Chapter 17 Sexually Transmitted Diseases

1. Chapter 17Sexually Transmitted Diseases

2. Incidence of STDs • Startling statistics • Most STD’s contracted by 15-29 year-olds • 1 in 4 treated for STD by age 21 • 25% of U.S. population > 1 STD by age 35 • Largest proportion of AIDS cases infected in teens or 20s

3. Incidence of STDs (cont.) • Why so high? • more sexual partners • use of oral contraceptive • limited access to health care • practitioners do not ask questions about STDs • some diseases have no obvious symptoms • difficulty talking to partner

4. Bacterial Infections • Chlamydia • most prevalent and damaging of STDs • females: urethritis, cervicitis • symptoms: few or none; mild irritation or itching; burning; slight discharge • pelvic inflammatory disease (PID) • symptoms: pain; fever; headache; n/v

5. Bacterial Infections (cont.) • Chlamydia (cont.) • males: epididymitis; nongonococcal urethritis • symptoms: heaviness in testis; small, hard, painful swelling in testis; inflamed scrotum

6. Bacterial Infections (cont.) • Chlamydia (cont.) • minimal or no symptoms in majority of men and women • consequences: chronic, contagious trachoma; infertility & sterility; preterm birth; infant conjunctivitis or pneumonia • treatment: doxycycline or azithromycin • Most recurrent infections result of re-exposure

7. Bacterial Infections (cont.) • Gonorrhea • females: gonococcal cervicitis • symptoms: 80% no early symptoms; yellow-green discharge, vulval irritation • males: gonococcal urethritis • symptoms: discharge, burning; swelling

8. Bacterial Infections (cont.) • Gonorrhea (consequences) • female: PID, ectopic pregnancy, severe pelvic pain, infant conjunctivitis • male: prostate abcesses, painful BMs, difficult urination, possible sterility • both: fever, loss of appetite, arthritic pain, can invade heart, liver, CNS • can cause blindness in infants

9. Bacterial Infections (cont.) • Gonorrhea (consequences) (cont.) • treatment: dual treatment for chlamydia & gonorrhea • resistant bacteria require special treatment • dual therapy now needed

10. Bacterial Infections (cont.) • Nongonococcal urethritis • female: few symptoms; may be itching, burning, vaginal discharge of pus • male: penile discharge, urinary burning • consequences: inflamed cervix or PID • treatment: doxycycline or azithromycin

11. Bacterial Infections (cont.) • Syphilis • rates have risen dramatically • all pregnant women should be tested • primary: red, painless chancre • secondary: painless, non-itching skin rash, flu-like symptoms • latent: no observable symptoms • tertiary: severe disorder, death

12. Bacterial Infections (cont.) • Syphilis (cont.) • other consequences: infected fetus can die • treatment: early cases treated with benzathine penicillin G or other antibiotic • 3 weekly injections for later case • all partners need testing at three month intervals

13. Bacterial Infections (cont.) • Chancroid • prevalent in tropical areas • associated with HIV infection • symptoms; small bumps that rupture and form painful ulcers • Treatment- variety of antibiotics

14. Viral Infections • Herpes: herpes simplex; types 1 & 2 transmitted even when no blisters • 20-25% of Americans have HSV-2 • symptoms: painful, red bumps develop into blisters that rupture & form sores • can spread even when no lesions present • may or may not be recurrent • prodromal symptoms can warn of recurrence

15. Viral Infections (cont.) • Herpes (cont.) • consequences: risk for cervical cancer • newborn infected during delivery may die or suffer severe damage • C-section for women with active disease • can cause eye infection • psychological distress

16. Viral Infections (cont.) • Herpes (cont.) • treatment: no cure; working on vaccine • acyclovir may reduce length & severity of outbreak & may reduce recurring attacks • suppressive vs episodic treatment • hygiene & stress reduction may provide relief • vaccine in development

17. Viral Infections (cont.) • Genital warts (human papilloma virus) • epidemic levels • transmitted even when no warts are evident; > 100 types • symptoms: moist, soft, cauliflower-like warts, or dry, yellow-gray, hard warts • majority of people have no symptoms

18. Viral Infections (cont.) • Genital warts (cont.) • consequences: urinary obstruction & bleeding; greater risk of genital cancers • respiratory infection in newborn • treatment: no cure; removal of warts • recurrence likely • vaccine trials underway

19. Viral Infections (cont.) • Viral hepatitis (3 types) • needle-sharing & sexual transmission • Hepatitis C most health threatening • symptoms: few or none; initially flu like; incapacitating fever, vomiting, abdominal pain; yellowed sclera & skin

20. Viral Infections (cont.) • Viral hepatitis (cont.) • consequences: liver cancer; death • treatment: bed rest & fluids; vaccines are available for Hepatitis A and B; antiviral combination may help Hepatitis C

21. Common Vaginal Infections • Bacterial vaginosis (Gardnerella) • symptoms: foul-smelling, thin flour-paste discharge (white, yellow or green) • may be genital irritation or urinary burning; most men have no symptoms

22. Common Vaginal Infections (cont.) • Bacterial vaginosis (Gardnerella) (cont.) • consequences: greater risk of PID; premature rupture of amniotic sac & preterm labor • treatment: oral, cream or gel Flagyl • Some recommend that male should be treated too

23. Common Vaginal Infections (cont.) • Candidiasis (moniliasis, yeast infection): • symptoms: white, (cottage cheese-like) discharge with intense itching, sore tissue • consequences: confused with other infections • treatment: vaginal suppositories or creams

24. Common Vaginal Infections (cont.) • Trichomoniasis • symptoms: copious, odorous, frothy, white or yellow-green vaginal discharge; inflamed, irritated, itchy and sore • male partners must be treated

25. Common Vaginal Infections (cont.) • Trichomoniasis (cont.) • consequences: may increase risk of cervical cancer • treatment: both partners; oral Flagyl; topical cream

26. Ectoparasitic Infections • Pubic lice • symptoms: little to severe itchiness • treatment: Lindane shampoo; 1% permethrin rinse • launder linens & clothing

27. Ectoparasitic Infections (cont.) • Scabies • symptoms: small, pimple-like bumps; red rash around primary lesion • intense itching, especially at night • treatment: topical scabicide; launder or dry-clean linens & clothing

28. Acquired Immunodeficiency Syndrome (AIDS) • HIV & AIDS • HIV = a retrovirus that targets & destroys helper T-4 cells • HIV becomes AIDS when • HIV is present, and • CD-4 count is < 200

29. Acquired Immunodeficiency Syndrome (cont.) • Incidence • rates among teenagers, women and minorities rising • MSM transmission increasing • decreasing IDU transmission • increasing heterosexual transmission, • especially among women & minorities

30. Acquired Immunodeficiency Syndrome (cont.) • Transmission • occurs in any bodily fluid • depends on viral load • likelihood greatest when HIV transmitted directly to blood • low risk: casual contact • high risk: sexual contact, sharing needles

31. Acquired Immunodeficiency Syndrome (cont.) • Symptoms: brief flulike symptoms that progress depending on immunosuppression • HIV antibody tests • most develop antibodies in a few months but can take three years to seroconvert • usual progression (8 to 11 years) • full-blown AIDS

32. Acquired Immunodeficiency Syndrome (cont.) • Treatment • no cure or vaccine at this time • combination drug therapy (HAART) shows best results for slowing progress • success dependent on compliance but side effects severe • zidovudine may significantly decrease maternal transmission

33. Acquired Immunodeficiency Syndrome (cont.) • Treatment (cont.) • the search for a vaccine • A number of vaccines are in clinical trials • problems due to disease mutations • none available for general use now

34. Acquired Immunodeficiency Syndrome (cont.) • Prevention is the best solution • use condoms and avoid multiple partners • do not share needles • avoid contact with bodily fluids • avoid sexual behaviors involving anus

35. Acquired Immunodeficiency Syndrome (cont.) • Prevention is the best solution (cont.) • avoid implements that could be contaminated with blood (e.g., razors) • avoid sexual contact with sex workers

36. Preventing STDs • Guidelines for lowering risk • abstinence • get to know partners before sex • obtain prior medical examinations • always use condoms properly & spermicide • avoid multiple sexual partners • inspect and wash genitals • disclose your STD status