Sexual infections: where can you get infected? A detailed guide for men and women: how to protect yourself from contracting sexually transmitted infections (during sex) Can you get an infection with dirty hands?

Dark red stripes running from the wound to the heart are a characteristic sign of blood poisoning.

A person is surrounded by a huge number of pathogens of various diseases. They are present in the air, in the ground, on the things we use. Of course, healthy skin is a barrier to the penetration of pathogens. But if the skin is damaged, there are wounds, cracks, ulcers, then this is an excellent opportunity for infection. Infectious agents enter the wound at the time it is received or can be brought in by dirty hands, in contact with non-sterile dressing material, or in contact with insects (flies). The pathogens, once in the human body, cause infectious inflammation. However, the body of a healthy person is able to defend itself against infectious agents that have entered it, destroy them and the poisons they secrete. This important protective function in the body is performed by leukocytes (white blood cells) and specific protective substances formed in the blood plasma (antibodies). There is a certain type of white blood cell that “devours” invading pathogens. They are called macrophages (killer cells). Substances produced by the immune system neutralize infectious agents or prevent their further reproduction. Thus, pathogens that enter the body can cause an infection if there are a lot of them and the immune system is not able to resist them, or when the immune system is completely weakened. The period from the moment pathogens enter the human body until the first signs of the disease appear is called the incubation period.

What types of wound infections are there?

• purulent inflammation of the wound,
• blood poisoning (sepsis),
• tetanus (tetany),
• gas gangrene,
• erysipelas on the wound,
• rabies.

Purulent wound:

The first signs of inflammation appear 12-24 hours after pathogens enter the human body. The wound and the tissue around it turn red as blood flow increases. The wound may feel burning and the body temperature may rise. Damaged tissues swell, so the nerves are pinched and pain occurs. The leukocytes that play a protective role die and, together with the destroyed tissue cells, form pus. Foci of infection are suppressed much faster in tissues that are well supplied with blood. Therefore, purulent infections on the head or neck appear less frequently than on the lower leg or foot. Any wound can become infected, but not every wound will fester. First, the microbes adapt to the wound and after about 6 hours they begin to multiply. The danger of suppuration depends on the nature and location of the wound. Newborn children and the elderly are more susceptible to purulent infection.

Blood poisoning:

A particular danger with a purulent wound is blood poisoning (sepsis). With sepsis, bacteria and the poisons (toxins) they secrete enter the bloodstream and then into all organs. Infectious agents (most often streptococci and staphylococci) spread throughout the body. They act on the lymphatic vessels, which causes their inflammation.

General infection of the body:

Lymph nodes are the last defensive “bastion” that protects the body from infectious agents. Pathogens enter the lymph nodes and enter the circulatory system, causing a severe general infection of the body. With sepsis, the patient's temperature rises, chills, headache, nagging pain in the extremities, general weakness, pulse and breathing increase, and appetite decreases. If the patient does not consult a doctor in a timely manner, his life may be in danger.

Pay attention to the appearance of the wound:

Wound infections may be obvious or subtle. For example, with tetanus and rabies, the wound does not change externally. With other diseases, changes in the wound are possible - the appearance of swelling or pus.

Pus:

Pus is a viscous yellowish or greenish liquid with an unpleasant odor. The composition of pus includes dead blood leukocytes, fragments of dead tissue and lymph.

Tetanus:

The vaccination course consists of intramuscular injections of toxoid.

Tetanus (lat. tetanus) is an acute infectious disease caused by clostridia found in soil and dust. These bacteria do not cause inflammation of the wound at the site of their entry into the body, therefore, with tetanus there are no early symptoms of the disease. The first symptoms appear only after 3-14 days after infection (less often from several hours to 30 days), i.e. at the end of the incubation period. The patient begins to have convulsions, first the masticatory muscles contract convulsively, then the convulsions gradually cover other muscles of the body. Muscle spasms are caused by any irritant. The bacterial venom attacks the nerves that innervate the respiratory muscles. A common cause of death in tetanus is suffocation caused by spasms of the respiratory muscles. The mortality rate reaches 60%. With preventive vaccination, this disease can be avoided. A vaccine made from tetanus toxins is injected into the gluteal muscles three times at regular intervals. Usually, if there are no contraindications, all children are vaccinated. For this purpose, a complex vaccine against pertussis, diphtheria and tetanus (DPT) is used.

Gas gangrene:

Gas gangrene is a dangerous wound infection caused by anaerobes living in soil and dust. Once in the wound, they penetrate into its deep layers. The causative agents of anaerobic gas gangrene are able to live and reproduce only in an oxygen-free environment, so crushed or bruised tissues, to which the flow of oxygenated blood is stopped as a result of damage to the blood vessels, are most susceptible to infection. During the metabolic process, the causative agents of the disease emit toxic gas, which causes an increase in pressure in the tissues, resulting in compression of the blood vessels in the wound area. Blood circulation in the wound area worsens, oxygen supply to the affected part decreases. These are excellent conditions for the spread of pathogens, so the affected tissues die and decompose after some time without the formation of pus.

Gas bubbles:

The swelling of some parts of the wound and the tightness of the skin can suggest the presence of gas gangrene. Gas bubbles form in the affected tissues; when pressing on the swollen tissues, a characteristic creaking sound is heard. The wound area becomes pale yellow, then red or blue-red, but as the process progresses, the pain goes away completely. The patient’s well-being worsens due to the multiplication of pathogens and the release of toxins into the blood, which are carried throughout the body.

You need to act quickly:

At the slightest symptom of gas gangrene, you should immediately go to the hospital. The doctor will make a wide incision and debride the wound, ensuring air access to the wound. After treating the wound, the patient is prescribed antibiotics, given oxygen, and other treatment methods, for example, hyperbaric oxygen therapy. If gangrene cannot be stopped, the affected limb must be amputated.

Rabies:

Rabies is a viral infection that affects the central nervous system and is transmitted through the bite or scratch of a sick domestic or wild animal. The appearance of the wound does not change when pathogens penetrate, and the incubation period can last up to a year, so if you suspect a bite from a rabid animal, consult a doctor immediately. The doctor will administer a serum that will protect against the disease. People who are in constant contact with animals should be vaccinated against rabies as a preventive measure.

Erysipelas:

Erysipelas is an infectious disease caused by streptococcus, characterized by increased body temperature and inflammation, mainly of the skin. Pathogens enter the lymphatic vessels through fresh or old lesions on the skin. Symptoms of the disease: redness of the wound tissue with clear boundaries, pain when touched, high fever, chills. To avoid blood poisoning, you should immediately consult a doctor who will prescribe penicillin or another antibiotic. Improper treatment of a disease caused by wound infection can cause great harm to a person and even pose a danger to his life. It is necessary to urgently call an ambulance (ambulance) or take the victim to the hospital. Often only a doctor can provide qualified assistance. However, Rozha is successfully treated with ancient spells and herbs. And often only healers can control this disease. From time immemorial, “grandmothers” cured soldiers from the field of severe wounds. This phenomenon still cannot be explained by traditional medicine.

ON A NOTE:

Can you get genital herpes if you sit on the toilet in a public restroom and accidentally touch it with your penis? Dermatovenerologist Oksana Zagortseva answers this and some other intimate questions.

Genital herpes is characterized by a contact mechanism of transmission of infection, but it usually occurs during sexual intercourse. Infection also occurs in newborns during childbirth from the mother.

Herpes simplex virus type 1-2 can persist for some time on the mucous membranes of the urethra, vagina, in the blood and urine. Thus, the possibility of contracting genital herpes in a public toilet exists, but it is extremely small.

If I have sex with my wife on the first or second day after her period ends, then the glans of my penis directly “corrodes”. Red spots appear on it and it stings. It goes away quickly, and on other days there is no such effect. What could it be?

Artem N., Samara

During menstruation, women often experience an exacerbation of the chronic inflammatory process in the uterus. Depending on the nature of the infectious agent and the state of the body’s defenses, both women and men, the clinical manifestations of the infection can be very diverse, including those described in the question. A woman needs to be examined for sexual and non-genital infections (this is PCR diagnostics, bacterial culture, smear for vaginal flora), preferably immediately after the end of menstruation.

I am undergoing treatment for trichomoniasis, they told me to avoid salty, spicy foods, alcohol, and stop sexual activity. Question: Is it possible to masturbate?

Nikolay P., Smolensk

During masturbation, there is an active flow of blood into the vessels of the genital organs. The inflammatory process (in this case caused by trichomoniasis) is also accompanied by blood overflow and dilation of the blood vessels of the urethral mucosa. This means that any sexual stimulation can slow down the healing process.

I have a regular sexual partner, with whom I have been having sex without protection for a year now. Recently it turned out that he has casual sex and uses a condom to protect himself. It just kills me that he doesn’t see anything criminal in this. Write what diseases are sexually transmitted, despite the use of a condom, and how much does he risk becoming infected himself and infecting me?

Nina S., St. Petersburg

There are many sexually transmitted diseases:

1. Bacterial infections - these include chlamydia, mycoplasma, ureaplasma, gonorrhea, syphilis, chancroid, donovanosis.

2. Caused by protozoa and fungi: trichomoniasis, candidiasis.

3. Viral - herpes, human papillomavirus and genital warts, molluscum contagiosum, HIV, cytomegalovirus, viral hepatitis (A, B, C).

It must also be remembered that all types of bacteria and viruses affect the mucous membranes of both the genitourinary organs and the oral cavity, the conjunctiva of the eyes and remain for some time in saliva, semen, and secretions of the genitourinary organs. Thus, the risk of contracting all of the listed infections during casual sexual intercourse, even using a condom, is quite high.

Tell me, where could I get infected with such infections as ureaplasma and gardnerella, if I have had a regular partner for about 3 years, and I am confident in my partner? Is it possible to become infected not through sexual contact, but through household means?

Alla B., Chelyabinsk region.

Ureaplasma and gardnerella are causative agents of sexually transmitted infections. The question of where the infection came from in a woman if she has had a regular partner for about 3 (or more) years naturally arises.

But the infection could enter the woman’s genital tract not necessarily in those years that she indicates as “years of a reliable partnership,” but much earlier, perhaps at the very beginning of sexual life (and this, unfortunately, happens in recent years, even at 14- 15 years, when the period of puberty of the female body has not yet ended and there are no reliable immune barriers against infection).

As for the examination for infections, which may have been carried out previously in the woman who asked this question, the result of such an examination (under the unconditional condition of its reliable quality) largely depends on what day of the menstrual cycle it was carried out.

If there are no clinical manifestations of infection, then it is better to carry out it 3-5 days before menstruation, or immediately after its end (plus after food challenge the day before). Otherwise, even if infection is present, the infectious agent may not be identified.

In addition, ureaplasmosis, for example, like many other sexually transmitted infections, very often occurs in a woman’s body unnoticed, without pronounced clinical symptoms. In this case, a woman may not even suspect that she is sick and can infect her sexual partner (with some infections this equally applies to a man).

From the above it follows that a proper comprehensive examination of both sexual partners is necessary. If one person is confirmed infected, both should be treated together.

Gardnerellosis is often a marker of dysfunction and microecology of the vagina. Thus, activation of gardnerella always occurs when the acidity of the vaginal contents is disturbed. This happens when other pathogenic microorganisms appear in the vagina, with a reduced content of female sex hormones (estrogens), or with improper vaginal hygiene.

Elimination of these factors - curing pathogenic microflora, normalizing hormonal relationships in the body - leads to the elimination of clinical signs of gardnerellosis.

Many factors can play a role in the occurrence of vaginal infections and discharge. What can you do to reduce your risk of vaginal infections? By practicing the tips below you can significantly reduce your risk of contracting vaginal infections:

1. Always wear cotton underwear. Cotton allows the genitals to breathe, thereby helping them stay dry at all times. It's also a good idea to only wear panties during the day and not at night when the body is resting. Wearing underwear at night can contribute to poor blood flow.

2. Try to get as much air exposure to your intimate area as possible. For example, sleeping naked or walking around your house without underwear. The air will help keep your skin dry, thereby protecting it from infections. This method can sometimes even solve the problem itself if your body has a normal bacterial imbalance, as it will give your body a chance to recover.

4. Rarely use petroleum jelly or oils for vaginal lubrication. This can create a breeding ground for the proliferation of pathogenic bacteria.

5. When treating a vaginal infection, you must strictly follow your doctor's instructions and take all prescribed medications. Therefore, it is best to discuss medications and their prices in the doctor’s office, so that you do not have the desire to voluntarily refuse treatment due to the high cost of the medicine. Remember, in Russia we have excellent analogues of foreign medicines at reasonable prices.

6. Do not have sex while treating a vaginal infection. Wait until the symptoms of the disease go away.

7. Avoid frequent use of intimate hygiene products, which may irritate the vagina, such as scented deodorants, gels, soaps, lotions and bubble baths, etc.

8. Try not to wear tight clothes, for example, sportswear, or tights, for a long period of time.

9. Avoid staying in wet swimsuits for long periods of time, clothes, as bacteria love damp places.

10. Change your underwear every day, This way you prevent pathogenic bacteria from entering the vagina.

11. Vaginal infections cause severe itching, so try not to itch. It’s easy to introduce an infection into scratches on an intimate part of the body with dirty hands, and the inflamed areas will take much longer to heal.

12. If the menstrual cycle begins at a time As treatment for a vaginal infection is carried out, you can continue treatment during this period, but you should stop using tampons - use pads instead. (You can read the article on this topic: Thrush and Menstruation: Why do women get candidiasis before menstruation?).

13. If you are treating a vaginal infection on your own and the condition has not improved, See your doctor for a medical examination. Do not use intimate hygiene products or medications 48 hours before performing any necessary procedures prescribed by your doctor.

14. Always use condoms during intercourse unless you are in a long-term relationship.

15. Drink enough fluids. This can help flush out the urinary tract to prevent vaginal infection. If your urine is light yellow or lighter, then you are drinking enough water per day.

16. Keep your private parts clean. However, in this situation it is better not to overdo it, i.e. do not use intimate hygiene products. If you need to wash an intimate part of the body, then use a chamomile decoction. Always wipe from front to back after urinating or having a bowel movement. If you don't wipe your intimate area properly, you can easily transfer harmful bacteria into the vagina, which can lead to vaginal infection and discharge.

18. If you have diabetes, try to keep your blood sugar levels under control.

19. Use harmless laundry detergents. You can add an extra rinse cycle at the end of the wash if the detergent irritates your skin.

20. If you smoke, try to quit. Smoking makes you more prone to vaginal infections. This habit is also harmful to the unborn child.

Of course, it is necessary to maintain basic hygiene, get a good night's sleep, and eat a balanced diet with appropriate fluid intake (very interesting article Foods to eat if you have thrush), these simple principles contribute to good health and well-being.

The information on the site is provided for informational purposes only. IT IS NOT INTENDED TO PROVIDE MEDICAL CARE. The author is not responsible for the possible consequences of treatment, procedures, exercises, diet, influence or use of drugs contained on the site. The publication of this information does not replace the advice of your doctor or other health care providers. The reader should consult a physician or other health care professional before undertaking any treatment.

Contents:

How do you know if there is a risk of contracting sexually transmitted infections?

One of the main problems of sexual relations in the modern world is the risk of contracting various sexually transmitted infections. Currently, there are many known infections that can be contracted during vaginal, oral or anal sex. Some of these infections pose a serious threat to human health, cannot be treated and can lead to death.

Many sexually transmitted infections do not have any external manifestations, that is, they can occur in people who look completely normal and healthy. Moreover, many people infected with sexually transmitted infections do not even suspect that they are infected and do not know that they infect other people during sex.

Gonorrhea is one of the most common sexually transmitted diseases in the world. In women, gonorrhea can cause chronic inflammation of the fallopian tubes, which in turn significantly increases the risk of infertility or ectopic pregnancy. In men, gonorrhea can cause severe narrowing of the urethra and inflammation of the prostate gland (prostatitis). In rare cases, meningitis, joint damage (arthritis), and inflammation of the eyes are possible against the background of gonorrhea. Gonorrhea responds well to antibiotic treatment.

Trichomoniasis- an extremely common sexually transmitted infection. Every year, more than 100 million new cases of this disease are registered worldwide. In women and men, trichomoniasis can cause long-term inflammation of the genital organs and infertility. Trichomoniasis responds well to antibiotic treatment.

Syphilis is a very dangerous sexually transmitted infection that develops over a long period of time and can lead to serious damage to internal organs several years after infection. In pregnant women, syphilis can cause serious problems with fetal development. Syphilis responds well to antibiotic treatment .

Viral hepatitis B and C is a highly contagious and extremely dangerous infection that leads to long-term inflammation of the liver tissue and increases the risk of developing liver cancer. Hepatitis B and C are not always treatable.

Chlamydia, Ureaplasmosis, Mycoplasmosis– a group of extremely common sexually transmitted infections that can cause long-term inflammation of the genital organs in men and women and lead to infertility or complications during pregnancy. These infections respond well to antibiotic treatment. Read more about.

Human papillomavirus(HPV, human papillomavirus infection) is an extremely common infection that can be found in the body of many young people who are sexually active. Some types of HPV can cause cervical cancer or laryngeal cancer.

How great is the risk of infection?

It is almost impossible to accurately calculate the risk of contracting a particular infection. This is due to the fact that in the process of infection, an important role is played not only by the presence of infection in the body of a sick person, but also by the susceptibility to infection of his partner, as well as many other factors that will be discussed below.

For some infections, the risk of infection is calculated statistically.

For example, the probability of contracting HPV during unprotected sex with a carrier of the infection is about 75%.

The probability of a man getting infected from a woman with gonorrhea is about 20% in the case of 1 sexual intercourse and more than 80% in the case of 4 or more sexual intercourses. At the same time, the probability of a woman becoming infected from a man with gonorrhea is about 70% per sexual contact.

Factors that increase the risk of infection during sex

During unprotected vaginal or anal sex, the risk of transmission of infection increases significantly if:

• One or both partners suffer from another genital tract infection, which causes inflammation of the genital organs and makes the body less resistant to new infections. For example, patients with trichomoniasis have a significantly higher risk of contracting HIV than healthy people.
• During hard sexual intercourse, the mucous membrane of the vagina, cervix or rectum, and penis were injured (usually this is evidenced by bleeding after sex).

During unprotected oral sex, the risk of transmission of infection increases significantly if:

• The partner performing oral sex has bites, cuts, or sores in the mouth;
• Ejaculation occurs in the mouth.

Is it possible to get sexually transmitted infections without sex?

Yes, contracting many of the above sexually transmitted infections is possible without sexual contact, so identifying a sexually transmitted infection in your partner cannot be considered an indisputable sign of infidelity.

• Syphilis and gonorrhea are transmitted sexually in the vast majority of cases. Infection with these infections through household contact is extremely unlikely.
• Trichomoniasis can be contracted while visiting a public swimming pool.
• Chlamydia, mycoplasmosis and ureaplasmosis can pass into the human body at birth, from the body of a sick mother.
• Herpes and HPV can enter the human body during normal household contact.
• The hepatitis B virus and HIV can be introduced into the human body during blood transfusion, as well as through various surgical procedures (injections, tooth extraction, operations on internal organs).

How to protect yourself from sexually transmitted infections?

There are several methods of protecting yourself from sexually transmitted infections:

Using precautions

One of the most accessible and effective methods of protection against contracting sexually transmitted infections during vaginal, oral and anal sex is the use of condoms.

Spermicides – have only a limited effect on pathogens of sexually transmitted infections and therefore cannot be used as a reliable means of protection.

The use of birth control pills reliably protects against unwanted pregnancy, but does not protect against sexually transmitted infections. Therefore, for reliable protection, use both birth control pills and condoms at the same time.

What to do if the condom slips or breaks during sex?

The likelihood of a condom breaking is approximately 3-14% with vaginal sex and slightly higher with anal sex.

If the condom slips or breaks during sex, you should assume that the protection against unwanted pregnancy and infections is zero.

As soon as you notice that the condom has broken or slipped, do the following:

For a man:

• Wash your penis thoroughly with warm water and soap
• Monitor your health and the condition of your penis over the next few weeks. If you experience discharge from the penis, itching or burning when urinating, ulcers or redness on the penis, you should consult a doctor.
• If you suspect that your partner could be a carrier of a sexually transmitted infection, consult a doctor.
• In order to find out whether you have contracted the infection, your doctor will prescribe special tests for you. Early detection of infection can be very important to successfully treat it and prevent further spread.

For woman:

• Wash your external genitalia thoroughly with warm water and soap.
• If you have spermicide, you can insert it into the vagina, but this does not guarantee protection against pregnancy or infections
• Monitor your well-being and the condition of your genitals over the next few weeks. If you experience vaginal discharge, itching or burning during urination, ulcers or redness in the labia and vaginal opening, you should consult a doctor (see also).
• If you suspect that your partner could be a carrier of a sexually transmitted infection, consult a doctor. In order to find out whether you have contracted the infection, your doctor will prescribe special tests for you. Early detection of infection can be very important to successfully treat it and prevent further spread.

Vaccinations

Vaccinations help provide reliable protection against some sexually transmitted infections.

Vaccinations against hepatitis B and human papillomavirus are currently available.

If you don't know whether you have received these vaccinations, be sure to ask your doctor and get the vaccinations if you do not have them.

Limiting the circle of sexual partners and excluding casual sex

Limiting the circle of sexual partners and having a responsible attitude towards sex is the most important measure to prevent sexually transmitted infections. If you have many sexual partners and often have casual sex, you must be aware that you are at high risk of contracting sexually transmitted infections with all the ensuing consequences.

In publications about STIs, one letter P somehow disappears by itself. Infections transmitted mainly sexually. This P, in particular, is the subject of heated debate between sufferers on the one hand and insurance companies on the other. What do insurance companies have to do with this? Usually, according to the terms of insurance, if the infection occurred through no fault of the patient, then it must be paid for. If the patient himself is “to blame” - he became infected during sex - he does not need to pay. This is where many myths in venereology originate. Let's figure it out.

For some reason, people consider the most common methods of non-sexual infection to be visits to the CVD and gynecologists (they say, insufficiently sterilized instruments), as well as to the swimming pool, sauna, toilet, etc.

I’ll tell you right away about my colleagues. In fact, the use of disposable instruments has already become almost universal, and in those rare places where reusable instruments are sterilized, one should think not about STIs, but about other infections, the pathogens of which are much more stable in the external environment. Although, with proper infection control, such cases are nonsense.

Now about everyday cases of transmission. Here “not proven” does not mean absent. Because it would never even occur to anyone to experiment - seating thousands of people on a obviously contaminated toilet. And animals, on which it is not forbidden to conduct experiments, do not suffer from venereal diseases characteristic of humans. Therefore, it is impossible to talk about a certain percentage of household infections, as most popular scientific medical media do.

However, it must be taken into account that most STI pathogens, except perhaps scabies, survive extremely poorly in the external environment, so in order to become infected in this way, you need to try very, very hard and sit on the toilet literally when it has not yet cooled down from the previous occupant ... And yet, according to statistics, if an event happens with a probability of one time in a thousand, then in a million cases there will already be a thousand hits.

Have I personally encountered cases of domestic infection? Yes, we met. But this was less than a dozen people per year in a city of a million and, most likely, was associated with such unhygienic habits of which I do not suspect my reader. (for example, “sterilizing” spoons or nipples that have fallen on the floor by licking). There have also been cases when blood or other biological fluids got onto open wound surfaces (during a fight or from a surgeon who cut himself during an operation). So there are other, non-sexual ways of transmitting STIs. But this happens so rarely...

Therefore, if at a New Year’s corporate party you sat on the toilet without first testing for STIs or were simply in the sauna or swimming pool, there is no need to worry. But if something else happened during the celebration, you need to think about how to get it checked in time. And if infection has occurred, then the question is how exactly it happened. The main thing is how to recover as quickly as possible and with minimal consequences.

List of reasons for urgent examination:

• The appearance of discharge (any) from the urethra in men and copious or green/yellow or unpleasant-smelling discharge from the genitals in women.
• Pain, itching, pain when trying to urinate (happens most often) and/or the same sensations in the genital area, anus, perineum.
• Frequent urination in small portions (pollakiuria). A very specific symptom.
• Difficulty urinating.
• The appearance of any rashes on the genitals, spots, ulcers, erosions, blisters, growths.
• Enlarged lymph nodes.

Reasons for a routine examination:

• Chronic urological/gynecological diseases: prostatitis, vesiculitis, spermatocystitis, adnexitis, persistent cystitis, etc., everything that ends in -it.
• Diseases of the joints with a characteristic “staircase” lesion. This is when small joints are affected first, and then large ones. However, it is a good idea to get tested for any joint pathology.
• Sexological disorders (weakened erection, accelerated ejaculation, etc., etc.).
• Infertile marriage: absence of pregnancy after two years of regular unprotected sex.

Reason for regular examination:

• Sexual relations with different partners, even if you are sure that the sex was “protected”. It is necessary to be examined at least once a year, suspicious people or those who often change partners - once every six months.

Good health!

Leonid Shchebotansky

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