes, preferred Yes, preferred Yes, preferred Toxoid/ 

inactivated IM

Varicella Yes, avoid conception 

for 4 weeks No Yes, give immediately postpartum if susceptible Live SC

For information on all vaccines, including travel vaccines, use this table with www.cdc.gov/vaccines

Get an answer to your specific question by e-mailing cdcinfo@cdc.gov or calling 

800-CDC-INFO (232-4636) • English or Spanish

National Center for Immunization and Respiratory Diseases

Immunization Services Division

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Women’s Health: A Guide to Preventing Infections

The Centers for Disease Control and Prevention (CDC) 

estimate that every year about 48 million people in the 

United States become ill from harmful germs in food; 

of these, about 3,000 die.

Food Safety

What are the signs of illness from food?

u Diarrhea.

u Fever.

u Vomiting.

u Abdominal cramps.

u Dehydration.

u Death.

How is food handled safely? 

u Start with food shopping strategies.

u Understand the role of keeping hands, surfaces, and 

foods clean.

u Learn proper food storage.

u Know proper food thawing.

u Utilize specific preparation techniques.

u Learn how to use a thermometer.

u Recognize serving principles.

u Be prudent when eating out.

When shopping for food:

u Visit the refrigerated or frozen section last. 

u Do not buy food if the package is torn, damaged 

or leaking. 

u Do not buy foods after the “Sell-By” or “Use-By” 

expiration dates. 

You can't see, smell, or 

taste harmful bacteria 

that may cause illness.

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Clean hands, surfaces, and foods:

u Wash hands 

thoroughly with 

water and soap.

u Wash hands 

before and after

handling food, 

and after using the bathroom, changing diapers, or 

handling pets.

u Wash cutting boards, dishes, counters, utensils, 

and hands with hot soapy water after contact with 

raw meat, poultry, seafood, or unwashed fruits 

or vegetables. 

u Peel or wash fruits and vegetables thoroughly 

before eating.

When storing foods you should:

u Always refrigerate perishable food within 2 hours 

(1 hour when the temperature is above 90°F). 

u Cook or freeze fresh poultry, fish, ground meats, and 

other meats within 2 days.

u Cook beef, veal, lamb, or pork, within 3 to 5 days. 

u Wrap meat and poultry.

u Wrap meat in the original package with foil or plastic 

wrap before freezing. 

u Store low-acid canned food such as meat, poultry, 

fish, and most vegetables up to 2 to 5 years.

u Store high-acid canned food such as tomatoes, 

grapefruit, and pineapples on the shelf for 

12 to 18 months. 

u Only store cans in good condition, and in a cool, 

clean, dry place. 

u Discard cans that are dented, leaking, bulging, 

or rusted. 

The U.S. Department of Agriculture, Food and Safety 

Inspection Service has recommendations and 

information on refrigerator and freezer food storage. 

Visit: www.fsis.usda.gov/factsheets/basics_for_

handling_food_safely/

When thawing food:

u Thaw in the refrigerator. 

 Make sure thawing meat and poultry are covered. 

Keep juices from dripping into or touching 

other food. 

 Refreeze refrigerator-thawed meat and poultry 

before or after cooking. 

u Use cold water for quick thawing if needed. 

 Place food in a leak-proof plastic bag. 

 Submerge in cold tap water. 

 Change the water every 30 minutes. 

 Cook immediately after thawing. 

u Use a microwave to thaw as needed.

 Cook food immediately after microwave thawing. 

The Danger Zone is the 

temperature that germs 

can grow in food. Keep food 

below 40°F or above 140°F 

(4°C and 60°C). Check the temperature of your 

refrigerator and freezer with 

an appliance thermometer. The 

refrigerator should be at 40°F 

or below and the freezer at 0°F 

or below.

For more on how 

to clean hands, 

see Clean Hands

on page 119.

Danger Zone

140

160

180

200

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Women’s Health: Food Safety

Table 1: Safe Minimum Cooking Temperatures

Category Food Temperature (°F) Rest Time 

Ground Meat & Meat Mixtures

Beef, pork, veal, lamb 160 None

Turkey, chicken 165 None

Fresh Beef, Veal, Lamb Steaks, roasts, chops 145 3 minutes

Poultry

Chicken & turkey, whole 165 None

Poultry breasts, roasts 165 None

Poultry thighs, legs, wings 165 None

Duck & goose 165 None

Stuffing (cooked alone 

or in bird) 165 None

Pork and Ham

Fresh pork 145 3 minutes

Fresh ham (raw) 145 3 minutes

Precooked ham (to reheat) 140 None

Eggs & Egg Dishes

Eggs Cook until yolk and white are firm None

Egg dishes 160 None

Leftovers & Casseroles

Leftovers 165 None

Casseroles 165 None

Seafood

Finfish 145 or cook until flesh is opaque and 

separates easily with a fork. None

Shrimp, lobster, and crabs Cook until flesh is pearly and opaque. None

Clams, oysters, and mussels Cook until shells open during cooking. None

Scallops Cook until flesh is milky white or 

opaque and firm None

* Table from: Safe Minimum Cooking Temperatures, www.foodsafety.gov/keep/charts/mintemp.html

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Women’s Health: Food Safety

When preparing food:

u Clean your hands 

before and after. 

u Keep cutting 

boards, utensils, 

and countertops 

clean. Use hot, 

soapy water and mix with liquid chlorine bleach (1 

tablespoon per 1 gallon of water). 

u Separate raw meat, poultry, and seafood from readyto-eat foods.

u Use at least two cutting boards.

 One for raw meat, poultry, and seafood. 

 One for fresh fruits and vegetables.

u Don’t let “juice” from foods and packaging touch 

other foods, utensils, or surfaces. 

u Use a clean plate or bowl for cooked food. 

u Never use the same plate or bowl that held the 

uncooked or raw food. Germs from the raw food 

could get into the cooked food Marinate meat and 

poultry in a covered dish in the refrigerator. 

When using a thermometer:

u Use a food thermometer to check that meat, poultry, 

and egg dishes reach a safe temperature. Refer 

to the chart in Table 1 or visit: www.fsis.usda.gov/

Is_It_Done_Yet/Brochure_Text/index.asp#SMIT.

u Follow the instructions for your food thermometer.

u Place thermometer in the thickest part of the food, 

not touching bone, fat, or gristle. 

u Check at the end of the cooking time, but before the 

food is expected to be “done”. 

u Check the temperature in several places to make 

sure the food is evenly heated.

u Clean your food thermometer with hot, soapy water 

before and after each use. 

u Large-dial oven-safe or oven-probe thermometers 

may be used during cooking. 

u After cooking, allow food to “rest” before cutting or 

eating. “Rest” times are in Table 1.

u During the rest time, the temperature of the food 

will stay the same or rise. This will help destroy 

harmful germs.

When serving foods:

u Keep hot food at 140°F or warmer. 

u Keep cold food at 40°F or colder. 

u Keep food hot with chafing dishes, slow cookers, 

and warming trays during parties. 

u Keep food cold by nesting dishes in bowls of ice or 

use small serving trays. Replace them often. 

u Don’t leave perishable foods out for more than 

2 hours at room temperature (1 hour when the 

temperature is above 90°F). 

2 Hour Rule: Keep hot food hot and 

cold food cold. If food that has been 

left out is not eaten within 2 hours, 

discard it. 

When eating out:

u Choose a clean restaurant. Look for health 

department reports online or posted in the 

restaurant. 

u Look around you before you sit down. If it's not clean 

think about eating somewhere else. 

u Clean your hands with soap and warm water before 

eating. If soap and water aren't available, use alcohol 

hand rub to clean your hands.

u Pay close attention to the type of food and how 

it's prepared – harmful germs can be hidden in 

some foods.

For more on how 

to clean hands, 

see Clean Hands

on page 119.

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Women’s Health: Food Safety

u Request that your food be cooked completely 

through – especially meat, poultry, fish, and eggs. 

u Make sure your hot food is piping hot and 

completely cooked. If lukewarm, send it back.

u Know that raw or undercooked finfish or shellfish 

(including oysters, clams, and mussels) are more 

likely to contain parasites or bacteria than foods 

made from cooked fish. 

u Refrigerate take-out and “leftover” food within 2 

hours after being served. If you will not be home 

within 2 hours, don't take the leftovers home 

with you. 

u Bring take-out and “leftover” food directly home after 

eating out and put your leftovers in the refrigerator 

as soon as you arrive.

u Eat delivery food within 2 hours after it arrives. This 

prevents the growth of harmful germs.

If the food is not going to be eaten within 2 hours, 

you can keep it hot in the oven – but the temperature 

must be set at or above 200°F (93°C). Side dishes, like 

stuffing, must also be kept hot in the oven. Covering 

food will help keep it moist while you keep it warm. 

Check with a food thermometer to make sure that the 

inside of the food is held at a temperature 140°F (60°C).

Leftover food should be 

used within 4 days. Reheat 

leftovers to 165°F.

For more on Food Safety see:

Department of Veterans Affairs (VA):

What Should I Know About Food Safety?

www.hiv.va.gov/patient/diet/food-safety.asp

U.S. Department of Agriculture (USDA), Food and Safety Inspection Service:

Kitchen Companion; Your Safe Food Handbook

www.fsis.usda.gov/PDF/Kitchen_Companion.pdf

Safe Food Handling

www.fsis.usda.gov/factsheets/Safe_Food_Handling_Fact_Sheets/

Check Your Steps: Food Safe Families

www.fsis.usda.gov/Food_Safety_Education/Check_Your_Steps/index.asp

Cooking Meat? Check the New Recommended Temperatures

www.foodsafety.gov/blog/meat_temperatures.html

At Risk Populations

www.fsis.usda.gov/factsheets/At_Risk_&_Underserved_Fact_Sheets/index.asp

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Women’s Health: A Guide to Preventing Infections

Anyone can get an infection or other type of illness 

caused by germs or chemicals in foods. Pregnant 

women are more likely to get a food-borne illness. 

Food-borne Illness 

During Pregnancy

It is important for you to learn about food-borne illness 

before and during pregnancy. Some illnesses caused 

by food can harm the pregnancy. There are ways to 

reduce these risks by learning about foods to avoid 

and how to prepare and handle food carefully. 

What is a food-borne illness?

Some people call this “food poisoning.” It is a sickness 

that occurs when you eat food or drink water that 

contains harmful substances such as:

u Bacteria.

u Parasites.

u Viruses. 

u Certain chemicals.

For both mother and baby, foodborne illness can cause serious 

health problems – or even death.

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Women’s Health: Food-borne Illness During Pregnancy

What are the signs of illness from food? 

You may get sick very soon after eating contaminated 

food or symptoms may not occur for days or weeks. 

This depends on what type of harmful substance 

is in the food. A food-borne illness can still harm a 

pregnancy even if the mother does not feel sick. Foodborne illness may cause: 

u Fever.

u Headache.

u Body aches.

u Upset stomach.

u Diarrhea.

u Vomiting.

u Abdominal cramps.

u Dehydration.

u Death.

Why are pregnant women at high risk?

u Your immune system is weaker during pregnancy. 

This makes it harder for your body to fight off 

harmful germs.

u Your baby's immune system is not fully ready to fight 

off harmful germs.

u For both mother and baby, food-borne illness can 

cause serious health problems – or even death.

What foods to eat during pregnancy and 

what foods to avoid:

Certain foods can put pregnant women at a higher 

risk for food-borne disease. Pregnant women should 

avoid uncooked meat, poultry and seafood, and 

unpasteurized dairy products and juices. Table 2 lists 

foods to be avoided and ones that are safe to eat.

If you're unsure about the ingredients in a particular 

dish, ask your server before ordering it. Refer to 

Table 2 to find foods safe to eat during pregnancy.

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Women’s Health: Food-borne Illness During Pregnancy

Table 2: Foods Safe to Eat or to Avoid During Pregnancy

Food Group Safe to Eat Avoid Eating

Fruits and Vegetables u Washed fruits and vegetables u Unwashed fruits and vegetables

u Cooked sprouts u Raw sprouts, such as alfalfa, clover, 

radish, and mung bean

u Pasteurized juice u Unpasteurized juice

Dairy u Eggs that are completely cooked u Eggs that are not fully cooked, runny, 

without a firm yolk and egg white

u Pasteurized eggs

u Store bought and pasteurized: 

 Mayonnaise 

 Dressings 

 Sauces 

 Cookie dough

 Other products made with eggs

u Raw unpasteurized eggs

u Products containing raw unpasteurized 

eggs including: 

 Raw batter, filling or cookie dough 

 Eggnog 

 Homemade Caesar salad dressing

 Béarnaise, hollandaise and aioli 

sauces

 Gomemade mayonnaise

 Gomemade ice cream

 Tiramisu

 Mousse

 Meringue

u Pasteurized milk u Unpasteurized or raw milk

u Pasteurized cheeses u Unpasteurized cheeses including: 

 Feta 

 Brie

 Camembert

 Blue-veined cheeses

 Queso blanco

 Queso fresco

 Panela

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Women’s Health: Food-borne Illness During Pregnancy

Food Group Safe to Eat Avoid Eating

Meat u Hot dogs and lunch meats heated until 

steaming hot

u Cold hot dogs and lunch meats

u Refrigerated smoked seafood in a 

cooked dish, like a casserole 

u Refrigerated smoked seafood including: 

 salmon

 trout

 whitefish

 cod

 tuna

 mackerel

often labeled as: 

 lox

 nova-style

 kippered

 smoked

 jerky

u Fully cooked meats and poultry u Undercooked or raw meat and poultry

u Refrigerated pâtés or meat spreads

u Pre-stuffed whole poultry that has been 

purchased frozen and cooked frozen, 

without defrosting first

u Pre-stuffed poultry that has been 

purchased fresh and raw

Seafood u Up to 12 oz. a week (2 average meals) 

of fully cooked fish with low levels of 

mercury*, including: 

 shrimp

 canned light tuna

 salmon

 pollock

 catfish

 cod

 tilapia

 whitefish

 fish sticks

u Up to 6 oz. a week of albacore (white) 

tuna or tuna steaks, which have more 

mercury than canned light tuna

u Fish with high concentrations of 

mercury*: 

 king mackerel

 shark

 swordfish

 tilefish

u Raw fish, found in foods such as sushi 

and sashimi

u Fully cooked shellfish u Raw shellfish including: 

 oysters

 mussels

 clams 

 scallops

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Women’s Health: Food-borne Illness During Pregnancy

* Mercury is a harmful metal found in high levels in some fish. Bigger and older fish usually have high levels of mercury. 

Unborn and newborn babies are more sensitive to mercury than adults. Pregnant and breastfeeding women should avoid 

fish with high levels of mercury. Pregnant women should eat a variety of fish with low levels of mercury, up to 12 oz. a week. 

The FDA has more information on mercury in fish and shellfish at: 

www.fda.gov/Food/ResourcesForYou/Consumers/ucm110591.htm. 

For more information on food safety, 

visit Food Safety on page 101.

For more on food diseases and food safety during pregnancy see:

U.S. Department of Agriculture (USDA):

Health and Nutrition Information for Pregnant and Breastfeeding Women

www.choosemyplate.gov/pregnancy-breastfeeding/food-safety.html

USDA Food Safety and Inspection Service: Fact Sheets

www.fsis.usda.gov/fact_sheets/

Is It Done Yet? Thermometer Placement & Temperatures

www.fsis.usda.gov/Is_It_Done_Yet/

Kitchen Companion; Your Safe Food Handbook

www.fsis.usda.gov/PDF/Kitchen_Companion.pdf

Check Your Steps: Food Safe Families 

www.fsis.usda.gov/Food_Safety_Education/Check_Your_Steps/

Centers for Disease Control and Prevention (CDC):

Questions and Answers about Foodborne Illness (sometimes called “Food Poisoning”)

www.cdc.gov/foodsafety/facts.html

Toxic Substances Portal – Mercury; ToxFAQsTM for Mercury

www.atsdr.cdc.gov/toxfaqs/tf.asp?id=113&tid=24

Food and Drug Administration (FDA):

Food Safety for Moms-to-Be

www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm081785.htm

What You Need to Know About Mercury in Fish and Shellfish

www.fda.gov/Food/ResourcesForYou/Consumers/ucm110591.htm

U.S. Department of Health and Human Services (HHS):

Safe Minimum Cooking Temperatures

www.foodsafety.gov/keep/charts/mintemp.html

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Women’s Health: A Guide to Preventing Infections

Listeriosis is a food-borne illness caused by bacteria 

called Listeria. Infected animals can spread these 

bacteria in their milk and cheese, and to the soil. This 

can infect animals, vegetables, and other foods that 

contact soil and animal manure. 

Listerosis

How is listeriosis spread?

Listeriosis is spread by eating food or drinking fluids 

contaminated with these bacteria. 

Anyone can get listeriosis, but you are at a higher risk 

if you:

u Are pregnant. 

 Pregnant women get listeriosis about 13 times 

more often than other healthy adults. 

 Newborn babies are at risk for more serious 

illness if infected.

u Are an adult over age 50.

u Have a weakened immune system, caused by: 

 AIDS.

 Cancer.

 Diabetes.

 Kidney disease.

 Medicines for organ transplants and other serious 

medical conditions.

What are signs of listeriosis?

You may have no signs. Or, you may have flu-like signs 

such as:

u Fever.

u Chills.

u Muscle aches.

u Diarrhea.

u Upset stomach.

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Women’s Health: Listerosis

If the illness gets worse, you can have:

u Headaches.

u Stiff neck.

u Confusion.

u Loss of balance.

u Convulsions.

How do you know if you have listeriosis?

The only way to know if you have listeriosis is by a 

medical exam. Your health care provider can examine 

and test for it. Lab samples may be taken from amniotic 

fluid, blood, feces, and urine.

How is listeriosis treated?

Listeriosis can be treated and cured with antibiotics. 

Always finish antibiotic treatment. 

What can happen to pregnant women if 

they are not treated for listeriosis?

Listeriosis can be very serious for the pregnant 

woman and for her child. Listeria bacteria can pass 

from a pregnant woman to her unborn child. Listeriosis 

can cause:

u Miscarriage. 

u Early birth.

u Birth of an infected baby.

u Brain damage or other problems in the baby.

u Death of both the mother and the baby. 

How can you avoid listeriosis? 

u Learn how to handle food safely. This can reduce 

your risk of listeriosis and other food-borne illness 

for you and your family. 

u Avoid non-pasteurized soft cheeses. 

u Cook food thoroughly.

Pregnant women should 

avoid eating soft cheeses, 

deli meats, and cold salads 

from salad bars. 

For more on listeriosis see:

Centers for Disease Control and Prevention (CDC):

Listeriosis (Listeria infection)

www.cdc.gov/listeria/index.html

Listeriosis (Listeria) and Pregnancy

www.cdc.gov/ncbddd/pregnancy_gateway/infections-listeria.html 

U.S. Department of Health and Human Services (HHS), Office on Women’s Health: 

Food Don’ts; Print-and-Go Guide

www.womenshealth.gov/pregnancy/mom-to-be-tools/pregnancy_food_donts.pdf

U.S. National Library of Medicine:

Listeriosis

www.nlm.nih.gov/medlineplus/ency/article/001380.htm

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Women’s Health: A Guide to Preventing Infections

Toxoplasmosis is an infection caused by a small 

parasite. It is found in humans, animals, and birds. 

Cats play a role in the spread of toxoplasmosis. 

Toxoplasmosis

Cats and kittens can get toxoplasmosis by eating 

infected small animals. The parasite is then passed 

in the cat’s feces. This can infect their litter box, sand 

boxes, and soil or dirt in gardens and yards. Kittens and 

cats can pass millions of parasites in their feces.

How is toxoplasmosis spread?

u Eating undercooked meat rewrite: (e.g., beef, lamb, 

pork, poultry, wild game).

u Touching your mouth after:

 Working in infected soil.

 Changing cat litter boxes without wearing gloves. 

Be sure to clean your hands after.

u Eating fruits and vegetables that are not washed 

or peeled.

u Handling raw meat without washing your hands 

afterwards.

u Using unwashed knives, cutting boards, and 

surfaces that have been in contact with raw meat or 

other food. 

u Drinking water that is infected with the parasite.

Eating undercooked meat is the 

biggest risk for toxoplasmosis. 

See Table 1 on page 103 for 

safe minimum temperatures for 

cooking meat. 

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Women’s Health: Toxoplasmosis

What are the signs of toxoplasmosis?

You may have no signs of sickness. Or, you may have:

u Muscle aches and pains.

u Headache.

u Fever.

u Sore throat.

u Enlarged lymph nodes.

u Feel like you “have the flu.”

If you are pregnant and have no signs of the illness, 

your unborn baby can still be affected.

How do you know you have 

toxoplasmosis?

The only way to know if you have toxoplasmosis is by a 

medical exam. Your health care provider can examine 

you and test your blood for it. If a pregnant woman is 

infected, other tests can show if the unborn baby has 

toxoplasmosis.

How is it treated?

Toxoplasmosis can be treated and cured with 

antibiotics. Always finish antibiotic treatment. 

What can happen to you if you are not 

treated for toxoplasmosis?

u Severe cases can affect the brain, lungs, eyes, heart, 

or liver. Infection can spread to the baby during 

pregnancy, labor, or birth.

u For the mother, the toxoplasmosis infection is often 

mild. She may not even know she has it. 

u For the baby, infection can cause severe problems. 

These are worse when the mother gets the infection 

early in pregnancy. Infection of the baby may:

 Cause early birth.

 Damage the baby’s eyes, nervous system, skin, 

and ears. 

 Not show for months or years. If not treated, eye 

or brain problems can occur.

For more on how 

to clean hands, 

see Clean Hands

on page 119.

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Women’s Health: Toxoplasmosis

How can you avoid toxoplasmosis? 

u Learn how to handle food safely. This can reduce the 

risk of toxoplasmosis and other food-borne illness for 

you and your family. 

u Avoid cat litter. If you have to change litter, wear 

disposable gloves. Clean your hands well with soap 

and water after.

u Feed your cat store-bought dry or canned food. Do 

not feed your cat raw or undercooked meats. 

u Keep cats indoors. This will keep the cat from 

hunting birds and rodents that might be infected.

u Avoid stray cats and kittens.

u Do not get a new cat while you are pregnant.

u Keep all sandboxes covered. This will stop cats from 

using them as litter boxes.

u Wear gloves when gardening or during contact with 

soil or sand. Clean hands well after gardening or 

contact with soil or sand. 

For more on toxoplasmosis see:

Department of Veterans Affairs (VA):

Toxoplasmosis

www.hiv.va.gov/patient/diagnosis/OI-toxoplasmosis.asp

Centers for Disease Control and Prevention (CDC):

Parasites – Toxoplasmosis (Toxoplasma infection)

www.cdc.gov/parasites/toxoplasmosis/

Toxoplasmosis and Pregnancy

www.cdc.gov/ncbddd/pregnancy_gateway/infections-toxo.html

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Women’s Health: A Guide to Preventing Infections

Keeping your hands clean is one of the best ways to 

prevent the spread of germs and infection. Clean your 

hands using soap and water. Or, an alcohol hand rub 

can be used when your hands are not visibly dirty.

Clean Hands

Germs can be spread from your hands to items 

around you such as doorknobs, grocery carts, 

handrails, phones, and computer keyboards. After, 

others may touch these items and then touch their 

eyes, nose, or mouth. This is just one way that germs 

pass from one person to another. Keeping your hands 

clean helps you: 

u Avoid getting sick.

u Avoid spreading germs to others.

u Keep your family and community healthy.

u Be a healthy role model for others. 

When should you clean your hands?

Before: 

u Preparing or eating food. 

u Caring for someone who is sick.

u Treating a cut or wound.

u Putting in contact lenses.

After: 

u Going to the bathroom. 

u Contact with body fluids such as blood, vomit, 

or feces.

u Changing diapers or helping someone with toileting.

u Caring for someone who is sick. 

u Blowing your nose.

u Coughing or sneezing. 

u Touching an animal or handling their toys or waste. 

u Handling garbage, trash cans, or drains.

u Treating a cut or wound. 

u Handling raw meat.

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Women’s Health: Clean Hands

Simply put: Clean your hands often, 

whether they look dirty or not.

How should you clean your hands?

You can clean your hands using soap and water. Or, 

you can use an alcohol hand rub (same as alcohol 

hand sanitizer).

With soap and water:

1. Wet your hands with clean running water. 

2. Add soap to make suds and scrub all over your 

hands and wrists. 

3. Rub:

 Palms.

 Back of hands.

 Between the fingers.

 Fingers.

 Wrists.

4. Continue rubbing hands for at least 20 seconds. 

5. Rinse hands well under running water. 

6. Dry your hands using a clean paper towel or air dryer. 

If possible, use your paper towel to turn off the water 

and to open the door when leaving the restroom.

Need a hand washing timer? Sing 

“Happy Birthday” through twice 

in your head!

With alcohol hand rub (alcohol hand sanitizer):

1. Apply product to the palm of one hand (see product 

label for directions / enough to use on BOTH hands). 

2. Rub:

 Palms.

 Back of hands.

 Between the fingers.

 Fingers.

 Wrists.

3. Keep rubbing until hands are dry, at least 

30 seconds.

Most alcohol hand rubs from grocery or 

drug stores contain alcohol to reduce 

or kill most germs and viruses. Alcohol 

hand rubs come in all sizes – even ones 

that fit in a child’s pocket.

Use soap and water instead of alcohol hand rub:

u When your hands are visibly dirty.

u Before eating or preparing food.

u After handling raw meat.

u After handling animal waste.

u After going to the bathroom.

u After changing a diaper.

u After assisting someone with toileting.

How can you help others to clean 

their hands?

u Lead by example and clean your own hands often.

u Teach your friends and family when and how to keep 

their hands clean.

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Women’s Health: Clean Hands

u Make alcohol hand rub convenient to use. Keep it in 

places around you such as work, home, and your car. 

Teach your family and friends to do the same. 

u Teach your children good hand cleaning habits, like 

cleaning their hands before touching their eyes, 

nose, or mouth.

One way to remind everyone of 

when to clean hands is to put a 

bottle of alcohol hand rub next to 

each box of tissues in your home.

If you are a patient or a visitor in a 

hospital or medical facility:

u Clean your hands and ask your family to do 

the same:

 Before entering a patient room or touching 

a patient.

 After leaving a patient room or touching a patient.

u See staff cleaning their hands with an alcohol hand 

rub or soap and water before and after they touch 

a patient. 

u See staff putting on gloves before touching broken 

skin or open wounds.

u See alcohol hand rub in hallways or near 

patient rooms.

u Ask doctors, nurses, and other staff about the 

steps the hospital is taking to help staff keep their 

hands clean.

u Ask or remind hospital staff to clean their hands 

before and after touching a patient.

Don’t be afraid to ask 

anyone, including health 

care providers, to clean 

their hands before 

touching a patient.

For more on clean hands see:

Department of Veterans Affairs (VA):

Infection: Don't Pass It On

www.publichealth.va.gov/InfectionDontPassItOn/

Centers for Disease Control and Prevention (CDC): 

CDC TV: Put Your Hands Together

www.cdc.gov/CDCTV/HandsTogether/

Hand Hygiene Saves Lives

www.cdc.gov/Features/HandHygiene/

Wash Your Hands

www.cdc.gov/Features/HandWashing/

An Ounce of Prevention Keeps the Germs Away; Seven Keys to a Safer Healthier Home

www.cdc.gov/ounceofprevention/docs/oop_brochure_eng.pdf

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Women’s Health: A Guide to Preventing Infections

Safely cleaning and storing your contact lenses 

is the best way to prevent eye infections. Lenses 

can collect bacteria, fungi, and other germs if not 

properly cleaned. 

Contact Lens Safety

Why should you clean your contact 

lenses?

Contact wearers are at risk of eye infections since 

contacts are worn directly on the eye. Eye infections 

can cause pain, blurred vision, and sometimes even 

blindness. Proper contact lens cleaning, storing, and 

hygiene are the best way to keep your eyes healthy. 

When should you wear contact lenses?

Most types of contact lenses are only worn while 

awake. Contact lenses should not be worn when:

u Sleeping (some can be worn overnight).

u Showering.

u Swimming in the pool or ocean.

Some types of extended wear lenses can be worn 

overnight. Talk to your eye care provider about when 

to remove contact lenses.

Replace contact storage 

cases every 3 to 6 months.

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Women’s Health: Contact Lens Safety

How should you clean and store your 

contact lenses?

Follow your eye care provider’s and manufacturer’s 

instructions for cleaning and storing your contact 

lenses. 

1. Always clean hands before touching your eyes and 

contact lenses.

2. Remove the lens and place in the palm of your hand.

3. Rub contact lens solution over the surface of the 

lens for 5 to 10 seconds on each side. 

4. Rinse lens with a stream of solution to remove 

bacteria and deposits from the lens.

5. Store lenses in the proper storage case with fresh 

solution. 

6. After removing lenses from the storage case, rinse 

case with fresh solution and allow to air dry. Never 

use tap water to rinse your contact lens case. 

7. Replace your contact lens storage case every 3 

to 6 months.

Discuss with your provider:

u Which contact lens products and solutions to use.

u How often to replace your contact lenses.

If you wear contact lenses:

Always:

u See your eye care provider for regular exams.

u Clean hands before touching your eyes and lenses.

u Use fresh, sterile solutions recommended by your 

provider for lens cleaning and storage.

u Remove your contact lenses and see your eye care 

provider if your eyes become red, irritated, or if you 

have problems seeing. 

u Contact your provider if you have any problems with 

your eyes, vision, or lenses.

Never:

u Re-use any lens 

solutions. Always 

discard all storage 

solutions after use. 

Used solutions can 

become contaminated 

with germs that can cause eye infections.

u Expose your lenses to water, including distilled, 

bottled, tap, lake, or ocean water. Water can contain 

germs that cause eye infections.

u Use saliva to wet your contact lenses.

u Transfer sterile contact lens solution to another 

container for later use.

Never expose 

contact lenses 

to water.

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Women’s Health: Contact Lens Safety

What are signs of an eye infection?

u Discomfort.

u Excessive tearing or mucus.

u Unusual sensitivity to light.

u Itching.

u Burning.

u “Gritty” feeling.

u Unusual redness.

u Blurred vision.

u Swelling.

u Pain.

See your eye care provider immediately if you have 

signs of an eye infection. Eye infections can be serious 

and in some cases cause blindness. 

Allergies can cause some of the same signs as an eye 

infection. Allergies usually affect both eyes equally. 

Some infections may affect only one eye. 

For more on contact lens safety see:

Centers for Disease Control and Prevention (CDC):

Parasites – Acanthamoeba; Contact Wearers

www.cdc.gov/parasites/acanthamoeba/contact_wearers.html

Food and Drug Administration (FDA):

Focusing on Contact Lens Safety

www.fda.gov/forconsumers/consumerupdates/ucm048893.htm

Video on Contact Lens Safety

www.accessdata.fda.gov/videos/cdrh/contactlens.wmv

Ensuring Safe Use of Contact Lens Solution

www.fda.gov/forconsumers/consumerupdates/ucm164197.htm

See your eye care 

provider immediately 

if you have signs of 

an eye infection.

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Women’s Health: A Guide to Preventing Infections

The terms below are defined in the context of 

their use within this health guide. For complete 

definitions, consult a reputable medical dictionary.

Definition of Terms

Acute infection. . . . . . . . . . . . . . . . . . . . A short-term illness caused by a germ.

AIDS (acquired 

immune deficiency syndrome). . . . . . The late stage of HIV infection. When you have AIDS, your immune system 

is very weak. 

Alcohol hand rub, 

or alcohol hand sanitizer. . . . . . . . . . . A liquid or gel used to clean hands. It contains alcohol to kill germs. 

Amniotic fluid. . . . . . . . . . . . . . . . . . . . . Fluid around an unborn baby in the uterus. Amniotic fluid can be used to 

test for infections during pregnancy. 

Antibiotics. . . . . . . . . . . . . . . . . . . . . . . . A type of medicine used to treat bacterial infections. Antibiotics do not work 

on viral infections.

Antiviral drugs. . . . . . . . . . . . . . . . . . . . . A type of medicine used to treat viral infections such as influenza (flu) 

and HIV. 

Bacteria. . . . . . . . . . . . . . . . . . . . . . . . . . . A type of germ that may cause infection. Not all bacteria are harmful or 

cause infection. Most bacterial infections are treated with antibiotics. 

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Women’s Health: Definition of Terms

Bacterial vaginosis (BV). . . . . . . . . . . . A common vaginal infection in women that occurs when the balance 

of normal bacteria in the vagina is upset. It is the most common 

vaginal infection in women of childbearing age. It is also common in 

pregnant women.

Biopsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . The removal of a small piece of an organ or tissue to look for signs of 

disease or damage. 

Bladder. . . . . . . . . . . . . . . . . . . . . . . . . . . The organ in the urinary tract that stores urine. 

Cervix. . . . . . . . . . . . . . . . . . . . . . . . . . . . The opening to the uterus (womb).

Chronic infection. . . . . . . . . . . . . . . . . . A long-term illness caused by a germ. 

Chlamydia. . . . . . . . . . . . . . . . . . . . . . . . A common sexually transmitted disease (STD) caused by bacteria. It can 

lead to unusual vaginal discharge and can be harmful during pregnancy. It 

may also cause problems getting pregnant. 

Cirrhosis. . . . . . . . . . . . . . . . . . . . . . . . . . Scarring of the liver.

Cold. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . An infection of the nose, sinuses, or throat caused by a virus.

“Community” or 

“Herd” Immunity. . . . . . . . . . . . . . . . . . . Disease prevention that occurs when most people have been vaccinated 

against or have had an infection. This stops the spread of a contagious 

disease to protect even those not vaccinated to avoid large outbreaks 

of disease.

Condom, female. . . . . . . . . . . . . . . . . . . A plastic barrier inserted into the vagina before intercourse to reduce the 

risk of sexually transmitted diseases (STDs) and pregnancy.

Condom, male. . . . . . . . . . . . . . . . . . . . . A latex, “lambskin”, or plastic barrier used to cover the penis during vaginal, 

anal, or oral sex to reduce the risk of sexually transmitted diseases (STDs) 

and pregnancy.

Contagious. . . . . . . . . . . . . . . . . . . . . . . . The spread of germs from one person (or other living organism) to another.

Dental dam. . . . . . . . . . . . . . . . . . . . . . . . A square piece of latex (rubber) or silicone used as a barrier during oral sex 

to reduce the risk of sexually transmitted diseases (STDs).

Diaphragm. . . . . . . . . . . . . . . . . . . . . . . . A type of birth control that is inserted into the vagina to cover the cervix. A 

diaphragm does not protect against sexually transmitted diseases (STDs).

Douching. . . . . . . . . . . . . . . . . . . . . . . . . Cleaning or washing the inside of the vagina with water or a mixture 

of fluids. The American College of Obstetricians and Gynecologists 

recommends that women do not douche. 

Fallopian tubes. . . . . . . . . . . . . . . . . . . . The tubes that carry eggs from the ovaries to the uterus. 

Fungus (fungi). . . . . . . . . . . . . . . . . . . . . A type of organism that may cause infection. Fungi can cause vaginal 

yeast infections and severe diseases like pneumonia in people with weak 

immune systems. 

Genital warts. . . . . . . . . . . . . . . . . . . . . . Small growths on the skin in the genital areas that include the penis, vulva, 

urethra, vagina, cervix, and around and in the anus caused by human 

papillomavirus (HPV).

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Women’s Health: Definition of Terms

Gonorrhea. . . . . . . . . . . . . . . . . . . . . . . . A sexually transmitted disease (STD) caused by bacteria. Also known as 

“the clap” or “the drips”. It can lead to unusual vaginal discharge and can be 

harmful during pregnancy. 

Hepatitis. . . . . . . . . . . . . . . . . . . . . . . . . . A swollen (inflamed) liver that can be caused by viral infections, drugs, 

diseases, alcohol, and/or toxins. 

Herpes. . . . . . . . . . . . . . . . . . . . . . . . . . . . A sexually transmitted disease (STD) caused by two types of herpes 

simplex viruses. 

HIV (human 

immunodeficiency virus). . . . . . . . . . . A virus that attacks and weakens the immune system.

Human papillomavirus (HPV). . . . . . . The most common sexually transmitted disease (STD) in the United States. 

There are over 40 types of HPV viruses that can infect genital, mouth, or 

throat areas. Some can lead to genital warts or increase the risk for 

cervical cancer.

Immune system. . . . . . . . . . . . . . . . . . . . Parts of the body that protect against germs and diseases. 

Immunity. . . . . . . . . . . . . . . . . . . . . . . . . . The ability of your body to avoid an infection or disease.

Influenza (flu). . . . . . . . . . . . . . . . . . . . . . A respiratory illness caused by a flu virus.

Intrauterine device (IUD). . . . . . . . . . . A type of birth control inserted into the uterus. An IUD does not protect 

against sexually transmitted diseases (STDs).

Kidneys. . . . . . . . . . . . . . . . . . . . . . . . . . . Organs in the urinary tract that collect waste from blood to make urine. 

Listeriosis. . . . . . . . . . . . . . . . . . . . . . . . . An infection mainly caused by eating food contaminated with the bacterium 

Listeria monocytogenes.

Lymph nodes. . . . . . . . . . . . . . . . . . . . . . Small organs within the immune system spread throughout the body that 

help fight infection. 

Ovaries. . . . . . . . . . . . . . . . . . . . . . . . . . . The organs that hold a woman’s eggs. 

Ovule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . A medicine tablet that is inserted into the vagina to treat infections. 

Parasite. . . . . . . . . . . . . . . . . . . . . . . . . . . An organism that can cause infection. Parasites may cause infections such 

as trichomoniasis and toxoplasmosis.

Pasteurization. . . . . . . . . . . . . . . . . . . . . A heating process often used in milk and cheese production that kills 

bacteria and other germs. 

Pelvic inflammatory 

disease (PID). . . . . . . . . . . . . . . . . . . . . . An infection of the female reproductive organs, including the uterus and 

fallopian tubes. Women with a sexually transmitted disease (STD) are at a 

higher risk for PID. 

Pneumonia. . . . . . . . . . . . . . . . . . . . . . . . An infection of the lungs that can be caused by bacteria, virus, fungi, 

or parasites.

Safer sex. . . . . . . . . . . . . . . . . . . . . . . . . . The use of barriers such as condoms during vaginal, anal, or oral sex to 

prevent and control the spread of sexually transmitted diseases (STDs) and 

other infections.

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Women’s Health: Definition of Terms

Sexually transmitted 

disease (STD). . . . . . . . . . . . . . . . . . . . . . Infection spread by vaginal, anal, or oral sex, and genital 

touching. STDs can be caused by bacteria, parasites, or viruses. 

Common STDs include chlamydia, HPV, and herpes. 

Sexually transmitted 

infection (STI). . . . . . . . . . . . . . . . . . . . . See sexually transmitted disease (STD).

Syphilis. . . . . . . . . . . . . . . . . . . . . . . . . . . A sexually transmitted disease (STD) caused by bacteria that can 

produce sores on the genitals, vagina, anus, rectum, and even 

on the lips and in the mouth. 

Toxoplasmosis. . . . . . . . . . . . . . . . . . . . . An infection caused by a small parasite. It is the leading cause of 

death from food-borne illness in the United States. It can be very 

harmful during pregnancy. 

Trichomoniasis. . . . . . . . . . . . . . . . . . . . A sexually transmitted disease (STD) caused by a small parasite. 

It can lead to unusual vaginal discharge and can be harmful 

during pregnancy. 

Ureters. . . . . . . . . . . . . . . . . . . . . . . . . . . Tubes of the urinary tract that move urine from the kidneys to the 

bladder. 

Urethra. . . . . . . . . . . . . . . . . . . . . . . . . . . The tube within the urinary tract that carries urine from the 

bladder out of the body. 

Urinary tract. . . . . . . . . . . . . . . . . . . . . . . The body system that makes, stores, and carries urine out of the 

body. Includes the kidneys, ureters, bladder, and urethra. 

Urinary tract infection (UTI). . . . . . . . . An infection that occurs when bacteria grow in the urinary tract.

Uterus. . . . . . . . . . . . . . . . . . . . . . . . . . . . The womb; the part of the female reproductive system where 

babies grow and develop during pregnancy. 

Vaccine. . . . . . . . . . . . . . . . . . . . . . . . . . . A medical preparation given to help the body produce immunity 

or to fight disease. 

Vaginal yeast infection. . . . . . . . . . . . . An infection of the vagina and vaginal area caused by a type 

of fungus called yeast. A yeast infection is not a sexually 

transmitted disease (STD). 

Virus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A type of germ that causes infections and disease. Influenza (flu), 

HIV, and herpes are caused by viruses. Antiviral drugs are used 

to treat viral infections.

Yeast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . A type of fungus that can lead to infection in the vagina. 

www.publichealth.va.gov/InfectionDontPassItOn
Infection: Don’t Pass It On 

A Campaign For Public Health

Veterans Health Administration

U.S. Department of Veterans Affairs

Clinical Public Health (10P3b)

810 Vermont Ave, NW

Washington, DC 20420

202-461-1040

publichealth@va.gov

August 2012 This material is NOT copyrighted and may be reproduced.