Sexually Transmieases are
Alive
and Well in the United States
This article is written
solely for the purpose of elaborating on a serious problem in our society. It is graphic and not for the timid or the
faint of heart. If you are offended by
the content, I apologize in advance. You
never know, someone may pass through your life that could benefit from your
advice and counsel. Sexually transmitted
diseases are worsening in our society, and they affect all strata of our
socioeconomic spectrum.
Sexually
Transmitted Diseases (STDs) are very common. In addition to HIV, there are dozens of other types
of sexually transmitted diseases. Often there are no symptoms, at least not at
first. Left untreated, STDs can cause serious health issues.
The
good news is all STDs, including HIV, are treatable, and many are curable.
While
routine testing for many STDs is recommended, that does not mean it always
happens as part of a regular checkup or gynecologist exam. To
know for sure, ask to be tested.
Scroll
on for more about specific STDs, including symptoms, testing and treatment.
A
healthcare provider can advise on which STDs you should be tested for and how
often. If you don’t have a regular provider, free or low-cost STD testing is available in most
areas.
Chlamydia is one of the most common STDs. There
are an estimated 1.7 million new cases a year in the U.S. Many people who have chlamydia
do not know it. Often there are no symptoms. Left untreated, chlamydia can
cause infertility and pain in both women and men. Once diagnosed, it is easily
cured with antibiotics.
Chlamydia
is a bacterial infection usually transmitted during vaginal, anal, or oral sex
through semen and vaginal fluids. It can infect the penis, vagina, cervix,
anus, urethra, eyes, and throat.
Chlamydia
can also be passed during birth to a baby if the mother has it and is not
treated.
When
used consistently and correctly, condoms protect against chlamydia and many other STDs.
Like
most STDs, chlamydia often does not show any symptoms. As a result, many people
with chlamydia do not know it. The only way to know is to get tested.
If
symptoms do appear, they may include pain or burning while urinating and/or
during sex, lower belly pain, swollen or tender testicles, or abnormal
discharge from the vagina, penis, or anus.
There
are different tests for chlamydia. It can be as simple and easy as urinating in
a cup. Some health providers might use a genital swab (like a big Q-tip) to
take cell samples from the urethra, vagina, cervix, or anus. The samples are
tested for chlamydia bacteria.
To find free and low-cost STD testing near you, go to
greaterthan.org/services.
Chlamydia
can be easily cured with antibiotics prescribed by a healthcare provider.
It
is important to complete the full treatment, as prescribed by your healthcare
provider, even if symptoms go away sooner. The infection stays in the body
until you finish the antibiotics. Also, do not share your medicine with anyone
or take someone else’s.
Some
healthcare providers may give a separate dose of antibiotics for your partner(s),
so you do not re-infect each other or anyone else. Do not have sex until
treatment is finished.
Get
tested again in 3-4 months to make sure the infection is gone, and you were not
re-exposed.
Untreated
chlamydia can cause pelvic inflammatory disease (PID) in women. Women with PID
may not realize they have it, but left untreated it can cause pain, infertility,
or ectopic pregnancy.
As
previously stated, pregnant women with untreated chlamydia can pass it to their
babies during childbirth. It can cause eye infections and pneumonia in newborns
and increase the risk of delivering a baby too early.
In men, chlamydia can spread to the epididymis
(a tube that carries sperm from the testicles), and can cause chronic joint
pain and infertility for some.
Gonorrhea is a common STD,
especially among teens and people in their 20s. Sometimes called “the clap” or
“the drip.” Gonorrhea may not show symptoms. Left untreated, it can cause
infertility and pain in both women and men. Once diagnosed, it is easily cured
with antibiotics.
Gonorrhea is a bacterial infection
usually transmitted during vaginal, anal, or oral sex. It is spread when semen
or vaginal fluids get on or inside the genitals, anus, or mouth. Gonorrhea can
be passed even if the penis does not go all the way in the vagina or anus.
Gonorrhea
can also be passed to a baby during birth if the mother has it and is not
treated.
Like
most STDs, gonorrhea often does not show any symptoms, or the signs may be so
mild a person does not even notice them. The only way to know is to get tested.
When
symptoms do appear, it is usually within a week of infection and may include
pain or burning when urinating, abnormal discharge from the vagina or penis,
and pain or swelling in the testicles.
Gonorrhea
can also infect the anus if the patient has anal sex or may spread to the anus
from another part of the body (like by wiping after using the bathroom). Anal
gonorrhea often does not have any symptoms, but signs can include itching in or
around the anus, discharge from the anus, or pain when defecating.
There
are different tests for gonorrhea. It can be as simple and easy as urinating in
a cup. Some healthcare providers might use a swab (like a big Q-tip) to take
cell samples from the penis, cervix, urethra, anus, or throat. The samples are
tested for gonorrhea bacteria.
To find free and low-cost STD testing near you, go to
greaterthan.org/services.
Gonorrhea
can be easily cured with antibiotics prescribed by a healthcare provider.
It
is important to complete the full treatment, as prescribed by the healthcare
provider, even if symptoms go away sooner. The infection stays in the body
until the patient finishes the antibiotics. Also, the patient should not share
medicine with anyone or take someone else’s.
Some
healthcare providers may give a separate dose of antibiotics for the patient’s
partner(s), so you do not re-infect each other or anyone else. It is important
not to have sex until one has finished treatment.
The
patient should get tested again in 3-4 months to make sure the infection is gone,
and the patient has not re-exposed.
Untreated
gonorrhea can cause pelvic inflammatory disease (PID) in women. Women with PID
may not realize they have it, but left untreated it can cause pain, infertility,
or ectopic pregnancy.
As
previously stated, pregnant women with untreated gonorrhea can pass it to their
babies during childbirth. It can cause blindness, joint infections, or blood
infections in newborns, which can be deadly.
In
men, untreated gonorrhea can spread to the epididymis (a tube that carries
sperm from the testicles) and can cause pain in the testicles. Rarely, it can
cause infertility.
Condoms are a low cost, easy to
get and highly effective prevention option. When used correctly and
consistently, condoms protect against gonorrhea, as well as many other STDs and
pregnancy.
Hepatitis B
Hepatitis B is a viral infection
that can cause liver disease. About half of people with hepatitis B do not
experience any symptoms. There is no cure, but a vaccine is available to
protect against infection.
Hepatitis B is transmitted through semen, vaginal fluids, blood,
and urine during sex – vaginal, anal, or oral – or through needles, razors, or
toothbrushes with blood on them.
Hepatitis B can also be passed to babies during birth if their
mother has it and is not treated.
When used consistently and correctly, condoms protect against
hepatitis B and many other STDs.
A vaccine to protect against
infection is available for hepatitis B. It requires a series of three shots
provided by a healthcare provider over several months. A patient needs all
three shots for it to most effective. Babies now get the hepatitis B vaccine
from their healthcare provider as a regular part of their checkup.
About
half of adults with hepatitis B do not experience any symptoms. If people do
have symptoms, they may go unnoticed or look like other common illnesses, like
the flu. Hepatitis B symptoms typically last for a few weeks but can sometimes
last for months.
If
symptoms do appear, they may include stomach pain, nausea and vomiting, joint
pain, fever, dark-colored urine, or hives. Because hepatitis B affects the
liver, it may also cause jaundice - when the eyes and skin yellow.
Hepatitis B is tested with a blood
sample. It may take up to two months after infection before a positive result.
To find free and low-cost STD testing near you, go to greaterthan.org/services.
If you have chronic hepatitis B,
there are prescription medications that can help keep your liver healthy. Check
with a healthcare provider before taking any over-the-counter drugs, vitamins,
or nutritional supplements to make sure they won’t further hurt your liver.
Hepatitis C
Hepatitis C is a viral infection that affects
the liver. An estimated 2.
million people are living with
hepatitis C in the U.S. Most people do not experience any symptoms. Hepatitis C
can be cured with prescription medication. Left untreated, it can lead to liver
disease, cancer and even death.
Hepatitis C is a blood-borne virus. Today, hepatitis C is most
often transmitted by sharing needles or other equipment to inject drugs. If you
inject drugs, always use new, sterile needles, and don’t reuse or share
needles, syringes, or other injection drug equipment.
Hepatitis C can also be transmitted during sex. When used
consistently and correctly, condoms protect against
hepatitis C and many other STDs.
Most
people with hepatitis C do not experience any symptoms. If people do have
symptoms, they may go unnoticed or look like other common illnesses, like the
flu.
If
symptoms do appear, they usually occur 6-12 weeks after infection and may
include: stomach pain, nausea and vomiting, joint pain, fever, or dark-colored
urine. Because hepatitis C affects the liver, it may also cause jaundice - when
the eyes and skin yellow.
Hepatitis C is tested with a blood
sample. To find free and low-cost STD testing near you, go to
greaterthan.org/services.
Hepatitis
C can be a short-term (acute) or long-term (chronic) disease. Acute hepatitis C
is typically monitored but not treated and may go away on its own without
treatment. According to the CDC, almost 85% of people with hepatitis C will
develop chronic infection.
There
are several medications available to treat chronic hepatitis C. New safe and
effective treatments can cure most people living with the virus.
Left untreated, chronic hepatitis C
can lead to liver cancer, liver cirrhosis and even death.
People
living with HIV are at higher risk for hepatitis C. Of the 1.2 million people
living with HIV in the U.S., about 1 in 4 also have hepatitis C.
Having
both HIV and hepatitis C (called co-infection) means increased risk for liver
disease, liver failure and liver-related death from hepatitis C. Because
hepatitis is often serious in people living with HIV and may lead to liver
damage more quickly, the CDC recommends people living with, or at risk for HIV,
also get tested for hepatitis C.
Herpes is a very common STD. It can
cause sores on the genitals and/or mouth. An estimated 1 in 6 people ages 14-49
in the U.S. has genital herpes. There is no cure for herpes, but prescription
medication can ease symptoms and lower the chances of passing the virus to
others. Herpes can be painful, but usually does not lead to serious health
problems.
There are two different herpes viruses: Herpes Simplex Virus
type 1 (HSV-1) and Herpes Simplex Virus type 2 (HSV-2).
Herpes is transmitted from skin-to-skin contact when an
individual’s genitals and/or mouth touch the genitals and/or mouth – usually
during oral, anal, or vaginal sex – of someone with the virus. Herpes can be
passed even if the penis or tongue does not go all the way in the vagina, anus,
or mouth.
While rare, a mother can pass genital herpes to the baby during
vaginal childbirth.
Herpes is most easily transmitted when sores are open and wet
because fluid from herpes blisters easily spreads the virus. But herpes can
also “shed” and be passed to others when there are no sores, and the skin looks
totally normal. Most people get herpes from someone who does not have any
sores. When used consistently and correctly, condoms help protect
against herpes and many other STDs.
The most common symptoms of genital herpes are
outbreaks of itchy, painful blisters or sores on the vagina, vulva, cervix,
penis, buttocks, anus, or inside of the thighs.
The first outbreak usually starts about 2 to 20 days after
exposure to herpes, but sometimes it takes years for the first outbreak to
happen. It usually lasts about 2 to 4 weeks. Even though the blisters go away,
the virus stays in the body and can cause sores again. It is common to get
repeat outbreaks, especially during the first year of having herpes.
The first outbreak of herpes is usually the worst. Repeat
outbreaks are usually shorter and less painful. Most people with herpes get
fewer outbreaks as time goes on, and some stop having them altogether.
Other symptoms may include itching, pain around the genitals or
having trouble urinating. If genital herpes is caused by HSV-2, there may also
be flu-like symptoms, such as swollen glands, fever, chills, and aches.
Usually, oral herpes is less painful than genital
herpes and doesn’t make one feel as sick. Oral herpes causes sores on the lips
or around the mouth – called cold sores or fever blisters.
Cold sores last a few weeks and then go away on their own. They
can re-appear in weeks, months, or years. Cold sores are usually harmless in
kids and adults but can be dangerous to newborn babies.
If there are blisters or sores, a healthcare provider may gently
swab the area to take a fluid sample and test it. If there are no sores, but
you are concerned you may have been exposed, a blood test may do. Herpes tests
are not normally recommended unless you have symptoms.
To find free and low-cost
STD testing near you, go to greaterthan.org/services.
There’s
no cure for herpes, but prescription medications can ease symptoms, end
outbreaks sooner, and lower the chances of passing the virus to other people.
The
patient can also help ease the pain caused by herpes outbreaks by taking a warm
bath, wearing loose clothing, and putting an ice pack on the sores.
Herpes
can be painful, but it generally does not cause serious health problems like
other STDs can.
Without
treatment, the patient might continue to have regular outbreaks, or they could
only happen rarely. Some people naturally stop getting outbreaks after a while.
Herpes typically does not get worse over time.
HIV
is a virus that attacks the immune system and can lead to AIDS, a clinical
diagnosis that indicates an advanced stage of HIV. HIV may not show symptoms
initially. Left untreated, HIV can lead to death. Testing for HIV is recommended as a part of
routine healthcare.
The most common way people get HIV is through unprotected anal
or vaginal sex with someone with HIV who is not aware of their status or not on
consistent antiretroviral treatment. According to the CDC, HIV transmission
through oral sex is extremely rare.
Sharing used needles, syringes, or other drug preparation
equipment increases the risk of getting HIV.
HIV can be passed from mother to child during pregnancy, birth
and through breastfeeding, although this risk can be almost eliminated with
treatment.
HIV is NOT spread through sharing glasses or plates, food,
holding hands, toilet seats, or other casual contact. You also cannot get HIV
through closed-mouth or “social” kissing or saliva.
When used consistently and correctly, condoms protect against
HIV and many other STDs. Another prevention option is pre-exposure
prophylaxis – a once-a-day pill for people who do not have
HIV and want added protection. It is available only by prescription and is
highly effective in protecting against getting HIV does not protect against
other STDs.
PEP – post-exposure prophylaxis – is a prescription medication
that can be taken within 72 hours after potential exposure to prevent HIV. It
is for emergency use only, and not intended for regular, ongoing use. If you
are prescribed PEP you will need to take it once or twice daily for 28 days.
Contact your healthcare provider or emergency room for a prescription.
Like most STDs, HIV often does not show any symptoms initially,
even for years. Sometimes people may experience symptoms within a few weeks of
exposure, however these symptoms may go unnoticed or look like other common
illnesses. The only way to know if you have HIV is to get tested.
Here
are several different types of HIV tests. Some use blood, others test cells
inside the mouth. HIV blood tests may be done by finger stick or a draw from
the inner arm. Oral HIV tests use a swab of the mouth. Rapid HIV tests can
provide results in under 20 minutes, sometimes as fast as one minute. Home
tests can be purchased in many drug stores.
If
you have a preference for the type of HIV test, ask your healthcare provider
what options are available.
There
is no cure for HIV/AIDS, but antiretroviral (ARV) prescription medications
allow people with HIV to live normal, healthy lifespans.
Antiretrovirals
work to lower the amount of virus in the body (viral load), often to levels
that are undetectable by standard lab tests. The vast majority of people who
take their ARVs every day as prescribed and remain in care are able to achieve
and maintain an undetectable viral load. In addition to improving health,
getting and keeping a low viral load also prevents the spread of the virus to
others.
A
person diagnosed with HIV today who is on ongoing ARV medication and in medical
care can live a normal, healthy lifespan and have children without HIV.
Taking
HIV treatment every day as prescribed prevents illness and the spread of the
virus to others. Left untreated, HIV can lead to death.
Missing
doses of antiretrovirals (ARVs) can cause the amount of virus in the body to
rise. This may result in the virus becoming resistant to a particular HIV
treatment, possibly making that treatment not work as well, including reducing
the preventative benefits.
If
you are having difficulty taking or keeping up with your treatment, talk with
your healthcare provider as soon as possible and consider using additional
strategies to prevent sexual HIV transmission. Your provider can work with you
to help get you back on track, including trying different ARVs if needed.
HPV is the most common STD. There
are more than 150 different types of HPV. Many forms of HPV do not show any
symptoms. Some cause genital warts. The HPV vaccine protects against certain
types that are associated with genital warts and cervical cancer.
About
40 types of HPV infect the genital area – the vulva, vagina, cervix, rectum,
anus, penis, and scrotum – as well as the mouth and throat.
These
kinds of HPV are transmitted from sexual skin-to-skin contact when the vulva,
vagina, cervix, penis, or anus touches the genitals, mouth or throat of someone
with HPV.
If you do not have HPV, the vaccine
can help protect you from certain types, including those associated with
cervical cancer. When used consistently and correctly, condoms help protect against HPV and many other STDs.
The
HPV vaccine also protects against certain types of HPV that can lead to cancer
or genital warts. The HPV vaccine works extremely well. Clinical trials showed
the HPV vaccine provides close to 100% protection against cervical precancers
and genital warts.
The
HPV vaccine is most effective during adolescence, when the body produces more
antibodies against the virus. It is given in a series of shots.
HPV,
like most STDs, often does not show any symptoms.
Two
types of HPV (6 and 11) can cause genital warts, which are harmless growths on
the skin of the vulva, vagina, cervix, penis, scrotum, or anus. Genital warts
look like fleshy, soft bumps that sometimes resemble miniature cauliflower.
Usually painless, these can be treated and removed just like the warts a
patient might get on his or her hands or feet.
Pap smears do not directly test for HPV but can detect abnormal
cell changes in the cervix of women that are likely caused by HPV and can lead
to cancer. If abnormal cells are detected, a healthcare provider will advise on
monitoring and treatment.
There is an HPV test that can find some high-risk types of the
virus directly, but it may not be widely available. It may be provided as a
follow-up to a Pap test that finds abnormal cells or when Pap test results are
not clear.
For men, there is currently no test approved to detect high-risk
HPV. By getting vaccinated against HPV, men can help to prevent transmission.
To find free and low-cost
STD testing near you, go to greaterthan.org/services.
There is no cure for HPV. If you
don't have HPV, the vaccine is the best defense against cancer caused by HPV,
as well as genital warts. Regular pap smears for women are also critical to
finding abnormal cell changes in the cervix early. Genital warts may be removed
by a healthcare provider to prevent the spread of that type of HPV.
Syphilis is a common STD. It often
does not show any symptoms. Left untreated, it can cause permanent damage, like
blindness or paralysis. Once diagnosed, it is easily cured with antibiotics.
Syphilis
is transmitted from skin-to-skin contact through vaginal and anal sex. It is
less common – but still possible – to get it from oral sex.
A
mother can also pass syphilis to a baby during pregnancy and childbirth if the
mother has it and is not treated.
When used consistently and
correctly, condoms protect against syphilis
and many other STDs.
As
stated above, syphilis often does not show symptoms like most STD’s. The only
way to know is to get tested.
There
are several stages of syphilis and symptoms can vary with each stage. In the
primary stage, symptoms may include sores on the vulva, vagina, anus, penis, scrotum,
or mouth, but many people do not have sores or notice them. Syphilis sores (called a chancre) are usually
firm, round, and painless, or sometimes open and wet.
In
the secondary stage, symptoms often include a rash – which can be hard to see
and usually does not itch. A patient may feel sick and have mild flu-like
symptoms, like a slight fever, tiredness, sore throat, swollen glands,
headache, and muscle aches.
Syphilis is tested with a blood sample. If you have open sores,
a healthcare provider may gently swab the area to take a sample of fluid and
test it.
As stated above, syphilis is
easily cured with antibiotics in the early stages. Left untreated, syphilis can
cause tumors, blindness, paralysis, damage to the nervous system, brain and
other organs, and may even be fatal.
If you are pregnant and have syphilis that is not treated, it
can be passed to the baby during pregnancy or birth – called congenital
syphilis. Congenital syphilis can lead to stillbirth, birth defects, or infant
death.
Trichomoniasis is a very common
STD. Sometimes called “trich” for short. There are an estimated 3.7 million
people living with trich in the U.S. It often does not show any symptoms. Trich
is usually not serious. Once diagnosed, it is easily cured with antibiotics.
Trich is caused by a tiny parasite (you cannot see it with the
naked eye) called a trichomonas. It is transmitted when semen or vaginal fluids
get on or inside the penis, vulva, or vagina.
Trich is often transmitted during vaginal sex but can also be
passed by vulva-to-vulva contact, sharing sex toys, and touching one’s genitals
or the genitals or the genitals of a sex partner if one has infected fluids on their
hand. Trich can easily infect the vulva, vagina, penis, and urethra, but it
usually does not infect other body parts (like the mouth or anus).
When used consistently and correctly, condoms protect against
trich and many other STDs.
Like
most STDs, trich often does not show any symptoms. The only way to know is to
get tested.
When
symptoms do appear it is usually three days to a month after infection and can
be barely noticeable, or really painful and irritating. It is common for the
symptoms to come and go, but that doesn’t mean the infection went away.
If trich does cause symptoms, the
most common one is vaginitis, which is when the vulva or vagina is irritated.
Signs of trich can also include irritation and itching, smelly discharge, or
painful or frequent urination. Trich is very unlikely to cause symptoms in men.
There are different tests for trich. It can be as simple and
easy as urinating in a cup. Some health providers might use a genital swab
(like a big Q-tip) to take cell samples from the patient’s penis or vagina. The
samples are then tested for trich.
Trich can be easily cured with antibiotics
prescribed by a healthcare provider.
It
is important to complete the full treatment, as prescribed by your healthcare
provider, even if symptoms go away sooner. The infection stays in your body
until you finish the antibiotics. Also, do not share your medicine with anyone
or take someone else’s.
Some
healthcare providers may give a separate dose of antibiotics for the patient’s
partner(s) so neither party reinfexts each other or anyone else. Do not have
sex until you’ve finished treatment.
Get
tested again in 3-4 months to make sure the infection is gone and you were not
re-exposed.
Trich
is usually not serious and can be cured in most cases. But if you don’t get
treated for trich, you can pass the infection to your partners – even if
you don’t have symptoms.
If
an individual has trich during pregnancy and does not treat it, the baby may be
born early or at a low birth weight.
Molluscum
Contagiosum
Molluscum
contagiosum is a relatively common viral infection of the skin that results in
round, firm, painless bumps ranging in size from a pinhead to a pencil eraser.
If the bumps are scratched or injured, the infection can spread to surrounding
skin. Molluscum contagiosum also spreads through person-to-person contact and
contact with infected objects.
Though
most common in children, molluscum contagiosum can affect adults as well —
particularly those with weakened immune systems. In adults with an otherwise
normal immune system, molluscum contagiosum involving the genitals is
considered a sexually transmitted infection.
The
bumps associated with molluscum contagiosum usually disappear within a year
without treatment but doctor-assisted removal is also an option.
Symptoms
Signs and symptoms of
molluscum contagiosum include bumps on the skin that:
·
Are raised, round and flesh colored
·
Are small — typically under about 1/4 inch (smaller than 6 millimeters)
in diameter
·
Characteristically have a small indentation (umbilication)
or dot at the top near the center
·
Can become red and inflamed
·
May be itchy
·
Can be easily removed by scratching or rubbing, which can
spread the virus to adjacent skin
·
Usually appear on the face, neck, armpits, arms and tops of
the hands in children
·
May be seen on the genitals, lower abdomen and inner upper
thighs in adults if the infection was sexually transmitted
When
to see a doctor
If the individual suspects
his or her your child has molluscum contagiosum, they should consult your
primary care physician.
Causes
The virus that causes
molluscum contagiosum spreads easily through:
·
Skin-to-skin contact
·
Contact with contaminated objects, such as towels
·
Sexual contact with an affected partner
·
Scratching or rubbing the bumps, which spreads the virus to
nearby skin
It's not clear if the
molluscum contagiosum virus can spread in the chlorinated water found in
swimming pools. Experts suspect that it's more likely that swimmers transmit
the virus through shared use of towels; equipment, such as kickboards; or skin
contact.
Risk
factors
More widespread
molluscum contagiosis infections may occur in people with weakened immune
systems.
Complications
The bumps and the
skin around them may become red and inflamed. This is thought to be an immune
response to the infection. If scratched, these bumps can become infected. If
lesions appear on the eyelids, pink eye (conjunctivitis) can develop.
Prevention
To help prevent the
spread of the virus:
·
Wash your hands. Keeping your hands clean can help
prevent spreading the virus.
·
Avoid touching the bumps. Shaving over the infected
areas also can spread the virus.
·
Don't share personal items. This includes clothing,
towels, hairbrushes or other personal items. Refrain from borrowing these items
from others as well.
·
Avoid sexual contact. If you have molluscum contagiosum
on or near your genitals, don't have sex until the bumps are treated and have
completely disappeared.
·
Cover the bumps. Cover the bumps with clothing when
around others, to prevent direct contact. When swimming, cover the bumps with a
watertight bandage.
Conclusion.
These
are the big ten sexually treated diseases.
They are by no means all inclusive.
Different STD’s are more prevalent among certain socio-economic groups.
What
is discouraging, in the information age, the problem of sexually transmitted
diseases in our culture is worsening.
Read and weep.
Jan
Ricks Jennings, MHA, LFACHE
Senior
Consultant
Senior
Management Resources, LLC
JanJenningsBlog.Blogspot.com
412.913.0636
Cell
724.733.0509
Office
September
2, 2021
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