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Saturday, January 13, 2024

Punishment

From Wikipedia, the free encyclopedia
The old village stocks in Chapeltown, Lancashire, England

Punishment, commonly, is the imposition of an undesirable or unpleasant outcome upon a group or individual, meted out by an authority—in contexts ranging from child discipline to criminal law—as a response and deterrent to a particular action or behavior that is deemed undesirable or unacceptable. It is, however, possible to distinguish between various different understandings of what punishment is.

The reasoning for punishment may be to condition a child to avoid self-endangerment, to impose social conformity (in particular, in the contexts of compulsory education or military discipline), to defend norms, to protect against future harms (in particular, those from violent crime), and to maintain the law—and respect for rule of law—under which the social group is governed. Punishment may be self-inflicted as with self-flagellation and mortification of the flesh in the religious setting, but is most often a form of social coercion.

The unpleasant imposition may include a fine, penalty, or confinement, or be the removal or denial of something pleasant or desirable. The individual may be a person, or even an animal. The authority may be either a group or a single person, and punishment may be carried out formally under a system of law or informally in other kinds of social settings such as within a family. Negative or unpleasant impositions that are not authorized or that are administered without a breach of rules are not considered to be punishment as defined here. The study and practice of the punishment of crimes, particularly as it applies to imprisonment, is called penology, or, often in modern texts, corrections; in this context, the punishment process is euphemistically called "correctional process". Research into punishment often includes similar research into prevention.

Justifications for punishment include retribution, deterrence, rehabilitation, and incapacitation. The last could include such measures as isolation, in order to prevent the wrongdoer's having contact with potential victims, or the removal of a hand in order to make theft more difficult.

If only some of the conditions included in the definition of punishment are present, descriptions other than "punishment" may be considered more accurate. Inflicting something negative, or unpleasant, on a person or animal, without authority or not on the basis of a breach of rules is typically considered only revenge or spite rather than punishment. In addition, the word "punishment" is used as a metaphor, as when a boxer experiences "punishment" during a fight. In other situations, breaking a rule may be rewarded, and so receiving such a reward naturally does not constitute punishment. Finally the condition of breaking (or breaching) the rules must be satisfied for consequences to be considered punishment.

Punishments differ in their degree of severity, and may include sanctions such as reprimands, deprivations of privileges or liberty, fines, incarcerations, ostracism, the infliction of pain, amputation and the death penalty. Corporal punishment refers to punishments in which physical pain is intended to be inflicted upon the transgressor. Punishments may be judged as fair or unfair in terms of their degree of reciprocity and proportionality to the offense. Punishment can be an integral part of socialization, and punishing unwanted behavior is often part of a system of pedagogy or behavioral modification which also includes rewards.

Definitions

Barbed wire is a feature of prisons.
A modern jail cell
Hester Prynne at the Stocks—an engraved illustration from an 1878 edition of The Scarlet Letter
Punishment of an offender in Hungary, 1793

There are a large number of different understandings of what punishment is.

In philosophy

Various philosophers have presented definitions of punishment. Conditions commonly considered necessary properly to describe an action as punishment are that

  1. it is imposed by an authority (single or multiple),
  2. it involves some loss to the supposed offender,
  3. it is in response to an offense and
  4. the human (or other animal) to whom the loss is imposed should be deemed at least somewhat responsible for the offense.

In psychology

Introduced by B.F. Skinner, punishment has a more restrictive and technical definition. Along with reinforcement it belongs under the operant conditioning category. Operant conditioning refers to learning with either punishment (often confused as negative reinforcement) or a reward that serves as a positive reinforcement of the lesson to be learned. In psychology, punishment is the reduction of a behavior via application of an unpleasant stimulus ("positive punishment") or removal of a pleasant stimulus ("negative punishment"). Extra chores or spanking are examples of positive punishment, while removing an offending student's recess or play privileges are examples of negative punishment. The definition requires that punishment is only determined after the fact by the reduction in behavior; if the offending behavior of the subject does not decrease, it is not considered punishment. There is some conflation of punishment and aversives, though an aversion that does not decrease behavior is not considered punishment in psychology. Additionally, "aversive stimulus" is a label behaviorists generally apply to negative reinforcers (as in avoidance learning), rather than the punishers.

In socio-biology

Punishment is sometimes called retaliatory or moralistic aggression; it has been observed in all species of social animals, leading evolutionary biologists to conclude that it is an evolutionarily stable strategy, selected because it favors cooperative behavior.

Examples against sociobiological use

One criticism of the claim of all social animals being evolutionarily hardwired for punishment comes from studies of animals, such as the octopuses near Capri, Italy that suddenly formed communal cultures from having, until then lived solitary lives. During a period of heavy fishing and tourism that encroached on their territory, they started to live in groups, learning from each other, especially hunting techniques. Small, younger octopuses could be near the fully grown octopuses without being eaten by them, even though they, like other Octopus vulgaris, were cannibals until just before the group formation. The authors stress that this behavior change happened too fast to be a genetic characteristic in the octopuses, and that there were certainly no mammals or other "naturally" social animals punishing octopuses for cannibalism involved. The authors also note that the octopuses adopted observational learning without any evolutionary history of specialized adaptation for it.

There are also arguments against the notion of punishment requiring intelligence, based on studies of punishment in very small-brained animals such as insects. There is proof of honey bee workers with mutations that makes them fertile laying eggs only when other honey bees are not observing them, and that the few that are caught in the act are killed. This is corroborated by computer simulations proving that a few simple reactions well within mainstream views of the extremely limited intelligence of insects are sufficient to emulate the "political" behavior observed in great apes. The authors argue that this falsifies the claim that punishment evolved as a strategy to deal with individuals capable of knowing what they are doing.

In the case of more complex brains, the notion of evolution selecting for specific punishment of intentionally chosen breaches of rules and/or wrongdoers capable of intentional choices (for example, punishing humans for murder while not punishing lethal viruses) is subject to criticism from coevolution issues. That punishment of individuals with certain characteristics (including but, in principle, not restricted to mental abilities) selects against those characteristics, making evolution of any mental abilities considered to be the basis for penal responsibility impossible in populations subject to such selective punishment. Certain scientists argue that this disproves the notion of humans having a biological feeling of intentional transgressions deserving to be punished.

Scope of application

Punishments are applied for various purposes, most generally, to encourage and enforce proper behavior as defined by society or family. Criminals are punished judicially, by fines, corporal punishment or custodial sentences such as prison; detainees risk further punishments for breaches of internal rules. Children, pupils and other trainees may be punished by their educators or instructors (mainly parents, guardians, or teachers, tutors and coaches)—see Child discipline.

Slaves, domestic and other servants were subject to punishment by their masters. Employees can still be subject to a contractual form of fine or demotion. Most hierarchical organizations, such as military and police forces, or even churches, still apply quite rigid internal discipline, even with a judicial system of their own (court martial, canonical courts).

Punishment may also be applied on moral, especially religious, grounds, as in penance (which is voluntary) or imposed in a theocracy with a religious police (as in a strict Islamic state like Iran or under the Taliban) or (though not a true theocracy) by Inquisition.

Hell as punishment

Belief that an individual's ultimate punishment is being sent by God, the highest authority, to an existence in Hell, a place believed to exist in the after-life, typically corresponds to sins committed during their life. Sometimes these distinctions are specific, with damned souls suffering for each sin committed (see for example Plato's myth of Er or Dante's The Divine Comedy), but sometimes they are general, with condemned sinners relegated to one or more chamber of Hell or to a level of suffering.

History and rationale

U.S. incarceration timeline

Seriousness of a crime; punishment that fits the crime

A principle often mentioned with respect to the degree of punishment to be meted out is that the punishment should match the crime. One standard for measurement is the degree to which a crime affects others or society. Measurements of the degree of seriousness of a crime have been developed. A felony is generally considered to be a crime of "high seriousness", while a misdemeanor is not.

Possible reasons for punishment

There are many possible reasons that might be given to justify or explain why someone ought to be punished; here follows a broad outline of typical, possibly conflicting, justifications.

Deterrence

Two reasons given to justify punishment is that it is a measure to prevent people from committing an offence - deterring previous offenders from re-offending, and preventing those who may be contemplating an offence they have not committed from actually committing it. This punishment is intended to be sufficient that people would choose not to commit the crime rather than experience the punishment. The aim is to deter everyone in the community from committing offences.

Some criminologists state that the number of people convicted for crime does not decrease as a result of more severe punishment and conclude that deterrence is ineffective. Other criminologists object to said conclusion, citing that while most people do not know the exact severity of punishment such as whether the sentence for murder is 40 years or life, most people still know the rough outlines such as the punishments for armed robbery or forcible rape being more severe than the punishments for driving too fast or misparking a car. These criminologists therefore argue that lack of deterring effect of increasing the sentences for already severely punished crimes say nothing about the significance of the existence of punishment as a deterring factor.

Some criminologists argue that increasing the sentences for crimes can cause criminal investigators to give higher priority to said crimes so that a higher percentage of those committing them are convicted for them, causing statistics to give a false appearance of such crimes increasing. These criminologists argue that the use of statistics to gauge the efficiency of crime fighting methods are a danger of creating a reward hack that makes the least efficient criminal justice systems appear to be best at fighting crime, and that the appearance of deterrence being ineffective may be an example of this.

Rehabilitation

Some punishment includes work to reform and rehabilitate the culprit so that they will not commit the offence again. This is distinguished from deterrence, in that the goal here is to change the offender's attitude to what they have done, and make them come to see that their behavior was wrong.

Incapacitation

Incapacitation as a justification of punishment refers to the offender's ability to commit further offences being removed. Imprisonment separates offenders from the community, for example, Australia was a dumping ground for early British criminals. This was their way of removing or reducing the offenders ability to carry out certain crimes. The death penalty does this in a permanent (and irrevocable) way. In some societies, people who stole have been punished by having their hands amputated.

Crewe  however, has pointed out that for incapacitation of an offender to work, it must be the case that the offender would have committed a crime had they not been restricted in this way. Should the putative offender not be going to commit further crimes, then they have not been incapacitated. The more heinous crimes such as murders have the lowest levels of recidivism and hence are the least likely offences to be subject to incapacitative effects. Antisocial behaviour and the like display high levels of recidivism and hence are the kind of crimes most susceptible to incapacitative effects. It is shown by life-course studies that long sentences for burglaries amongst offenders in their late teens and early twenties fail to incapacitate when the natural reduction in offending due to ageing is taken into account: the longer the sentence, in these cases, the less the incapacitative effect.

Retribution

Criminal activities typically give a benefit to the offender and a loss to the victim. Punishment has been justified as a measure of retributive justice, in which the goal is to try to rebalance any unjust advantage gained by ensuring that the offender also suffers a loss. Sometimes viewed as a way of "getting even" with a wrongdoer—the suffering of the wrongdoer is seen as a desired goal in itself, even if it has no restorative benefits for the victim. One reason societies have administered punishments is to diminish the perceived need for retaliatory "street justice", blood feud, and vigilantism.

Restoration

Especially applied to minor offenses, punishment may take the form of the offender "righting the wrong", or making restitution to the victim. Community service or compensation orders are examples of this sort of penalty. In models of restorative justice, victims take an active role in a process with their offenders who are encouraged to take responsibility for their actions, "to repair the harm they've done—by apologizing, returning stolen money, or community service." The restorative justice approach aims to help the offender want to avoid future offences.

Education and denunciation

Gothic pillory (early 16th century) in Schwäbisch Hall, Germany

Punishment can be explained by positive prevention theory to use the criminal justice system to teach people what are the social norms for what is correct, and acts as a reinforcement.

Punishment can serve as a means for society to publicly express denunciation of an action as being criminal. Besides educating people regarding what is not acceptable behavior, it serves the dual function of preventing vigilante justice by acknowledging public anger, while concurrently deterring future criminal activity by stigmatizing the offender. This is sometimes called the "Expressive Theory" of denunciation. The pillory was a method for carrying out public denunciation.

Some critics of the education and denunciation model cite evolutionary problems with the notion that a feeling for punishment as a social signal system evolved if punishment was not effective. The critics argue that some individuals spending time and energy and taking risks in punishing others, and the possible loss of the punished group members, would have been selected against if punishment served no function other than signals that could evolve to work by less risky means.

Unified theory

A unified theory of punishment brings together multiple penal purposes—such as retribution, deterrence and rehabilitation—in a single, coherent framework. Instead of punishment requiring we choose between them, unified theorists argue that they work together as part of some wider goal such as the protection of rights.

Criticism

Some people think that punishment as a whole is unhelpful and even harmful to the people that it is used against. Detractors argue that punishment is simply wrong, of the same design as "two wrongs make a right". Critics argue that punishment is simply revenge. Professor Deirdre Golash, author of The Case against Punishment: Retribution, Crime Prevention, and the Law, says:

We ought not to impose such harm on anyone unless we have a very good reason for doing so. This remark may seem trivially true, but the history of humankind is littered with examples of the deliberate infliction of harm by well-intentioned persons in the vain pursuit of ends which that harm did not further, or in the successful pursuit of questionable ends. These benefactors of humanity sacrificed their fellows to appease mythical gods and tortured them to save their souls from a mythical hell, broke and bound the feet of children to promote their eventual marriageability, beat slow schoolchildren to promote learning and respect for teachers, subjected the sick to leeches to rid them of excess blood, and put suspects to the rack and the thumbscrew in the service of truth. They schooled themselves to feel no pity—to renounce human compassion in the service of a higher end. The deliberate doing of harm in the mistaken belief that it promotes some greater good is the essence of tragedy. We would do well to ask whether the goods we seek in harming offenders are worthwhile, and whether the means we choose will indeed secure them.

Golash also writes about imprisonment:

Imprisonment means, at minimum, the loss of liberty and autonomy, as well as many material comforts, personal security, and access to heterosexual relations. These deprivations, according to Gresham Sykes (who first identified them) "together dealt 'a profound hurt' that went to 'the very foundations of the prisoner's being. But these are only the minimum harms, suffered by the least vulnerable inmates in the best-run prisons. Most prisons are run badly, and in some, conditions are more squalid than in the worst of slums. In the District of Columbia jail, for example, inmates must wash their clothes and sheets in cell toilets because the laundry machines are broken. Vermin and insects infest the building, in which air vents are clogged with decades' accumulation of dust and grime. But even inmates in prisons where conditions are sanitary must still face the numbing boredom and emptiness of prison life—a vast desert of wasted days in which little in the way of meaningful activity is possible.

Destructiveness to thinking and betterment

There are critics of punishment who argue that punishment aimed at intentional actions forces people to suppress their ability to act on intent. Advocates of this viewpoint argue that such suppression of intention causes the harmful behaviors to remain, making punishment counterproductive. These people suggest that the ability to make intentional choices should instead be treasured as a source of possibilities of betterment, citing that complex cognition would have been an evolutionarily useless waste of energy if it led to justifications of fixed actions and no change as simple inability to understand arguments would have been the most thrifty protection from being misled by them if arguments were for social manipulation, and reject condemnation of people who intentionally did bad things. Punishment can be effective in stopping undesirable employee behaviors such as tardiness, absenteeism or substandard work performance. However, punishment does not necessarily cause an employee to demonstrate a desirable behavior.

Vertebrate paleontology

From Wikipedia, the free encyclopedia
Paleontologists at work at the dinosaur site of Lo Hueco (Cuenca, Spain)

Vertebrate paleontology is the subfield of paleontology that seeks to discover, through the study of fossilized remains, the behavior, reproduction and appearance of extinct vertebrates (animals with vertebrae and their descendants). It also tries to connect, by using the evolutionary timeline, the animals of the past and their modern-day relatives.

The fossil record shows aspects of the meandering evolutionary path from early aquatic vertebrates to modern fish as well as mammals, birds, reptiles and amphibians, with a host of transitional fossils, though there are still large blank areas. The earliest known fossil vertebrates were heavily armored fish discovered in rocks from the Ordovician period about 485 to 444 Ma (megaannum, million years ago), with jawed vertebrates emerging in the following Silurian period (444 to 419 Ma) with the placoderms and acanthodians. The Devonian period (419 to 359 Ma) saw primitive air-breathing fish to develop limbs allowing them to walk on land, thus becoming the first terrestrial vertebrates, the stegocephalians.

Romer's gap in the early Carboniferous period (359 to 299 Ma) left little of the early stegocephalians, but allowed vertebrates more adapted to life on land to flourish in their wake. Crown-group tetrapods appeared in the early Carboniferous, with temnospondyls dominating the ecosystem and becoming the first land vertebrate megafauna. A lineage of reptiliomorphs developed a metabolism better suited for life exclusively on land, as well as a novel form of reproduction freeing them from the water: the amniotic egg, with full-fledged amniotes appearing in the mid-Carboniferous. Sharks and their holocephalian relatives flourished in the seas, while rivers were dominated by lobe-finned fish like rhizodonts.

During the Permian period (299 to 252 Ma), one of the two major branches of amniotes, the synapsids, flourished, with derived therapsids taking over in the middle of the period. The Great Dying wiped out most of the synapsid diversity, with archosaurs, emerging from the other sauropsid branch, replacing many of them in the Triassic period (252 to 201 Ma). Lissamphibians, modern amphibians, likely arose around that time from temnospondyls. True mammals, derived from cynodont therapsids, showed up in the Middle Triassic around the same time as the dinosaurs, who emerged from a clade of archosaurs. At the same time, ray-finned fish diversified, leading to teleost fish dominating the seas.

Ancestral birds (Avialae) like Archaeopteryx first evolved from dinosaurs during the Jurassic, with crown-group birds (Neornithes) emerging in the Cretaceous between 100 Ma and 60 Ma.

The K-Pg mass extinction wiped out many vertebrate clades, including the pterosaurs, plesiosaurs, mosasaurs and nearly all dinosaurs, leaving many ecological niches open. While therian mammals had already evolved in the Late Jurassic, they would rise to prominence in the Paleogene following the mass extinction and remain to this day, although squamates and birds still lead in diversity.

History

One of the people who helped figure out the vertebrate progression was French zoologist Georges Cuvier (1769–1832), who realized that fossils found in older rock strata differed greatly from more recent fossils or modern animals. He published his findings in 1812 and, although he steadfastly refuted evolution, his work proved the (at the time) contested theory of extinction of species.

Thomas Jefferson is credited with initiating the science of vertebrate paleontology in the United States with the reading of a paper to the American Philosophical Society in Philadelphia in 1797. Jefferson presented fossil bones of a ground sloth found in a cave in western Virginia and named the genus (Megalonyx). The species was ultimately named Megalonyx jeffersonii in his honor. Jefferson corresponded with Cuvier, including sending him a shipment of highly desirable bones of the American mastodon and the woolly mammoth.

Paleontology really got started though, with the publication of Recherches sur les poissons fossiles (1833–1843) by Swiss naturalist Louis Agassiz (1807–1873). He studied, described and listed hundreds of species of fossil fish, beginning the serious study into the lives of extinct animals. With the publication of the Origin of Species by Charles Darwin in 1859, the field got a theoretical framework. Much of the subsequent work has been to map the relationship between fossil and extant organisms, as well as their history through time.

In modern times, Alfred Romer (1894–1973) wrote what has been termed the definitive textbook on the subject, called Vertebrate Paleontology. It shows the progression of evolution in fossil fish, and amphibians and reptiles through comparative anatomy, including a list of all the (then) known fossil vertebrate genera. Romer became the first president of the Society of Vertebrate Paleontology in 1940, alongside co-founder Howard Chiu. An updated work that largely carried on the tradition from Romer, and by many considered definitive book on the subject was written by Robert L. Carroll of McGill University, the 1988 text Vertebrate Paleontology and Evolution. Carroll was president of the Society of Vertebrate Paleontology in 1983. The Society keeps its members informed on the latest discoveries through newsletters and the Journal of Vertebrate Paleontology.

Classification

Classical spindle diagram of the evolution of the vertebrates at class level

The "traditional" vertebrate classification scheme employ evolutionary taxonomy where several of the taxa listed are paraphyletic, i.e. have given rise to another taxa that have been given the same rank. For instance, birds are generally considered to be the descendants of reptiles (Saurischian dinosaurs to be precise), but in this system both are listed as separate classes. Under phylogenetic nomenclature, such an arrangement is unacceptable, though it offers excellent overview.

This classical scheme is still used in works where systematic overview is essential, e.g. Benton (1998), Hildebrand and Goslow (2001) and Knobill and Neill (2006). While mostly seen in general works, it is also still used in some specialist works like Fortuny & al. (2011).

Kingdom Animalia

Sexually transmitted infection

Sexually transmitted infection
Other namesSexually transmitted disease (STD);
Venereal disease (VD)
Herpes genitalis
SpecialtyInfectious disease
SymptomsNone, vaginal discharge, penile discharge, ulcers on or around the genitals, pelvic pain
ComplicationsInfertility
CausesInfections commonly spread by sex
PreventionSexual abstinence, vaccinations, condoms
Frequency1.1 billion (STIs other than HIV/AIDS, 2015)
Deaths108,000 (STIs other than HIV/AIDS, 2015)

A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex. STIs often do not initially cause symptoms, which results in a risk of passing the infection on to others. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Some STIs can cause infertility.

Bacterial STIs include chlamydia, gonorrhea, and syphilis. Viral STIs include genital herpes, HIV/AIDS, and genital warts. Parasitic STIs include trichomoniasis. STI diagnostic tests are usually easily available in the developed world, but they are often unavailable in the developing world.

Some vaccinations may also decrease the risk of certain infections including hepatitis B and some types of HPV. Safe sex practices, such as use of condoms, having a smaller number of sexual partners, and being in a relationship in which each person only has sex with the other also decreases the risk of STIs. Comprehensive sex education may also be useful. Most STIs are treatable and curable; of the most common infections, syphilis, gonorrhea, chlamydia, and trichomoniasis are curable, while HIV/AIDS and genital herpes are not curable.

In 2015, about 1.1 billion people had STIs other than HIV/AIDS. About 500 million were infected with either syphilis, gonorrhea, chlamydia or trichomoniasis. At least an additional 530 million people have genital herpes, and 290 million women have human papillomavirus. STIs other than HIV resulted in 108,000 deaths in 2015. In the United States, there were 19 million new cases of STIs in 2010. Historical documentation of STIs in antiquity dates back to at least the Ebers Papyrus (c. 1550 BCE) and the Hebrew Bible/Old Testament (8th/7th centuries BCE).

There is often shame and stigma associated with STIs. The term sexually transmitted infection is generally preferred over sexually transmitted disease or venereal disease, as it includes those who do not have symptomatic disease.

Signs and symptoms

Not all STIs are symptomatic, and symptoms may not appear immediately after infection. In some instances a disease can be carried with no symptoms, which leaves a greater risk of passing the disease on to others. Depending on the disease, some untreated STIs can lead to infertility, chronic pain or death.

The presence of an STI in prepubescent children may indicate sexual abuse.

Cause

Transmission

A sexually transmitted infection present in a pregnant woman may be passed on to the infant before or after birth.

Risk of transmission per unprotected sexual act with an infected person

Known risks Possible
Performing oral sex on a man
Performing oral sex on a woman
Receiving oral sex—man
Receiving oral sex—woman
Vaginal sex—man
Vaginal sex—woman
Anal sex—insertive
Anal sex—receptive
Anilingus

Bacterial

Viral

Micrograph showing the viral cytopathic effect of herpes (ground glass nuclear inclusions, multi-nucleation). Pap test. Pap stain.

Parasites

Main types

Sexually transmitted infections include:

  • Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. In women, symptoms may include abnormal vaginal discharge, burning during urination, and bleeding in between periods, although most women do not experience any symptoms. Symptoms in men include pain when urinating, and abnormal discharge from their penis. If left untreated in both men and women, chlamydia can infect the urinary tract and potentially lead to pelvic inflammatory disease (PID). PID can cause serious problems during pregnancy and even has the potential to cause infertility. It can cause a woman to have a potentially deadly ectopic pregnancy, in which the egg implants outside of the uterus. However, chlamydia can be cured with antibiotics.
  • The two most common forms of herpes are caused by infection with herpes simplex virus (HSV). HSV-1 is typically acquired orally and causes cold sores, HSV-2 is usually acquired during sexual contact and affects the genitals, however, either strain may affect either site. Some people are asymptomatic or have very mild symptoms. Those that do experience symptoms usually notice them 2 to 20 days after exposure which lasts 2 to 4 weeks. Symptoms can include small fluid-filled blisters, headaches, backaches, itching or tingling sensations in the genital or anal area, pain during urination, flu like symptoms, swollen glands, or fever. Herpes is spread through skin contact with a person infected with the virus. The virus affects the areas where it entered the body. This can occur through kissing, vaginal intercourse, oral sex or anal sex. The virus is most infectious during times when there are visible symptoms, however, those who are asymptomatic can still spread the virus through skin contact. The initial infection and symptoms are usually the most severe because the body does not have any antibodies built up. After the primary attack, one might have recurring attacks that are milder or might not even have future attacks. There is no cure for the disease but there are antiviral medications that treat its symptoms and lower the risk of transmission (Valtrex). Although HSV-1 is typically the "oral" version of the virus, and HSV-2 is typically the "genital" version of the virus, a person with HSV-1 orally CAN transmit that virus to their partner genitally. The virus, either type, will settle into a nerve bundle either at the top of the spine, producing the "oral" outbreak, or a second nerve bundle at the base of the spine, producing the genital outbreak.
  • The human papillomavirus (HPV) is the most common STI in the United States. There are more than 40 different strands of HPV and many do not cause any health problems. In 90% of cases, the body's immune system clears the infection naturally within two years. Some cases may not be cleared and can lead to genital warts (bumps around the genitals that can be small or large, raised or flat, or shaped like cauliflower) or cervical cancer and other HPV related cancers. Symptoms might not show up until advanced stages. It is important for women to get pap smears in order to check for and treat cancers. There are also two vaccines available for women (Cervarix and Gardasil) that protect against the types of HPV that cause cervical cancer. HPV can be passed through genital-to-genital contact as well as during oral sex. The infected partner might not have any symptoms.
  • Gonorrhea is caused by bacterium that lives on moist mucous membranes in the urethra, vagina, rectum, mouth, throat, and eyes. The infection can spread through contact with the penis, vagina, mouth, or anus. Symptoms of gonorrhea usually appear two to five days after contact with an infected partner however, some men might not notice symptoms for up to a month. Symptoms in men include burning and pain while urinating, increased urinary frequency, discharge from the penis (white, green, or yellow in color), red or swollen urethra, swollen or tender testicles, or sore throat. Symptoms in women may include vaginal discharge, burning or itching while urinating, painful sexual intercourse, severe pain in lower abdomen (if infection spreads to fallopian tubes), or fever (if infection spreads to fallopian tubes); however, many women do not show any symptoms. Antibiotic resistant strains of Gonorrhea are a significant concern, but most cases can be cured with existing antibiotics.
Secondary syphilis
  • Syphilis is an STI caused by a bacterium. Untreated, it can lead to complications and death. Clinical manifestations of syphilis include the ulceration of the uro-genital tract, mouth or rectum; if left untreated the symptoms worsen. In recent years, the prevalence of syphilis has declined in Western Europe, but it has increased in Eastern Europe (former Soviet states). A high incidence of syphilis can be found in places such as Cameroon, Cambodia, Papua New Guinea. Syphilis infections are increasing in the United States.
  • Trichomoniasis is a common STI that is caused by infection with a protozoan parasite called Trichomonas vaginalis. Trichomoniasis affects both women and men, but symptoms are more common in women. Most patients are treated with an antibiotic called metronidazole, which is very effective.
  • HIV (human immunodeficiency virus) damages the body's immune system, which interferes with its ability to fight off disease-causing agents. The virus kills CD4 cells, which are white blood cells that help fight off various infections. HIV is carried in body fluids and is spread by sexual activity. It can also be spread by contact with infected blood, breastfeeding, childbirth, and from mother to child during pregnancy. When HIV is at its most advanced stage, an individual is said to have AIDS (acquired immunodeficiency syndrome). There are different stages of the progression of and HIV infection. The stages include primary infection, asymptomatic infection, symptomatic infection, and AIDS. In the primary infection stage, an individual will have flu-like symptoms (headache, fatigue, fever, muscle aches) for about two weeks. In the asymptomatic stage, symptoms usually disappear, and the patient can remain asymptomatic for years. When HIV progresses to the symptomatic stage, the immune system is weakened and has a low cell count of CD4+ T cells. When the HIV infection becomes life-threatening, it is called AIDS. People with AIDS fall prey to opportunistic infections and die as a result. When the disease was first discovered in the 1980s, those who had AIDS were not likely to live longer than a few years. There are now antiretroviral drugs (ARVs) available to treat HIV infections. There is no known cure for HIV or AIDS but the drugs help suppress the virus. By suppressing the amount of virus in the body, people can lead longer and healthier lives. Even though their virus levels may be low they can still spread the virus to others.

Viruses in semen

Twenty-seven different viruses have been identified in semen. Information on whether or not transmission occurs or whether the viruses cause disease is uncertain. Some of these microbes are known to be sexually transmitted.

Pathophysiology

Many STIs are (more easily) transmitted through the mucous membranes of the penis, vulva, rectum, urinary tract and (less often—depending on type of infection) the mouth, throat, respiratory tract and eyes. The visible membrane covering the head of the penis is a mucous membrane, though it produces no mucus (similar to the lips of the mouth). Mucous membranes differ from skin in that they allow certain pathogens into the body. The amount of contact with infective sources which causes infection varies with each pathogen but in all cases, a disease may result from even light contact from fluid carriers like venereal fluids onto a mucous membrane.

Some STIs such as HIV can be transmitted from mother to child either during pregnancy or breastfeeding. Healthcare professionals suggest safer sex, such as the use of condoms, as a reliable way of decreasing the risk of contracting sexually transmitted infections during sexual activity, but safer sex cannot be considered to provide complete protection from an STI. The transfer of and exposure to bodily fluids, such as blood transfusions and other blood products, sharing injection needles, needle-stick injuries (when medical staff are inadvertently jabbed or pricked with needles during medical procedures), sharing tattoo needles, and childbirth are other avenues of transmission. These different means put certain groups, such as medical workers, and haemophiliacs and drug users, particularly at risk.

It is possible to be an asymptomatic carrier of sexually transmitted infections. In particular, sexually transmitted infections in women often cause the serious condition of pelvic inflammatory disease.

Diagnosis

World War II US Army poster warning of venereal disease

Testing may be for a single infection, or consist of a number of tests for a range of STIs, including tests for syphilis, trichomonas, gonorrhea, chlamydia, herpes, hepatitis, and HIV. No procedure tests for all infectious agents.

STI tests may be used for a number of reasons:

  • as a diagnostic test to determine the cause of symptoms or illness
  • as a screening test to detect asymptomatic or presymptomatic infections
  • as a check that prospective sexual partners are free of disease before they engage in sex without safer sex precautions (for example, when starting a long term mutually monogamous sexual relationship, in fluid bonding, or for procreation).
  • as a check prior to or during pregnancy, to prevent harm to the baby
  • as a check after birth, to check that the baby has not caught an STI from the mother
  • to prevent the use of infected donated blood or organs
  • as part of the process of contact tracing from a known infected individual
  • as part of mass epidemiological surveillance

Early identification and treatment results in less chance to spread disease, and for some conditions may improve the outcomes of treatment. There is often a window period after initial infection during which an STI test will be negative. During this period, the infection may be transmissible. The duration of this period varies depending on the infection and the test. Diagnosis may also be delayed by reluctance of the infected person to seek a medical professional. One report indicated that people turn to the Internet rather than to a medical professional for information on STIs to a higher degree than for other sexual problems.

Classification

A poster from the Office for Emergency Management, Office of War Information, 1941–1945

Until the 1990s, STIs were commonly known as venereal diseases, an antiquated euphemism derived from the Latin venereus, being the adjectival form of Venus, the Roman goddess of love. However, in the post-classical education era the euphemistic effect was entirely lost, and the common abbreviation "VD" held only negative connotations. Other former euphemisms for STIs include "blood diseases" and "social diseases". The present euphemism is in the use of the initials "STI" rather than in the words they represent. The World Health Organization (WHO) has recommended the more inclusive term sexually transmitted infection since 1999. Public health officials originally introduced the term sexually transmitted infection, which clinicians are increasingly using alongside the term sexually transmitted disease in order to distinguish it from the former.

Prevention

Strategies for reducing STI risk include: vaccination, mutual monogamy, reducing the number of sexual partners, and abstinence. Also potentially helpful is behavioral counseling for sexually active adolescents and for adults who are at increased risk. Such interactive counseling, which can be resource-intensive, is directed at a person's risk, the situations in which risk occurs, and the use of personalized goal-setting strategies.

The most effective way to prevent sexual transmission of STIs is to avoid contact of body parts or fluids which can lead to transfer with an infected partner. Not all sexual activities involve contact: cybersex, phone sex or masturbation from a distance are methods of avoiding contact. Proper use of condoms reduces contact and risk. Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom.

"Syphilis is a dangerous disease, but it can be cured". Poster encouraging treatment. Published between 1936 and 1938.

Both partners can get tested for STIs before initiating sexual contact, or before resuming contact if a partner engaged in contact with someone else. Many infections are not detectable immediately after exposure, so enough time must be allowed between possible exposures and testing for the tests to be accurate. Certain STIs, particularly certain persistent viruses like HPV, may be impossible to detect.

Some treatment facilities use in-home test kits and have the person return the test for follow-up. Other facilities strongly encourage that those previously infected return to ensure that the infection has been eliminated. Novel strategies to foster re-testing have been the use of text messaging and email as reminders. These types of reminders are now used in addition to phone calls and letters. After obtaining a sexual history, a healthcare provider can encourage risk reduction by providing prevention counseling. Prevention counseling is most effective if provided in a nonjudgmental and empathetic manner appropriate to the person's culture, language, gender, sexual orientation, age, and developmental level. Prevention counseling for STIs is usually offered to all sexually active adolescents and to all adults who have received a diagnosis, have had an STI in the past year, or have multiple sex partners.

Vaccines

Vaccines are available that protect against some viral STIs, such as hepatitis A, hepatitis B, and some types of HPV. Vaccination before initiation of sexual contact is advised to assure maximal protection. The development of vaccines to protect against gonorrhea is ongoing.

Condoms

Condoms and female condoms only provide protection when used properly as a barrier, and only to and from the area that they cover. Uncovered areas are still susceptible to many STIs.

In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin; therefore, properly shielding the penis with a properly worn condom from the vagina or anus effectively stops HIV transmission. An infected fluid to broken skin borne direct transmission of HIV would not be considered "sexually transmitted", but can still theoretically occur during sexual contact. This can be avoided simply by not engaging in sexual contact when presenting open, bleeding wounds.

Other STIs, even viral infections, can be prevented with the use of latex, polyurethane or polyisoprene condoms as a barrier. Some microorganisms and viruses are small enough to pass through the pores in natural skin condoms but are still too large to pass through latex or synthetic condoms.

Proper male condom usage entails:

  • Not putting the condom on too tight at the tip by leaving 1.5 centimetres (0.6 in) room for ejaculation. Putting the condom on too tightly can and often does lead to failure.
  • Wearing a condom too loose can defeat the barrier
  • Avoiding inverting or spilling a condom once worn, whether it has ejaculate in it or not
  • If a user attempts to unroll the condom, but realizes they have it on the wrong side, then this condom may not be effective
  • Being careful with the condom if handling it with long nails
  • Avoiding the use of oil-based lubricants (or anything with oil in it) with latex condoms, as oil can eat holes into them
  • Using flavored condoms for oral sex only, as the sugar in the flavoring can lead to yeast infections if used to penetrate

In order to best protect oneself and the partner from STIs, the old condom and its contents are to be treated as infectious and properly disposed of. A new condom is used for each act of intercourse, as multiple usages increase the chance of breakage, defeating the effectiveness as a barrier.

In the case of female condoms, the device consists of two rings, one in each terminal portion. The larger ring should fit snugly over the cervix and the smaller ring remains outside the vagina, covering the vulva. This system provides some protection of the external genitalia.

Other

The cap was developed after the cervical diaphragm. Both cover the cervix and the main difference between the diaphragm and the cap is that the latter must be used only once, using a new one in each sexual act. The diaphragm, however, can be used more than once. These two devices partially protect against STIs (they do not protect against HIV).

Researchers had hoped that nonoxynol-9, a vaginal microbicide would help decrease STI risk. Trials, however, have found it ineffective and it may put women at a higher risk of HIV infection. There is evidence that vaginal dapivirine probably reduces HIV in women who have sex with men, other types of vaginal microbicides have not demonstrated effectiveness for HIV or STIs.

There is little evidence that school-based interventions such as sexual and reproductive health education programmes on contraceptive choices and condoms are effective on improving the sexual and reproductive health of adolescents. Incentive-based programmes may reduce adolescent pregnancy but more data is needed to confirm this.

Screening

Specific age groups, persons who participate in risky sexual behavior, or those have certain health conditions may require screening. The CDC recommends that sexually active women under the age of 25 and those over 25 at risk should be screened for chlamydia and gonorrhea yearly. Appropriate times for screening are during regular pelvic examinations and preconception evaluations. Nucleic acid amplification tests are the recommended method of diagnosis for gonorrhea and chlamydia. This can be done on either urine in both men and women, vaginal or cervical swabs in women, or urethral swabs in men. Screening can be performed:

  • to assess the presence of infection and prevent tubal infertility in women
  • during the initial evaluation before infertility treatment
  • to identify HIV infection
  • for men who have sex with men
  • for those who may have been exposed to hepatitis C
  • for HCV

Management

In the case of rape, the person can be treated prophylacticly with antibiotics.

An option for treating partners of patients (index cases) diagnosed with chlamydia or gonorrhea is patient-delivered partner therapy, which is the clinical practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner. In term of preventing reinfection in sexually transmitted infection, treatment with both patient and the sexual partner of patient resulted in more successful than treatment of the patient without the sexual partner. There is no difference in reinfection prevention whether the sexual partner treated with medication without medical examination or after notification by patient.

Epidemiology

Age-standardized, disability-adjusted life years for STIs (excluding HIV) per 100,000 inhabitants in 2004.
STI (excluding HIV) deaths per million persons in 2012
  0-0
  1-1
  2–3
  4–9
  10–18
  19–31
  32–55
  56–139

In 2008, it was estimated that 500 million people were infected with either syphilis, gonorrhea, chlamydia or trichomoniasis. At least an additional 530 million people have genital herpes and 290 million women have human papillomavirus (HPV). STIs other than HIV resulted in 142,000 deaths in 2013. In the United States there were 19 million new cases of sexually transmitted infections in 2010.

In 2010, 19 million new cases of sexually transmitted infections occurred in women in the United States. A 2008 CDC study found that 25–40% of U.S. teenage girls has a sexually transmitted infection. Out of a population of almost 295,270,000 people there were 110 million new and existing cases of eight sexually transmitted infections.

Over 400,000 sexually transmitted infections were reported in England in 2017, about the same as in 2016, but there were more than 20% increases in confirmed cases of gonorrhoea and syphilis. Since 2008 syphilis cases have risen by 148%, from 2,874 to 7,137, mostly among men who have sex with men. The number of first cases of genital warts in 2017 among girls aged 15–17 years was just 441, 90% less than in 2009 – attributed to the national HPV immunisation programme.

AIDS is among the leading causes of death in present-day Sub-Saharan Africa. HIV/AIDS is transmitted primarily via unprotected sexual intercourse. More than 1.1 million persons are living with HIV/AIDS in the United States, and it disproportionately impacts African Americans. Hepatitis B is also considered a sexually transmitted infection because it can be spread through sexual contact. The highest rates are found in Asia and Africa and lower rates are in the Americas and Europe. Approximately two billion people worldwide have been infected with the hepatitis B virus.

History

World War II-era British poster urging men to be tested for sexually transmitted infections before marriage

The first well-recorded European outbreak of what is now known as syphilis occurred in 1494 when it broke out among French troops besieging Naples in the Italian War of 1494–98. The disease may have originated from the Columbian Exchange. From Naples, the disease swept across Europe, killing more than five million people. As Jared Diamond describes it, "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months," rendering it far more fatal than it is today. Diamond concludes,"[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today." Gonorrhea is recorded at least up to 700 years ago and associated with a district in Paris formerly known as "Le Clapiers". This is where the prostitutes were to be found at that time.

U.S. propaganda poster targeted at World War II servicemen appealed to their patriotism in urging them to protect themselves. The text at the bottom of the poster reads, "You can't beat the Axis if you get VD".

Prior to the invention of modern medicines, sexually transmitted infections were generally incurable, and treatment was limited to treating the symptoms of the infection. The first voluntary hospital for STIs was founded in 1746 at London Lock Hospital. Treatment was not always voluntary: in the second half of the 19th century, the Contagious Diseases Acts were used to arrest suspected prostitutes. In 1924, a number of states concluded the Brussels Agreement, whereby states agreed to provide free or low-cost medical treatment at ports for merchant seamen with STIs. A proponent of these approaches was Nora Wattie, OBE, Venereal Diseases Officer in Glasgow from 1929, encouraged contact tracing and volunteering for treatment, rather than the prevailing more judgemental view and published her own research on improving sex education and maternity care.

The first effective treatment for a sexually transmitted infection was salvarsan, a treatment for syphilis. With the discovery of antibiotics, a large number of sexually transmitted infections became easily curable, and this, combined with effective public health campaigns against STIs, led to a public perception during the 1960s and 1970s that they have ceased to be a serious medical threat.

During this period, the importance of contact tracing in treating STIs was recognized. By tracing the sexual partners of infected individuals, testing them for infection, treating the infected and tracing their contacts, in turn, STI clinics could effectively suppress infections in the general population.

In the 1980s, first genital herpes and then AIDS emerged into the public consciousness as sexually transmitted infections that could not be cured by modern medicine. AIDS, in particular, has a long asymptomatic period—during which time HIV (the human immunodeficiency virus, which causes AIDS) can replicate and the disease can be transmitted to others—followed by a symptomatic period, which leads rapidly to death unless treated. HIV/AIDS entered the United States from Haiti in about 1969. Recognition that AIDS threatened a global pandemic led to public information campaigns and the development of treatments that allow AIDS to be managed by suppressing the replication of HIV for as long as possible. Contact tracing continues to be an important measure, even when diseases are incurable, as it helps to contain infection.

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