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Sexually Transmitted Diseases/Infections

Sexually Transmitted Diseases/Infections. Recent History. In the first half of 20th century, STD information: Fear driven Military Abstinence only Men vs Women Changes in last 50 years Less on abstinence only More on safe sex practices Humor. Vintage Photos (eBaum ’ s World).

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Sexually Transmitted Diseases/Infections

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  1. Sexually Transmitted Diseases/Infections

  2. Recent History • In the first half of 20th century, STD information: • Fear driven • Military • Abstinence only • Men vs Women • Changes in last 50 years • Less on abstinence only • More on safe sex practices • Humor

  3. Vintage Photos (eBaum’s World)

  4. Vintage Photos (eBaum’s World)

  5. Current Campaigns

  6. Current Campaigns

  7. Current Campaigns • Alberta Health Video

  8. Disclaimer, Warning, & Support • Incidence variation • Per DOH: STIs comprise 75% of communicable conditions reported in 2010 • State report requirements vary • WA: chlamydia, gonorrhea, HIV, AIDS, syphilis, herpes, hepatitis, chancroid, lymphogranulomavenereum, granuloma inguinale (rare in US) • OR: chlamydia, gonorrhea, HIV/AIDS, syphilis, lymphogranulomavenereum, chancroid, hepatitis (all forms), pelvic inflammatory disease • ID: chlamydia, gonorrhea, syphilis, HIV/AIDS

  9. Disclaimer, Warning, & Support • Graphic Graphics • Where to get tested

  10. General Information • Most STI’s are caused by viral or bacterial infections • Bacterial = usually curable • Complications caused by bacterial infection may be irreversible • Viral = usually treatable, not curable • STI’s may be asymptomatic, esp. in women

  11. General Information • Transmission: vaginal sex, anal sex, oral sex • Other • Breastfeeding: per US HHS, OK if have chlamydia or gonorrhea; syphilis and herpes = can transmit via sores; HIV = can transmit; others = check with physician • Kissing: herpes, syphilis (outbreak), hepatitis B • Injection drug users • Mother to fetus: syphilis & HIV (about.com) • Vaginal delivery: gonorrhea, chlamydia, hepatitis B, herpes

  12. Chlamydia

  13. About Chlamydia • Among the most common STD’s seen in the US • Three million new cases each year • WA State: 21,178 cases in 2009 (DOH) • King County cases: 5946 in 2010 • 3906 women • 2039 men • Bacterial infection • Chlamydia can be passed via oral, vaginal, anal sex with an infected partner

  14. Chlamydia Rates (CDC, 2012)

  15. Chlamydia Prevalence by State, CDC, 2012

  16. Chlamydia Symptoms • Sometimes no symptoms are present • Symptoms generally appear within three weeks of infection • Abnormal discharge (mucus, pus) from cervix, penis • Pain during urination • Illustration • Photos (Sexually Transmitted Disease Guide, 6 images)

  17. Chlamydia Treatment • Antibiotics • Take all medication • Communicate with all sex partners • Sexual intercourse should be avoided until treatment plan is finished • Condoms can help prevent the spread of chlamydia

  18. Chlamydia Complications • Conjunctivitis in newborn (eye drops given) • Reiter’s Disease (sensitive photos) • Pelvic Inflammatory Disease (“PID” Illustration) • Infection • Disease-causing organisms migrate to uterus, fallopian tubes, ovaries • Untreated, PID leads to scarring, pelvic pain, tubal pregnancy, infertility • Treatment includes antibiotics • Approximately 1 million women affected each year • Approximately 100,000 women become infertile each year • Video clip (2:05 via medicalvideos.us)

  19. Chlamydia Complications • Epididymitis • 600,000 cases a year • Inflammation of epididymis • Tube located in back of testicle • Holds maturing sperm • Disease-causing microbe enters urethra, travels • Symptoms include fever, pain, discharge, swelling • Treatment includes antibiotics, STD treatment if applicable • Chronic epididymitis does not threaten fertility • Sensitive photo ,photo2(Seattle STD/AIDS Prevention Training Center)

  20. Lymphogranuloma Venereum

  21. Lymphogranuloma venereum • From different chlamydia bacteria • More prevalent in Asia, Africa, South America, but increasing in North America; now required to be reported in WA • Per DOH, six cases in 2008-2009 • Painless pimple or lesion on genitals • Infection spreads to lymph tissue

  22. Gonorrhea

  23. About Gonorrhea • Incidence • US: 358,366 cases reported to CDC in 2006 (half the estimated actual number) • WA State: 2,268 cases in 2009 • King County: • 1570 reported cases in 2010 • 404 in women, 1166 in men • Gonorrhea surveillance map (CDC, 2009) • Bacterial infection • Gonorrhea can be passed via vaginal, oral, anal intercourse

  24. Gonorrhea Rates, 1941-2012 (CDC)

  25. Gonorrhea Symptoms • Symptoms usually appear within 10 days of contact with infected partner • Some cases are asymptomatic • Among women: bleeding/pain during intercourse, vaginal discharge, burning during urination • Among men: pus-like discharge from penis, burning during urination, swollen testicles • Anal infection: burning, itching, fresh blood in feces; painful bowel movements • Illustration • Photos (Sexually Transmitted Diseases Guide)

  26. Gonorrhea Treatment • Antibiotics • Take all medication • Communicate with all sex partners regarding infection • Refrain from sexual activity until infection is gone • Condoms can help prevent the spread of gonorrhea

  27. Gonorrhea Complications • Gonorrhea passed to newborns during delivery • Antibiotic eyedrops • PID • Epididymitis • Rarely, gonorrhea may spread bacteria to the body, infecting blood, joints, heart • Those with gonorrhea are more susceptible to HIV

  28. Human Papillomavirus (HPV)

  29. About HPV • Incidence, Prevalence: • Incidence numbers = new cases • Prevalence numbers = those living with a condition • Other interpretation = those who may experience a condition at some point in their lives • US: Several million a year new cases; 20-40 million already infected (King County Public Health); 75-90% of population may expect to have HPV at some point in their lives • No required reporting • The most common STD

  30. About HPV • Virus; therefore, incurable • A group of many viruses • 200+ strains • 40+ HPV forms can be sexually transmitted (CDC) • Transmission via vaginal, oral, anal sex

  31. HPV Symptoms • Sometimes HPV provides no symptoms • Most common symptom is genital warts • Appearing days, weeks or longer after infection • Less common among men • Illustration • Photos: common & plantar warts, men, women , other images (OSU Student Health Services, afraidtoask.com, MayoClinic.com, avert.org)

  32. HPV Symptoms: Genital Warts (CDC)

  33. STD Surveillance Network: Genital Warts (CDC)

  34. HPV Prevention & Treatment • Genital warts may disappear on their own • Topical ointments/creams provided by physician • Freezing/burning/laser treatments for smaller warts • Communicate with all sex partners regarding HPV • Refrain from sexual activity until warts are gone • Condoms may help prevent HPV transmission (less definite than other conditions)

  35. HPV Complication: Cancer • Approximately 30 of the HPV strains are thought to cause cervical cancer • HPV-16, HPV-18 thought to cause the most cervical cancer cases (Gardasil specific to these, also strains HPV-6, HPV-11, which are associated with warts ) • Women should have regular pap tests • HPV may also increase risk of vulvar, anal, penile, and oral cancers(ABC News, January 2012, 3:28)

  36. HPV Prevalence, High- and Low-Risk, Among Females 14-59, 2003-2006

  37. HPV Vaccines • Vaccines for several HPV strains • Gardasil • FDA approved for males & females, age 9-26 yrs • 3 injections across 6 months • Protects against four high-risk HPV types (6, 11, 16, 18) • Side effects (4:10; CNN, 2009, via YouTube) • Cervarix(1:04; NHS, 2009, via YouTube) • FDA approved for females, aged 10-25 • 3 injections • Protects against HPV types 16, 18

  38. Syphilis

  39. Syphilis

  40. About Syphilis • Incidence • US: 13,997 in 2009 • Top 13 states = 75% of cases per CDC • Data by sex (males on the increase, females on the decrease) • King County: 289 early syphilis cases in 2010 • 285 - men, 4 - women • Over 90% among men (MSM) • Source: 2009 King County STD Epidemiology Report • Caused by bacteria, therefore curable • Transmission via vaginal, oral, anal sex

  41. Syphilis Rates, 1941-2012 (CDC)

  42. Syphilis Symptoms • Syphilis is a multi-stage disorder: • Primary stage - painless, infectious chancre • Several days-few months after infection • Genitals, mouth, rectum, other areas • Sometimes there is no chancre • Ulcer heals; many may think there is no problem • Illustration: male (MayoClinic) • Photos: oral, male, female(CDC, Univ. of South Carolina Integrated Biomedical Sciences; University of Quebec; Cincinnati STD/HIV Prevention Training Center; istdpictures.com)

  43. Syphilis Symptoms • Secondary stage • Infectious rash • 3-6 weeks following infection • Hands, soles of feet; other areas • Fever and flu-like symptoms may also be apparent • Rash typically heals after several weeks • More photos, including rash pix (Hardin Library, CDC) • CondylomataLata • Wart-like lesions (on female,male,CDC)

  44. Syphilis Symptoms • Latent Stage • Infection hides in body, often central nervous system • Infected person can remain in this stage for years • There may be no symptoms for a long time • Disease begins to attack organs • Latent further divided into early, late, or unknown stages based on when infection occurred • Late/Tertiary Stage • Severe symptoms develop: paralysis/numbness; blindness; heart disease; dementia

  45. Syphilis Treatment • Penicillin or other antibiotic • Communicate with all sex partners regarding syphilis • Refrain from sexual activity until infection is gone • Condoms may help prevent syphilis transmission

  46. Syphilis Complications • Late-stage syphilis • If blood vessels affected, stroke,other cardiovascular incident may occur • Nervous system (brain) damage • Al Capone • Apparently knew, did not treat • Became confused, disoriented

  47. Syphilis • PBS “Frontline:”The Children of Rockdale County • Tuskegee Syphilis Experiment • Began in 1930s • ~400 African American males with syphilis observed • When penicillin became available, not provided • Ended in 1972 as a result of a news leak; settlement in 1974; Al Gore overview(1:35, usrf.org) • Formal apology did not occur until 1997 (1:10, usrf.org) • Over 100 individuals died from syphilis complications • PBS “Nova” - “The Deadly Deception”(1:30-9:44/20:41/22:13/23:45/ 26:39/31:08 via Youtube)

  48. Syphilis • Guatemala Experiment (3:07, NBC News) • March 14, 2011 - lawsuit filed after demands for out-of-court settlement were not met • June 2012 – lawsuit dismissed in federal court

  49. Herpes

  50. About Herpes • STD caused by the herpes simplex virus • Incidence • US: 500,000 to 1,000,000 new cases/year • King County: 700 initial infections in 2006 • Prevalence: 45 million adolescents and adults have had “genital herpes” (CDC) • Caused by a Herpes Simplex I (HS-1) or Herpes Simplex II virus (HS-2) • HS-1 generally causes oral lesions; HS-2 generally causes genital lesions; not exclusive

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