Sexually Transmitted Diseases

1. Sexually Transmitted Diseases

2. A Plague of Epic Proportions • Worldwide  400 million new cases/year • The U.S.  15 million/year • Hits the 15-25 age group hardest • ¼ by 21! • Teen women  gonorrhea & Chlamydia • Genital warts and Aids are huge threats • Pelvic Inflammatory Disease a frequent consequence

3. The Biggest Threats? • Aids/HIV  deadly and dreaded • But other STDs, especially Chlamydia and genital warts are more prevalent

4. Why the Epidemic? • An explosion of risk behaviors multiple partners unprotected sex • Oral contraceptive use increase susceptibility decrease condom use

5. More Reasons • Public Health failures meager access to prevention/treatment MDs don’t ask enough questions • Symptoms are often latent • Shame

6. Chlamydia • An urogenital infection caused by the bacteria chlamydia trachomatis • Very common and dangerous • Increase of 400% from ’87 to ’99 • 3-5 million new cases in US each year • Teens suffer the highest infection rates • Oral contraceptives & douching increase • Often transmitted through fingers

7. Chlamydia Symptoms • Two types • One infects the lower reproductive tract with just mild burning • The other manifests as a PID of the upper reproductive tract, infecting the uterus, fallopian tubes or ovaries

8. Common PID Consequences • For women: disrupted menstrual periods chronic low back and pelvic pain fever/nausea/headaches Salpingitisinfertility and entopic pregnancies IUDs to be ineffective • For men: epididymis and urethra infections

9. If that wasn’t enough • For many, the symptoms are not noticeable, can spread unknowingly • Also causes Trachoma, the world’s leading cause of preventable blindness • Many other effects on infants • Fortunately, easily treated with Doxycycline and Azithromycin

10. Herpes • The most common viral STD • Two types of interest: HSV-1 usually lesions or sores on mouth (cold sores) HSV-2 lesions on and around the genitals

11. How Bad is it? • Huge #s HSV-1  100 million HSV-2  50 million • With 1 million new cases a year • 20-25% US adults over 12 • Unprotected sex with multiple partners? Guaranteed Exposure

12. Transmission • Both types can be spread through a variety of ways oral sex can spread either type recently many cases of genital herpes arose from HSV-1 rather than HSV-2

13. The Horror of Viral Shedding • While victims with sores can easily spread the infection, HSV can be transmitted even in the absence of symptoms through “viral shedding” • Many spread HSV without even knowing that they are infected • Condoms provide some, but not complete, protection • Fingers can spread the virus

14. Symptoms • HSV2 2-14 day incubation 20 days of symptoms: one or more small, painful red bumps or “papules” in the genital areas or around the anus

15. It gets worse • The papules fill with nasty infectious particles permeating pus • They burst to form red, ringed sores • The sores crust and heal but can still infect someone for another 10 days • Other symptoms can be present also

16. As for HSV1 • Papules form on the lips, and occasionally on the inside of the mouth, tongue, or throat • Crust over and heal within 10-16 days • Other symptoms – fever, muscle aches, flu like maladies, bleeding in the mouth

17. Recurrence • The infection retreats up nerve fibers where it can lie dormant, perhaps permanently • Usually though, it flares up periodically with less severe symptoms and a more rapid course • Prodromal symptoms warn of eruption and ability to infect others

18. Factors which Trigger Recurrences • Emotional stress • Anxiety • Depression • Fever • Ultraviolet light • Menstruation • Fatigue

19. Complications • Few for men, but for women: 1) Cervical cancer, rare but still calls for an annual Pap smear. 2) Infection of a newborn viral shedding can cause infection as the child passes through the birth canal cesarean delivery prevents the severe danger to the child

20. Treatment of Herpes • Currently nothing can cure herpes • Three Antiviral drugs help manage it • Two treatment strategies: Suppressive – take daily to prevent Episodic – to minimize an outbreak • Neither eliminates viral shedding

21. Genital Warts • Viral warts, caused by the virus human papillomavirus (HPV) which appear on the genitals • 40 million victims in North America • Five million new cases/year

22. Top This • “Most sexually active people will get HPV.” • Recent survey – 27% of all women, 44% between 20 & ? • Even condoms fail to protect! • Most commonly spread by the asymptomatic!

23. A Disgusting Sight, Usually • First appear 3 weeks to 8 months after contact • Women  usually on the bottom of the vaginal opening • Men  throughout the penis • Can appear on the anus • In moist areas – pink/red, soft cauliflower • Dry – hard, yellow/grey

24. But Then Again • Many, probably most, do not develop visible symptoms despite infection • In other words, you can’t see it, but you can certainly get it • From any one of 40+million people

25. Complications • Bleeding & obstruction of the urethra • Association with various cancers • Account for 85-90% of attributable risk for cervical cancer. • Can be transmitted to infants at birth

26. Treatment (?) • Nothing has been shown to remove or prevent recurrence • Freezing is 60-70% effective • More aggressive treatments such as surgical removal can cause serious side effects • Perhaps vaccines will, some day, help prevent infection