Highlights The risk of sexual transmission is still unanswered, and thus it is recommended to have sex with people close to yourself There is no evidence to support recommendations for sexual practices with casual partners. Solitary sexual practices like sexual fantasies, autoerotism, masturbation, and sex toys are recommended when the exposure of a partner is known, one (or both) partner is infected, and one partner is suspicious of infection. Wash your hands and any sex toys used, both before and after masturbating The use of media and bibliotherapy can be help isolated people to build sexual phantasies and autoerotic practices Avoid kisses, hugs, and physical proximity to those that do not live in the same household

Vaginal bleeding during the neonatal period is commonly related to the withdrawal of maternal estrogens. Vaginal bleeding has also been reported in female infants with congenital adrenal hyperplasia and has been proposed to be due to a treatment-induced activation of the hypothalamic-pituitary-ovarian axis.We report a female infant with the salt-losing form of congenital adrenal hyperplasia due to 21-hydroxylase deficiency, who had the onset of vaginal bleeding at 3 months of life. Adrenal steroid suppression had been achieved by 2.5 weeks of age. At the time of bleeding, imaging studies revealed an enlarged right ovary with a dominant 3-cm cyst and additional small cysts that had not been seen on the newborn sonogram. The uterus was enlarged and stimulated. Three weeks later (1 week after the cessation of bleeding), repeat ultrasound demonstrated a marked decrease in the size of the right ovary, and the dominant cyst was no longer seen. The patient had a heightened FSH response to GnRH and elevated levels of estradiol for age. At 5 months of age, no further episodes of sustained vaginal bleeding were observed. Repeat hormonal levels were prepubertal, and pelvic sonogram demonstrated no evidence of stimulation.The findings in our patient suggest that a decline in adrenal androgens after glucocorticoid treatment resulted in an increase in gonadotropin levels, which then triggered a transient and augmented end-organ response (menses). Further, we suggest that our infant's hormonal findings may reflect a delay in the timely development of the negative restraint by sex steroids on gonadotropins that is normally observed in infancy. (J Clin Endocrinol Metab 82: 3298 -3302, 1997)

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