SEXUALLY TRANSMITTED DISEASES

2. SEXUALLY TRANSMITTED DISEASES Lynne D. Feldman, MD, MPH – District Health Director Elsie Napier, RN, FNP – District Program Manager Brenda Mims, RN – Infectious Disease Coordinator

3. South Health District, 8-1STD Presentation Presentation to Valdosta State University / Student Health Brenda Mims, RN – Infectious Disease Coodinator

4. DCH Mission RESPONSIBLE HEALTHY ACCESS Access to affordable, quality health care in our communities Responsible health planning and use of health care resources Healthy behaviors and improved health outcomes

5. DCH InitiativesFY 2009 and FY 2010 FY 2010 FY 2009 Medicaid Transformation Health Care Consumerism Financial & Program Integrity Health Improvement Solutions for the Uninsured Workforce Development PeachCare for KidsTM Program Stability Customer Service Medicaid Transformation Health Care Consumerism Financial & Program Integrity Health Improvement Workforce Development Customer Service Emergency Preparedness

6. Disclosure Statements • To obtain nursing contact hours for this session, you must be present for the entire hour and complete an evaluation. • Neither the planners of this session nor I have any financial relationship with pharmaceutical companies, biomedical device manufacturers, or corporations whose products and services are related to the vaccines we discuss. • There is no commercial support being received for this event. • The mention of specific brands of vaccines in this presentation is for the purpose of providing education and does not constitute endorsement. • The GA Immunization Program utilizes ACIP recommendations as the basis for this presentation and for our guidelines, policies, and recommendations. • For certain vaccines this may represent a slight departure from or off-label use of the vaccine package insert guidelines.

7. Goal • To promote Sexually Transmitted Disease awareness, prevention and education.

8. Objectives • After the completion of this presentation participants should be able to: • Define Sexually Transmitted Diseases (STDs); • Describe how STDs are transmitted; • Name at least three of the most commonly diagnosed STDs; • Identify signs and symptoms of STDs; • Understand the effects of STDs on pregnancy; • Describe recommended CDC treatments for STDs; • Understand the STD reporting and follow-up process.

9. Sexually Transmitted Diseases(STDs) • Definition • An infection passed during sex by means of sexual contact, including vaginal intercourse, oral sex, and anal sex. • Until the 1990’s these illnesses/diseases were commonly known as venereal diseases. Veneris – the Latin name for Venus, who is considered the Roman goddess of love. • Can have no symptoms • Infect the following areas: • Mouth • Rectum • Sex organs ( vagina, vulva, penis, testes)

10. Can You Name these STD?

11. Lets Talk About STDs !!

12. CHLAMYDIA GONORRHEA Genital Warts HEPATITIS A, B. & C Bacterial Vaginosis Scabies Epididymitis Nongonococcal Urethritis Pediculosis Pubis GENITAL HERPES/HPV HIV/AIDS SYPHILIS Trichomoniasis “Trich” Genital & Perianal Warts Lymphogranuloma Venereum Vulvovaginal Candidiasis Pelvic Inflammatory Disease STDs

13. Chlamydia

14. Chlamydia • What is Chlamydia? • Sexually transmitted infection • A common STD caused by the bacterium Chlamydia Trachomatis • Can be transmitted through vaginal, anal or oral sex as well as to a child from the mother during birth • Can cause sterility • Mode of transmission • Spread during vaginal, anal or oral sex with someone who has Chlamydia • Symptoms • May present as non-gonococcal urethritis (NGU) syndrome in males or mucopurulent cervicitis syndrome in females • Known as the “silent” disease • Abnormal vaginal bleeding (between menstrual periods) • Burning sensation during urination • Back pain and/or pain during intercourse • Treatment • Antibiotic (Usually Azithromycin or Doxyclycline) • Partner should also be treated to prevent re-infection • Prevention • Abstinence • Condoms • Monogomy

15. Chlamydia

16. Chlamydia

17. Treatment For Chlamydia • Chlamydia can be treated with the following medications: • Azithromycin • Doxyclycline • Amoxicillin • Erythromycin

18. Gonorrhea

19. Gonorrhea • What is Gonorrhea? • Sexually transmitted disease caused by Neisseria Gonorrhoeae • Can also grow in the mouth, throat, eyes, and anus • Mode Of Transmission • Spread during vaginal, anal or oral sex with someone who has Gonorrhea • Symptoms • Many men may have no symptoms • Some symptoms may take up to 30 days to appear • Burning sensation during urination • White, yellow or green discharge from the penis or vagina • Painful or swollen testicles • Vaginal bleeding between periods • Painful bowel movements • Many with Gonorrhea also have other STDs • Treatment • Antibiotics • Drug resistant strains are increasing • Prevention • Abstinence • Condoms • Monogomy

20. Gonorrhea

21. Treatment For Gonorrhea • Gonorrhea can be treated with the following medications: • Ceftriaxone (Rocephin) • Cefixime • Azithromycin • Doxycycline • Erythromycin

22. Genital Warts/HPV

23. Genital Warts • What is Genital Warts • Small, sexually transmitted growths that is caused by Human Papillona Virus • Flesh-colored (look like miniature cauliflower florets) • Can be visible in the vagina, urethra, cervix, vulva, penis, anus • Mode of Transmission • Spread during vaginal, anal or oral sex, and sometimes by genital touching, with someone who has genital warts • Symptoms • The virus lives in the skin or mucous membranes • Can cause no symptoms • Treatment • Can be removed • No Cure (will have the virus for the rest of your life) • Prevention • Condoms • Monogamy

24. Genital Warts

25. Treatment For Genital Warts • Genital Warts can be treated but not cured: • Podofilox • Imiquimod • Trichloroacetic Acid • Podophyllin • Gardasil (HPV Vaccine)

26. Hepatitis

27. Hepatitis • What is Hepatitis? • A disease that damages the liver • Caused by a virus • Hepatitis A, B, C are most common • Hepatitis A • Passed in human feces, food and water • Symptoms: Jaundice, Fatigue, Abdominal Pain, Diarrhea, Nausea • Hepatitis B • Passed through blood, saliva, semen, or vaginal fluids (anal or oral sex), from mother to baby during birth, sharing needles to inject drugs or for any other reason • Symptoms: Persistent flu-like feelings, tiredness, jaundice, dark urine, light-colored bowel movements • Hepatitis C • Passed through blood, from mother to baby during birth, during sex (not common) • Hepatitis B & C can become chronic • Can cause cirrhosis (scarring) of the liver • Liver cancer • Prevention • Hepatitis A & B vaccine available • Hepatitis C – No Vaccine but medication available to prevent further liver damage

28. Picture of a healthy liver Effects of hepatitis on the liver Hepatitis

29. Treatment For Hepatitis A, B & C • Hepatitis A • No treatment • There is a vaccine to prevent Hepatitis A • Goes away by itself in 2-6 months • Hepatitis B • Yes / Treatment isn’t always successful • There is a vaccine that should be started at birth – all ages 0-18 should be vaccinated • Hepatitis C • Treatment with antivirals (interferon – most common) to manage and slow disease progression • There is no vaccine for Hepatitis C

30. Perinatal Hepatitis B

31. Perinatal Hepatitis B Prevention Program • Program Goals • Ensure all pregnant women are screened for HBsAg at their initial prenatal screening panel as standard of care • Be sure Public Health conducts case investigations on all positive HBsAg pregnant women • Confirm 90% of all infants born to HBsAg positive women receive HBIG and the first dose of Hep B vaccine within 12 hours of birth • Ensure that 90% of all infants born to HBsAg positive women receive the second dose of vaccine at 1-2 months of age • Ensure that 80% of all infants born in Georgia to HBsAg positive women are tested at 9 months to 18 months of age for HBsAg and Hepatitis B surface antibodies (Anti-HBs)

32. Genital Herpes

33. Genital Herpes • What is herpes? • A viral infection characterized by recurring vesicular and ulcerative lesions on the genitals or adjacent areas that heal spontaneously without scarring. • Some severe cases of first episode infection last an average of 12 days and aseptic meningitis or generalized symptoms due to viremia may occur. • Mode of transmission • Spread through vaginal, anal and oral sex – sometimes by genital touching with someone who has herpes • Symptoms • Oral Herpes • Cold sores or “fever blisters” • Genital Herpes • Most have no symptoms • Most common symptoms – cluster of blistery sores – usually on the vagina, vulva, cervix, penis, buttocks or anus • May last several weeks – may return in weeks, months or years • Fever, blisters, burning feelings if urine flows over sores, itching, open sores • Prevention • Abstinence • Do not have sexual contact during outbreaks • Use condoms between outbreaks

34. Oral & Genital Herpes

35. Treatment For Genital Herpes • There is no cure for Genital Herpes • Treatment may include: • Acyclovir • Famciclovir • Valacyclovir • Valtrex • Acetominophen or Ibuprofen (Oral Analgesic)

36. Syphilis

37. Syphilis • What is Syphilis? • An STD caused by the bacterium Treponema Pallidum • Called the “great intimidator” because many of the signs and symptoms are indistinguishable from those of other diseases • Stages of Syphilis • Primary • Secondary • Late • Congenital • Mode of Transmission • Spread during vaginal, anal or oral sex, and sometimes by genital touching, with someone who has Syphilis • Symptoms • Primary: Appearance of a sore (chancre) at the spot where syphilis entered the body – could be one or more • Secondary: Skin rash and mucous membrane lesions, fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue • Late: Difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, dementia • Congenital: rash, thinning of the skin • Prevention • Abstinence • Condoms • Monogamy

38. Primary Syphilis

39. Secondary Syphilis

40. Late Syphilis

41. Congenital Syphilis

42. Treatment of Syphilis • Syphilis can be treated; however, a person will usually have a “titer” after treatment • Titer, def. the concentration of antibodies present in the highest dilution of a serum sample at which visible clumps with an appropriate antigen are formed. The concentration of antibodies present in the highest dilution of a serum sample at which visible clumps with an appropriate antigen are formed. • Benzathine Penicillin G • Doxyclycline (Cannot be used on lactating clients)

43. HIV / AIDS

44. Can You Tell Who Has HIV?

45. HIV • Human Immunodeficiency Virus • The virus that causes AIDS • Damages the body’s immune system which protects the body from diseases • Can have for many years without signs or symptoms

46. During vaginal, oral or anal sex Blood-to-blood contact (blood with HIV in it comes into contact with blood or mucous membranes of another person) Sharing needles Needles used for tattoos and piercing or to inject vitamins or steroids Healthcare workers caring for HIV can get HIV from needle-stick injuries Mother to baby during pregnancy, childbirth, or breast feeding HIVModes of Transmission

47. HIV • HIV is not passed by: • Donating blood • Hugging, dry kissing, or sharing food • Telephones, toilet seats, or eating utensils • Tears, saliva, sweat or urine • Mosquitoes or other insects • Coughing, sneezing, or spitting

48. HIV • Incubation Period: • Some people develop symptoms shortly after being infected • Sometimes it takes more than 10 years for symptoms to appear.

49. Stages of HIV“Stage 1” • Primary HIV Infection • Last for a few weeks • Have flu-like symptoms • Body begins seroconversion • Body responds to the virus by producing HIV antibodies • Can last 3 weeks to 6 months

50. Stages of HIV “Stage 2” • Asymptomatic Stage • Having no obvious signs of symptoms • Immune system still strong enough to prevent symptoms • Last for an average of 10 years • People continue to look and feel healthy • The virus can still be passed to other people • Unprotected sex, needle sharing • HIV virus continues to weaken the immune system