Exotic diseases that affect small numbers of people get plenty of media coverage, but with 92 million new cases each year Chlamydia gets far less attention than it deserves, particularly because it can be avoided.

We hear a lot about sexually transmitted infections like HIV, which are incurable and may result in death.

There's good reason for that: HIV is a serious infection that is resulting in the deaths of millions. There are also some not-so-good reasons. Because they are so deadly, infections and diseases like HIV are often used as tactics to try and scare teenagers away from having se, and to scare our culture in general into enabling both sexual shame and sexual stereotypes and biases.

But HIV isn't the most common sexually transmitted infection (STI) among most young adults. You might know that two currently incurable STIs -human papillomavirus (HPV, or genital warts) and herpes -are incredibly common among adults and young adults alike, although both can be difficult to diagnose, even with STI screenings.

However, Chlamydia -an infection that is both easy to diagnose and completely treatable -is the most common sexually transmitted disease in the United States, United Kingdom and Australia, and is on the rise, especially among women aged 15-24.In 2001 more than 15, 000 new cases of chlamydia in young adults were reported in Australia, and this is just the number of young adults who have been screened and obtained sexual health care.

According to the World Health Organisation, in 1999 alone there were 92 million new cases of Chlamydia worldwide; by the age of 30 half of all sexually active women have evidence they have had Chlamydia at some point. One reason that Chlamydia rates are higher in teenage and young adult women than in older women is because the cells or the cervix are not yet fully matured.

This higher rate is also because young women and men are not obtaining or accessing annual sexual health care and regular STI screenings; they not consistently using latex barriers during sexual activity; and there are other lifestyle issues. Populations in lower income brackets and who live in poorer areas are also often more commonly affected.

In Australia, aboriginal populations often have greater incidence of chlamydial infection. In all countries, those of the lowest incomes, and thus usually with the least health services, are always hardest hit by STIs, primarily because they are not screened as often as their wealthier counterparts.

Chlamydia's Effects

Left untreated, as many as 40% of all women infected will develop pelvic inflammatory disease (PID) -a very serious infection of the female reproductive organs -and around half of these women will become infertile as a result. PID also often results in chronic pelvic pain and a higher incidence of ectopic pregnancy.

Women infected with Chlamydia are also more susceptible to contracting other STIs. The risk of acquiring HIV when infected with Chlamydia is as least three times as high as it would be otherwise.

The majority of people who acquire Chlamydia will not experience any obvious symptoms. Young women will sometimes experience painful intercourse or spotting from intercourse, but since so many experience those things regularly without an active STI, those symptoms may go unnoticed or be confused for discomfort and bleeding expected from intercourse.

Those men and women who do have symptoms may experience unusual genital discharges, or discomfort when urinating. However, most chlamydial infections are entirely asymptomatic, especially in women. People who do not get regular STI screenings generally do not know they have Chlamydia.

But Chlamydia is easy to test for and easy to treat. Once diagnosed, a round of antibiotics very effectively remedies the bacterial infection. If treated quickly, Chlamydia does not usually cause any kind of long-term health issues. Better still, it's easy to prevent.

Chlamydia is nearly always only spread via sexual activities, and primarily via vaginal, anal or oral sex. By practising all aspects of safer sex smartly -annual sexual health exams and STI screenings for all partners, condom use for sexual activities and limiting partners -Chlamydia is very easy to avoid.

Avoiding Chlamydia

To prevent the spread of Chlamydia and other STIs, men and women alike need to use latex or polyurethane condoms for vaginal, anal and/or oral sex, and for all direct genital to-genital and oral-genital contact. For receptive oral sex for women, latex dental dams can be used or a condom (latex or polyurethane) can be cut down the middle with scissors to create a dam (although cunnilingus is not a typical mode of transmission).

Handwashing before and after manual sex for men or women will also help to prevent Chlamydia infection, including rarer infections that can occur from hand-to-eye.

These techniques will not avoid all sexually transmitted infections. HPV, for example, can be transmitted even when condoms are used. But if you're being careful about Chlamydia you're also probably protecting yourself against AIDS and a host of other diseases.

Any sexually active person should have full screenings for all known sexually transmitted infections at least annually, and more often if new partners are added or if sex without latex barriers occurs.

A chlamydial infection can often easily be diagnosed in those of any gender within just a couple weeks of acquiring the infection. A urine test can be obtained through a general practitioner or family doctor, walk-in clinics or clinic systems like Marie Stopes. Many areas are currently working to increase availability and frequency of Chlamydia screening in response to the growing rates of the infection.

It is important that both, or all, current partners are treated for Chlamydia. If only one partner is treated, he or she will usually continue to contract Chlamydia from the other infected partner. Treatment does not create an immunity to the infection.

It is also important while being treated for Chlamydia to abstain from sex during and for 1 week after treatment. Left untreated, not only does Chlamydia often result in PID and infertility in women, in men it can result in urethral infections that can also cause male infertility and other complications.

It is generally recommended that a patient treated for Chlamydia have a follow-up visit with their doctor or clinician to be sure that the infection was cured and is no longer present. Rarely, some cases will require more than one treatment, but continued infection is most often due to reinfection, rather than to treatment not being successful.

Negotiating Safer Sex

Negotiating safer sex practices isn't easy for many young adults, especially when they are just becoming sexually active. Talking about sex often feels more challenging than having sex. The intimacy and vulnerability that comes along with sexual partnership -whether heady with romance, or in hookups or "friends with benefits" scenarios -can be intimidating, especially with something as unsexy as disease and infection, especially in a cultural environment that stigmatises sexuality in general and where young adult sexuality is particularly controversial.

STIs are fairly stigmatised in any population, but that stigma carries even more weight for young adults. Who has and who has not had sex can often have a great effect on the esteem a young person is held in by peers as well as their romantic or sexual partners, and this is of special concern for young women.

Social mores regarding who is a"slut" and who is a"good girl" have changed a lot less in the past 50 years than many adults would assume. As young women are more and more sexualised by media and culture, the attention paid to their sexual behaviour - and what value judgments about their character are made by that token -is magnified.

Sex among young adults is often unplanned. Even for those who would use condoms -and many young adults often report that young male partners say they don't like them, (even though plenty who say this have never used one) or will argue against using them -sex often feels like it"just happens". In that whirlwind, when condoms aren't right there, the sex often goes on without them.

In addition, a great many young women experience date rape or coerced sex from partners, often while intoxicated. Condoms are very rarely used in these cases.

Protecting Yourself, Partners and Friends

Be prepared

If you're even thinking about having any sort of sex with someone else, keep condoms and lubricant on hand. Get started with your once-a-year sexual health exams and STI screenings, even if you haven't had any sort of sex at all. Suss out your own limits and boundaries, and give some thought to how you'll communicate them to a partner.

Be confident

When it's made clear that sex without safer sex practices just isn't going to happen, partners will be much less inclined to try and negate or ignore that boundary.

You can do this clearly, plainly and pleasantly: there's no need to feel you have to get angry or appear aggressive to assert that boundary. Calmly explaining to any potential or current partner that you're fine if you don't have sex, but it needs to be safe if you do, generally gets positive results.

No one "owes" another person sex, nor is obligated to have any sort of sex with another person. If you worry that you'll be taunted or made fun of for having that limit, know that the complications from an STI will often follow you far longer, and far more dangerously, than an incident of taunting will.

Sex is no place to be shy. If you don't yet feel comfortable talking about sex, including the unsexy stuff like safer sex, STIs and birth control, then it's too soon to be having sex. That's not just about your safety, either: sexual partnership without open communication tends to result in unsatisfying sex, emotionally and physically, for at least one partner and usually for both.

Don't rush a partner or allow a partner to rush you

Sure, impetuous, spontaneous sex is sexy: it's heated, it's passionate. But that sort of on-a-whim sex can still happen among partners who have already established safer sex boundaries and practices in advance, and leave you feeling just as good the next morning as you did the night before. If good sex is going to happen, it can happen a few weeks from now with safer sex practices at play, too.

Don't be in a hurry to get to a point where you and a partner can go without latex barriers

Plenty of young adults have the idea that condoms put "something between" them and their partner. Any birth control method does that. The pill, for instance, usually results in women being less aroused and lubricated, and in women changing their lives and schedules to be sure to take it.

That's something that is no less of a barrier between partners than a condom. Of course, a pregnancy and child absolutely puts something in the middle, as does a sexually transmitted infection. The vaginal canal doesn't actually have many nerves within it -the big pile of nerve endings responsible for genital sexual response in women are primarily in the clitoris -so most women really cannot physically feel a condom.

While it's understandable to want to do things for a partner to feel closer to one another, condoms do not inhibit intimacy. If, without condoms, you do feel closer, chances are that's because you're taking greater risks and that is what is responsible for increased feelings of closeness. After all, when any situation is life or death with someone, when your health is on the line it's bound to feel more important.

Condoms have come a long way

At this point in time there are scores of ultra-thin condoms on the market that, when used with a little latex-safe lubricant inside and outside the condom and purchased in the proper size for the wearer, are nearly imperceptible. As an extra bonus, the thinner the condom, the less likely it is to break or tear since thinner condoms produce less friction than those that are thicker. It is vital to use condoms correctly for them to be effective.

For safer sex practices to be as effective as they can be, partners need to be together monogamously for at least 6 full months, using barriers during those 6 months and each to have two full, negative screenings under their proverbial belts. Everyone wants to trust their partners: no one wants to imagine that a partner cheats or that a partner can have sex with others without their partner at least suspecting something's up.

However, people do often deceive partners and often do have sex outside their relationships. Many times when they do, they do not practice safer sex. It's reasonable to recognise that trust isn't instant: it takes time to nurture and earn, and that's as it should be.

Safer sex practices actually help, rather than hinder, trust. It's a safe bet that a partner who is dedicated to keeping things as safe as possible for you and themselves is someone you can likely trust far more than a person who wiints to take risks and put you at risks. When someone says"trust me" a little to often it's often a big red light not to.

Trust your instincts and yourself

If any part of you feels like something's just not right with a partner or a sexual situation, pull back and give yourself plenty of time to evaluate the situation.

If a partner doesn't have any condoms, isn't willing to use condoms, isn't willing to talk about STIs and safer sex or take risks seriously, or puts off those discussions while pursuing sex. you're not with a partner who is safe for you to be with, in terms of STIs and overall.

It might be that the partner just isn't ready for all the responsibility that sex entails.It might be that person simply doesn't care about their risks or yours.

Enable safe practices among your peers

If you hear friends dodging condoms or bragging about taking risks, don't fall into line. Share a few kind words to help support safer sex and good health. Help support friends with partners who won't engage in safer sex to get out of those relationships. Offer to go get tested together so they can get the screenings they need.

Extra Information on Chlamydia

The Australian Chlamydia Research Network (ACRN) is a group of researchers, academics, clinicians and pathology specialists interested in the broad area of chlamydial diseases (humans and animals), epidemiology, diagnostics, pathology, molecular biology, cell biology, immunology and vaccine development. See http://src.sci.qut.qut.au/programs/infectious_diseases/chlamydia/

Information on chlamydia issues specific to Aboriginal populations can be found at http://mja.com.au/public/issues/may5/skov/skov.html

The ACT Chlamydia Factsheet is available at http://health.act.gov.au/c/health?a=da&did=10009573&pid=1055374861

At www.scarleteen.com you can read about many aspects of STIs and use the forums to discuss your issues with sex and relationships.