It's Monday morning, the start of a new day, a new week. Across the city, people are waking up, and, in some cases, to rude surprises.

Keisha is 21 and had a restless night. She has intense, crampy pain below her belly button which is now becoming more noticeable on her left side. At first, she thought it might have been something she ate, but in talking it over with her cousin, a nurse, she did not have another of the other symptoms of food-poisoning such as diarrhea or vomiting.  Her cousin did not think it was appendicitis either, since the appendix is usually located on the right side. She advised Keisha to call her doctor.

James is 17 and discovers greenish discharge on his underwear when he wakes up. When he goes to the bathroom to urinate, he feels an uncomfortable burning sensation. He is worried, but too embarrassed to talk to his mother. Then he remembered that a friend of his told him about a program called Project STAY. Their health educators  showed a video at a health fair he went to about the need to get regular check-ups for sexually-transmitted infections. His friend went to their clinic for a check-up to make sure he was ok. James pulls out his cell phone and sends a text to his friend to get the phone number for the clinic to make an appointment.

Rafael is 30, and while washing his face in the sink, noticed several circles on the palms of his hands. He tries scrubbing them out with different soaps, but nothing seems to work. When he removes his shirt to take a shower, he sees a rash all over his chest and back. Alarmed, he takes a picture of the circles and the rash with his cell phone, and sends them to his brother who works for the Department of Health. He gets a response back encouraging him to go to the Central Harlem STD clinic for an evaluation.

Rebekah, 19, is away upstate at college and has just pulled an all-nighter, cramming for an exam. She gets out of the shower, and checks her email before heading out to class.  There is an "E-card" from something called "In spot.org". When she opens the E-card, she reads a message that says "I'm sorry. I didn't know I had an infection when we got together. You should get checked out".  Rebekah slumps back down in her chair, and buries her head in hands. "I don't need this, especially right before a test! What are they talking about? I feel fine" Shaking her head, she grabs her books, and makes a mental note to visit the college health center right after her test.

April is STD Awareness Month, and we urge everyone to learn the basic facts about sexually-transmitted diseases - What are the most common signs and symptoms? What tests are available for detection? Where can I go for treatment? What can I do to keep myself (and my partner/s) safe?  [For a list of good website resources, or telephone numbers, see resources]. Over 15 million people in the United States will become infected with one or more sexually-transmitted diseases each year. The fiscal price tag for treatment of these diseases (and their complications) run into the billions of dollars. The emotional price tag of contracting an infection which, in some cases may last a lifetime, is incalculable.

Keisha went to her doctor and was found to have pelvic inflammatory disease (PID),  a condition commonly caused, in her case, by Chlamydia. Over 59,000 New Yorkers were infected with Chlamydia last year. Left untreated, the infection can cause scarring in the fallopian tubes of a woman which may later be associated with ectopic pregnancies or infertility. In men, Chlamydia can cause pain and swelling in the testicles, and can also lead to infertility. However, very often, there are No symptoms for this disease, as was the case with her partner when she told him. Keisha was given antibiotics, monitored closely, and recovered. Her partner was also treated. They were both also tested for HIV, which was negative.

James came in to the Project STAY clinic at the Farrell Community Health Care Center on 158th Street and Riverside Drive. He was evaluated thoroughly and found to have Gonorrhea. Over 10,000 New Yorkers were infected with gonorrhea last year. Problems associated with Gonorrhea are very similar to Chlamydia, and often the two infections are found together in the same person. While James had obvious signs of the infection, many people with Gonorrhea have NO symptoms.  A simple uurine test diagnosed his condition, and he received treatment for the infection. Later, he brought his current and former girlfriends in to the clinic, at different times, for treatment. All had negative HIV tests, and received extensive counseling about condoms and safer sex.

Rafael underwent a series of tests at the Central Harlem STD Clinic. His evaluation for Chlamydia and Gonorrhea were negative, but his blood test for Syphilis showed that he had been exposed. Over 4,000 New Yorkers were infected with Syphilis last year. While sores (chancres) on the tongue, penis, vagina or anus are common signs, along with a rash in the later stages of infections, many individuals infected with syphilis have NO symptoms. While the infection is easily cured with one or more shots of penicillin, left undiagnosed and untreated, syphilis can cause damage of almost every organ in the body, and can lead to death. In Rafael's case, the syphilis was easily managed; however, his HIV test revealed that he had also been infected with HIV, as well. The Central Harlem HIV Clinic [hyperlink here] arranged for Rafael to be referred to a HIV  treatment clinic at a local hospital. Based on further testing, it was recommended to Rafael that he start treatment for HIV. Due to new advances, he was able to select a treatment plan wherein he had to only take 1 pill a day (as compared to a dozen or more if he had been diagnosed 10 years ago). Within 1 month, the levels of virus in his body were found to be at "undetectable" levels. However, Rafael will need to be on treatment for the remainder of his life in order to keep the virus under control. Rafael gave the Health department the names of all the partners he could remember being with over the past year,  so that they could be contacted and offered screening and treatment services.

After her chemistry exam, Rebekah had an exam of a different type at the college health service. All her tests were negative. She exhaled a sigh of relief. The nurse-practitioner encouraged her to consider getting vaccinated to prevent acquiring a type of virus (HPV- Human Papilloma Virus) that could lead to cervical cancer, a condition that kills over 3,500 women annually. Rebekah rolled up her sleeve quickly, "Let's do this", she said.

Sexually transmitted infections (STIs) are common and can have serious and potentially deadly consequences. Learn the facts, get tested, and get treated. Protect yourself and your partners. The Harlem Health Promotion Center has teamed up with the Healthy Monday Campaigns. Healthy Monday, an initiative conceived by Sid Lerner, encourages consumers to get their week off to a good start by engaging in health promoting behaviors. Specifically related to sexual health, two initiatives have been developed called "Check Yourself Mondays" and "Re-stock Mondays". Check Yourself Mondays, encourages consumers to make appointments with their health providers to get evaluated for a variety of health conditions, including STIs and HIV. For a listing of free clinics in NYC run by the New York City Department of Health and Mental Hygiene, click here.

For a listing of clinics providing services specifically to adolescents and young adults, click here.

Re-stock Mondays, encourages consumers to remember to pick up condoms and contraceptive methods from their local drugstores, clinics or health providers.

For more information about Healthy Monday, log on to: http://www.HealthyMonday.org

Alwyn Cohall MD, is Professor of Clinical Public Health and Pediatrics at the Mailman School of Public Health and New York Presbyterian Hospital. He is the Director of the Harlem Health Promotion Center (one of 37 Prevention Research Centers funded by the Centers for Disease Control and Prevention) and Project STAY  (a Specialized Care Center funded by the New York State Department of Health's AIDS Institute). He is also a member of the National Chlamydia Coalition, a network of organizations supported by the CDC, to increase awareness about Chlamydia and other STIs. To contact Dr. Cohall for more information, use the following email: atc1@columbia.edu

For more information on STDs, visit:
http://www.plannedparenthood.org/health-topics/stds-hiv-safer-sex-101.htm

To learn more about STD testing, visit:

http://www.sexetc.org/page/get_tested/ or

http://www.plannedparenthood.org/health-topics/stds-hiv-safer-sex/std-testing-21695.htm

To find free and confidential clinics in New York City, visit:

http://www.nyc.gov/html/doh/html/std/std2.shtml or you can call 311 to request information.

For more information download ASHA's STD Fact Sheets in pdf format at
http://www.ashastd.org/news/news_factsheets.cfm.

Also visit ASHA's STD Message Board Forums online at
http://www.ashastd.org/phpbb/ for support and information.

If you are between 13-24, and want to find out more about getting tested for sexually-transmitted infections and HIV at Project STAY, call 646-319-4998 or visit http://www.projectstay.net

If you are a young man between 13-35 and want to find out more about getting tested for sexually-transmitted infections and HIV at the Young Men's Clinic, visit:
http://www.youngmensclinic.org

Nationwide, you can text your zip code to KnowIT (566984), or visit hivtest.org.

NYC Teen Health, a place for teens to get straightforward and accurate health information:

http://www.nyc.gov/html/doh/html/std/teenhealth.shtml