Chapter Fifteen

1. Sexually Transmitted Infections and HIV/AIDS Chapter Fifteen

2. Agenda • Discuss Attitudes and STIs • Review Information about Sexually Transmitted Infections • Discuss Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) • Review Cross-Cultural Aspects of AIDS • Discuss Preventing STIs and AIDS

3. Introduction • Over 65 million people in the U.S. are living with an incurable STI • 19 million STI infections occur each year, half to those to people 15-24 years old • There are more than 25 infections that spread mainly through sexual activity

4. Design a Campaign • You have been chosen to develop a campaign aimed at developing healthy sexuality for high school students. • In this particular city the rate of STIs is the highest in the country. • Develop the components of your ad campaign. • Present your campaign plan to class.

5. Self Reflection Exercise Do NOT discuss. Write down your thoughts privately. • If I found out I was infected with herpes or genital warts, I would … • If my partner were infected with chlamydia, I would … • If I found out I had AIDS, I would …

6. Attitudes about Sexually Transmitted Infections

7. Attitudes and the STI Epidemic • STIs have been viewed as a sign of corrupt sexuality • Punishment concept of disease – that a person got what they deserved • Negative beliefs and stigma about STIs currently exist • These negative attitudes can interfere with getting tested for an STI

8. Attitudes and the STI Epidemic • College students believe they are immune to STIs and engage in high-risk sexual behaviors • e.g. multiple partners, unprotected intercourse • 2/3 of STIs occur in people under 25

9. Reporting Pregnancy Complications Protection Sexually Transmitted Infections: Trends

10. Reporting Issues • All states must report syphilis, gonorrhea, chancroid, chlamydia, HIV, & AIDS cases • Many states require that genital warts and herpes be reported • Women are more susceptible to gonorrhea, chlamydia, HIV • Women have more risk of complications from STIs because vaginal tissue is fragile • Women are more likely to be asymptomatic

11. Pregnancy Complications • STIs can affect pregnancies • 30-40% of preterm births and infant deaths are due to STIs • Some can cross the placenta (syphilis, HIV) • Some can infect the newborn during delivery (chlamydia, gonorrhea, herpes, HIV) • HIV can be transmitted through breastfeeding • Antibiotics and c-sections can minimize harm

12. Protection • Barrier methods can decrease the risk of STIs • Non-oxynol 9 may increase the risk of infection by irritating the skin • Condoms are the most effective contraceptive that reduces the STI risk • Condoms cannot cover all of the penis, vulva, or scrotum

13. Protection: Partner Issues • Most effective way of avoiding STIs is to abstain from oral, vaginal, and anal sex or be in a long-term, mutually monogamous relationship with someone free from STIs • If a person does have an STI, treatment should include treatment of their sexual partner(s)

14. Penis becomes erect Carefully open package and remove condom Buy/Get condoms Store condoms in cool, dry place Check expiration date Decide with partner to have sexual intercourse Check to see which way condom unrolls Talk about protection and safer sex Lose erection Pull back foreskin if uncircumcised Place condom on head of penis Orgasm and ejaculation Gently squeeze air out of tip of condom Roll condom all the way down erect penis Intercourse Throw away condom in garbage – don’t flush Hold condom at base of penis and withdraw penis Remove condom from penis Lose erection Decide with partner to have sexual intercourse Talk about protection and safer sex Buy/Get condoms Store condoms in cool, dry place Check expiration date Penis becomes erect Carefully open package and remove condom Check to see which way condom unrolls Lose erection Pull back foreskin if uncircumcised Place condom on head of penis Gently squeeze air out of tip of condom Roll condom all the way down erect penis Intercourse Orgasm and ejaculation Hold condom at base of penis and withdraw penis Remove condom from penis Lose erection Throw away condom in garbage – don’t flush Class Exercise: Condom Line Up

15. Ectoparasitic Infections Bacterial Infections Viral Infections Sexually Transmitted Infections

16. Ectoparasitic Infections • Parasites that live on the skin’s surface • Two sexually transmitted varieties: • Pubic Lice • Scabies

17. Pubic Lice • Also called “crabs” • Small, wingless insects that are difficult to detect on light-skinned people • Attach to pubic hair (preferred) by their claws & drink from tiny blood vessels under the skin • Cannot survive more than 24 hours off of the body, however, they reproduce rapidly and eggs are cemented to the hair • Highly contagious

18. Pubic Lice: Prevalence, Symptoms, Treatment • Incidence: common • Symptoms: mild to severe itching (particularly at night) thought to be due to allergic reaction from their saliva • Diagnosis: lice and eggs are visible • Treatment: kill eggs & lice with Kwell ointment (shampoo, cream); clothing & sheets dry cleaned, boiled, or washed in hot water

19. Scabies • Mite Sarcoptes scabiei • Spread via any skin-to-skin contact • Mites can live up to 48 hours off of the body • Not visible to naked eye

20. Scabies: Prevalence, Symptoms, Treatment • Incidence: millions worldwide • Symptoms: rash and severe itching • Diagnosis: examination of the rash and a skin scraping can confirm diagnosis • Typically less than 10 mites on the body during an infection • Treatment: topical creams; clothing and sheets washed in hot water

21. Bacterial Infections • Gonorrhea • Syphilis • Chlamydia and Nongonococcal Urethritis • Chancroid • Vaginal Infections • Pelvic Inflammatory Disease

22. Gonorrhea • Also called the “clap” or “drip” • Survives only in mucous membranes, such as the cervix, mouth, urethra, rectum, throat, eyes • Transmitted when mucous membranes contact each other • Incidence: second most commonly reported infectious disease in the U.S.; 600,000 to 1 million new cases each year

23. Gonorrhea: Symptoms • Women: most are asymptomatic, cervix is most common infection site; urinary frequency, abnormal bleeding • Men: 25% are asymptomatic; epididymitis, urethral discharge, painful, frequent, & urgent urination • Swelling, pain, & pus in the joints • Rectal gonorrhea: bloody stools & pus

24. Gonorrhea: Diagnosis & Treatment • Diagnosis: examine for bacteria in a sample of the discharge; can also run DNA testing of urine • Treatment: antibiotics (oral, injection) • Note: there are rare cases when they have become drug-resistant

25. Syphilis • Live in the mucous membranes • Typically first infects the cervix, anus, penis, lips, or nipples • Incidence: 7,177 cases reported in 2003 • Symptoms: 3 stages • Primary/Early • Secondary (after chancres disappear) • Tertiary (remission, but still infectious; can lead to long term health risks)

26. Syphilis: Stage 1 • 1: primary/early syphilis 10-90 days after infection • Chancres (small, round, red-brown, painless sores with a hard raised edge & sunken center) may appear on the vulva, penis, vagina, cervix, anus, mouth, lips

27. Syphilis: Stage 2 • 2: secondary syphilis after chancres disappear • Syphilis invades the central nervous system • Reddish patches on the skin, possible wart-like growths in area of infection • Lymph glands enlarge • Headaches, fever, anorexia, flu-like symptoms, fatigue

28. Syphilis: Stage 3 • 3: tertiary/late syphilis • Stage of remission and a person feels fine, though able to transmit the disease for 1 year • If not treated, this stage can cause neurological, muscular, sensory, & psychological difficulties and is eventually fatal

29. Syphilis: Diagnosis & Treatment • Diagnosis: culture taken from a lesion; blood tests • Treatment: Penicillin; antibiotics can temporarily increase the symptoms for a few hours

30. Chlamydia and Nongonococcal Urethritis • May also cause epididymitis and nongonococcal urethritis in men • Incidence: most commonly reported infectious disease in the U.S.; estimated 2.8 million new cases per year • Highest among African Americans • Higher in young women • Underdiagnosed in men

31. Chlamydia and Nongonococcal Urethritis: Symptoms • Chlamydia is highly contagious • Symptoms: asymptomatic in 75% of women and 50% of men • Female symptoms: burning while urinating, painful intercourse, pain in lower abdomen, bleeding/spotting, rare for discharge • 40% will get PID, 20% will become infertile • Male symptoms: discharge from penis, burning while urinating, burning & itching at penile opening, pain or swelling of testicles

32. Chlamydia and Nongonococcal Urethritis: Diagnosis & Treatment • Diagnosis: culture cervical discharge for women, blood test, urine test for men • Treatment: antibiotics for 7-10 days; some cases have become drug-resistant

33. Vaginal Infections • There are many common vaginal infections related to sexual intercourse • Trichomoniasis • Bacterial vaginosis • Candiasis

34. Trichomoniasis • Trichomonas vaginalis • Female symptoms 3-28 days after infection: increase in yellowish, frothy, & foul-smelling vaginal discharge; burning/itching in vagina; asymptomatic • Male symptoms: asymptomatic, discharge at tip of penis, burning while urinating or ejaculating • Treatment: metronidazole (Flagyl™)

35. Bacterial Vaginosis • Most common vaginal infection in women of childbearing age, though half are asymptomatic • Increased susceptibility with: multiple partners, douching, low concentrations of beneficial vaginal bacteria • Treatment: metronidazole or clindamycin

36. Candidiasis • Vulvovaginal candiasis; yeast infection • Caused by a variety of fungi, most commonly Candida albicans • Fungi normally common in vagina, but will multiply when the pH balance is disturbed • pH changes due to: pregnancy, oral contraceptives, douching, antibiotics, diabetes, fecal material contacting the vagina

37. Candidiasis • Symptoms: burning, itching, and increase in vaginal discharge that may be thin, white, and including white chunks • 75% of women will have at least one yeast infection • Recurrences are common • Treatment: antifungal prescription or over-the-counter drugs (cream is topical or inserted into the vagina); plain yogurt

38. Pelvic Inflammatory Disease • Infection of the female genital tract • Most often caused by chlamydia and gonorrhea • PID can cause long-term complications such as ectopic pregnancies, chronic pelvic pain, infertility • Estimated to affect 1 out of 7 women by age 35 at least once

39. Pelvic Inflammatory Disease: Symptoms & Tratment • Characteristics of a typical PID sufferer: young, unmarried, multiple partners, had an STI, early age at first intercourse, minority, use douches • Symptoms: acute pelvic pain, high fever, abnormal vaginal discharge • Often asymptomatic • Treatment: antibiotics for 14 days

40. Viral Infections • Once a virus enters a body, it can reproduce and the person will have it for the rest of their life • Although they may not experience symptoms while the virus lies dormant, they are still infected • Common Viral STIs • Herpes • Human Papillomavirus • Viral Hepatitis

41. Herpes • Infection with herpes simplex virus (HSV) • The virus prefers the mouth and face (herpes simplex I) or the genitals (herpes simplex II) • The symptoms may be less severe if the virus infects a less preferred site • The virus exists in the sores, as well as from the infected skin without the sores present (viral shedding) • HSV can be spread without active symptoms • A person can reinfect themselves on another body part

42. Herpes: Incidence & Symptoms • Incidence: one of the most common STIs in the U.S.; 1 million infected each year • Symptoms: sores that last 8-10 days, tingling/burning feeling, itching & red swollen genitals, painful urination, blisters with pus, fever, headaches, pain, itching, discharge, fatigue • Over time, outbreak frequency diminishes • Psychological reactions: guilt, anger, anxiety, helplessness, frustration, depression, lowered self-esteem

43. Herpes: Diagnosis & Tratment • Diagnosis: presence of blisters, sometimes a scraping will be taken • Treatment: no cure; therapy with antiviral drugs (topical, oral, injected) to decrease outbreaks, prevent complications, & reduce viral shedding; ice pack; cooling or drying agent; L-lysine; decrease sugar & nuts • Vaccines are undergoing trials

44. Human Papillomavirus • Over 30 types of HPV • Almost all cervical cancers can be attributed to HPV and HPV can also cause genital warts • Transmitted through intercourse, oral sex, vulva-to-vulva sex, anal sex • Incidence: estimated 50% of sexually active people will get HPV • Related factors: intercourse before 16, 2+ sexual partners in a year, Hispanic women

45. Human Papillomavirus: Symptoms & Treatment • Symptoms: asymptomatic; genital warts in 10% of HPV cases (highly contagious); foul-smelling discharge; itching & pain • Diagnosis: visual inspection of warts, biopsies, Pap test • Treatment: chemical topical solutions, cryotherapy, electrosurgical interventions, laser surgery • May resolve itself or need many treatments

46. Viral Hepatitis • 3 types & their transmission routes: • Hepatitis A (HAV) – fecal-oral contact; vaccine-preventable • Hepatitis B (HBV) – high-risk sexual behaviors • Hepatitis C (HCV) – sexual behavior, drug use, unscreened blood transfusion • Incidence: • HAV: 1/3 in the U.S. • HBV: 1.25 million in the U.S. • HCV: 3.9 million in the U.S.

47. Viral Hepatitis: Symptoms • HAV: fatigue, abdominal pain, loss of appetite, diarrhea • HBV: asymptomatic, nausea, vomiting, headaches, jaundice, fever, fatigue, darkened urine, liver enlargement, chronic liver disease • HCV: asymptomatic, mild illness, chronic liver infection

48. Viral Hepatitis: Diagnosis & Treatment • Diagnosis: blood test • Treatment: 3 drugs that interfere with the life cycle of the virus and induces an immune response • Vaccines are available for HAV and HBV • Recommended for high risk individuals

49. Incidence Knowledge and Attitudes about AIDS Symptoms Diagnosis Treatment Prevention Families and AIDS HIV/AIDS

50. CNN Video: Fighting AIDS in Africa