SEXUALLY TRANSMITTED DISEASES (STDs)

1. Nicholas Perez Stephanie Torres Tiffany Wainwright Kristen Crawford Heidi Milad Jay Patel SEXUALLY TRANSMITTED DISEASES (STDs) Health Issues in the African American Community Dr. Kamal Khan

2. Problem: Here’s a fact… The CDC estimates that 19 million new sexually transmitted infections occur each year. Almost half of them among young people ages 13 to 24

3. OUR QUESTION: Why are STDs so prevalent among African Americans between 13-24 years of age?

4. STI General Overview What is an STI (Sexually Transmitted Infection)? • A serious infection of the reproductive organs acquired during sexual contact. They may cause painful localized symptoms such as burning and itching or a more generalized illness affecting the entire body, such as infertility, blindness or even death.

5. STI General Overview (con’d) • STIs are caused by pathogens such as viruses (AIDS, Genital Herpes, HPV/genital warts), bacterium (Gonorrhea, Chlamydia), parasites (Scabies) or a fungi. • They are spread through sexual contact which includes vaginal, oral and anal sex as well as basic skin to skin contact (genital warts/herpes) and contact with bodily fluids (Hepatitis C). More than 20 sexually transmitted diseases have been identified.

6. Another Fact… African Americans are disproportionately INFECTED and AFFECTED by STIs.

7. WHY? • Poverty • Lack of health care resources • Distrust of health systems • Lack of sexual education programs in schools/communities • Barriers due to racial and sexual stigmas • Lack of testing and treatment

8. What’s Most Prevalent? Gonorrhea cdc.gov

9. AND… Chlamydia cdc.gov

10. GonorrheaA.K.A“The Drip”“The Clap”

12. What is gonorrhea? • Gonorrhea is a very common sexually transmitted disease, caused by a bacteria that easily grows and multiplies in warm, moist areas of the reproductive tract such as the cervix, the uterus, the fallopian tubes, and the urethra. This bacterium can also grow in the mouth, throat, eyes, and anus.

13. Infection • Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. • Ejaculation does not have to occur for infection to occur. • Gonorrhea can also be spread from mother to baby during delivery. This may cause blindness, joint infection, or a life-threatening blood infection in the baby. • People who have had gonorrhea and were treated may become infected again .

14. Signs and Symptoms • For men: • Burning while urinating • White, yellow, or green discharge from penis • Painful or swollen testicles • Many men experience no symptoms • Some have symptoms 2-5 days after infection, but they can take up to 30 days to appear

15. Signs and Symptoms • For women: • Pain or burning while urinating • Increased vaginal discharge • Irregular bleeding • Symptoms are often mild, but most women have no symptoms at all • Even when symptoms do occur, they are often mistaken for a bladder or vaginal infection

16. Signs and Symptoms • Rectal infections (both men & women): • Discharge • Anal itching • Soreness • Bleeding • Painful bowel movements • May cause no symptoms • Throat infections: • Sore throat • Usually causes no symptoms

17. Diagnosis • A doctor or a nurse can obtain a sample from parts of the body likely to be infected, such as the cervix, urethra, rectum, or throat, and send it to a lab for analysis. • Gonorrhea present in the cervix or urethra can be diagnosed through a urine sample. • A Gram stain is a quick lab test that can be done in a clinic or doctor’s office. This test allows the doctor to see the gonorrhea bacterium under a microscope and can be done for men and women.

18. Treatment • Several antibiotics can successfully cure gonorrhea • However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States. • Successful treatment is becoming more difficult. • Because many people with gonorrhea also have Chlamydia, antibiotics for both infections are usually given together. • In women, gonorrhea is a common cause of pelvic inflammatory disease (PID).

19. Incidence and Prevalence • The Center for Disease Control estimates that more than 700,000 persons in the United States alone get new gonorrheal infections each year! • But, only half of these infections are reported. • In 2004, 330,132 cases of gonorrhea were reported to the CDC. • In 2001, 75% of the total number of cases of gonorrhea reported to CDC occurred among African-Americans. • Compared to all races, ethnicities, and ages, African-Americans aged 15- to 24-years had the highest rates of Gonorrhea in 2001.

20. Gonorrhea — Rates by race and ethnicity: United States, 1981–2001

21. Chlamydia

22. What is Chlamydia? • Chlamydia, which is caused by the bacterium Chlamydia trachomatis, is the most frequently reported sexually transmitted disease in the United States. • Chlamydia is known as a “silent disease” because about ¾ of infected women and ½ of infected men have no symptoms. • Chlamydia can damage a woman’s reproductive organs. Serious complications that cause irreversible damage, such as infertility, can occur before a woman ever recognizes a problem and before any symptoms occur.

23. Infection • Chlamydia can be transmitted during vaginal, anal, or oral sex. • Women are frequently re-infected if their sex partners are not treated • Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth. Untreated chlamydia can lead to premature childbirth, and chlamydial infections of the eyes and respiratory tracts. Also, chlamydia is the leading cause of early infant pneumonia and conjunctivitis (pink eye) in newborns. • People who have had chlamydia and were treated may become infected again.

24. Signs and Symptoms • If symptoms do occur, they usually appear 1-3 weeks after exposure. • For women: • Initial infection is of the cervix and urethra: • Abnormal vaginal discharge • Burning while urinating • Infection spreads from cervix to fallopian tubes: • Lower abdominal pain • Low back pain • Nausea • Fever • Painful intercourse • Irregular bleeding • Cervical infection can spread to the rectum

25. Signs and Symptoms • For men: • Discharge from penis • Burning while urinating • Burning and itching around opening of penis • Rectal infection: • Rectal pain • Discharge • Bleeding • Throat infections can also occur through oral sex

26. Diagnosis • Laboratory tests are done to diagnose chlamydia • Some are performed using a urine test • Other require a specimen from the penis or cervix

27. Treatment • There are several antibiotics that can successfully treat and cure chlamydia • Most common: Azithromycin (single dose) & Doxycycline (twice daily for a week) • To avoid re-infection, persons with chlamydia should abstain from sexual intercourse until they and their partners have completed treatment. • In women, untreated chlamydia can spread to the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). • Up to 40% of women with untreated chlamydia develop PID. • PID can cause permanent damage, leading to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancies.

28. Complications

29. Incidence and Prevalence • The Center for Disease Control estimates that approximately 2.8 million American are infected with chlamydia each year. • However, under-reporting is common because most people are unaware of their infections and do not seek testing • In 2004, 929,462 chlamydial infections were reported to the CDC in the U.S. • African Americans have the highest rate of chlamydia. • African American women are disproportionately impacted by chlamydia. In 2004, the rate of reported chlamydia among black females (1,722.3) was more than 7.5 times that of white females (226.6).

30. Prevalence In African Americans in 2004

31. Prevention • As with any STD, the only sure way to prevent gonorrhea and chlamydia is to abstain from sexual intercourse, or to be in a long-term monogamous relationship with a partner who has been tested. • Latex male condoms, if used consistently and correctly, can reduce the risk of transmission of both diseases. • Annual screening is recommended for sexually active women under 25 years of age, and for older women with risk factors for chlamydia or gonorrhea. • To avoid serious complications and the spreading of STD’s, any genital symptoms such as discharge or burning during urination should be a signal to stop being sexually active and to see a doctor immediately!

32. Why such a disparity? • Young black women are at heightened risk of contracting a sexually transmitted disease. • One reason for this disparity is the significantly larger proportion of African American girls engaging in risky sexual behavior.

33. High Risk Behaviors • Sexual Intercourse: • Primary mode of transmission of STD’s • In 2003, 61% of all black high school females reported ever having sexual intercourse, compared to 46% of Latina and 43% of white female high school students. • Multiple Partners: • Research associates a higher number of lifetime sexual partners with increased risk of STD infection • In 2003, 16% of black, teenage females reported four or more lifetime sex partners, compared to 11% of Latina and 10% of white teenage females. • An Older Male Partner: • Young women may be at higher risk of infection when an older male is their sex partner. Research has also shown that a younger female may be less able to negotiate condom use, or more likely to rely on her older partner to make sexual health decisions for her that may not be in her best interest. • According to one study, 24% of black females aged 14-17 years old reported their first sexual intercourse to have occurred with an older male. • Compared to their peers whose first encounter occurred with a male of their own age, these young women were significantly younger at the age of their first sexual intercourse, and much less likely to use condoms.

34. Other Factors… • Other factors, such as socioeconomic and cultural factors, may make young black women more vulnerable to sexually transmitted diseases than young girls of other racial/ethnic groups

35. Other Factors… • Poverty: Over 24% (1 in 4) of blacks lived in poverty in 2003, compared to 8% (1 in 12) of whites. In 2002, 43% of black households were headed by single women, and one study found that children living in households headed by single women were 5 times more likely to be living in poverty. Limited resources in poor households can force women to choose between competing priorities, such as putting sexual risk reduction second to the need for food, clothing, shelter, safety, and childcare.

36. Other Factors… • Discrimination:Many black women face daily racism and gender discrimination, leading to a lack of job opportunities and increased poverty. • Through interviews with African American women living in the South, which continues to have the highest rates of STD’s than any other U.S. region, one study found that the difficult economic situation and persistent racial oppression, lack of recreational outlets, boredom, and substance use were co-factors in this region’s STD epidemic. • Very few jobs are available locally and many must travel long distances to work, which is often impossible without a car and very little public transportation. Respondents simply saw the risk of sexually transmitted diseases as a lesser problem than other problems with which they must struggle.

37. Other Factors… • Disproportionate Incarceration:63% of prisoners are black or Hispanic. Blacks are 7 times more likely than whites to be incarcerated. Women of color comprise 60% of female inmates, and black women are 6 times more likely to be incarcerated than are white women. • The cycle of imprisonment and release among the African American community, for both black men and women, contributes to their high rates of STD’s. Those put in prison are at high risk of infection due to shared paraphernalia for injection drug use, tattooing, body piercing, survival sex, and rape. Upon being released, they may transmit the STD to their partner. If they return to prison, their partner may form new relationships and transmit the disease to other blacks in the community. This vicious cycle perpetuates the STD epidemic among blacks.

38. Other Factors… • Survival Sex:Many women living in poverty may have multiple sex partners, often times concurrently, in order to obtain social networks, acquire food, shelter, or other necessities, or even for companionship. • Having multiple sex partners is a primary risk factor in the transmission of sexually transmitted diseases. Non-monogamous sexual relationships causes many people to become infected in a very short amount of time. • Research has shown that black men are more likely to have multiple sex partners than white or Hispanic men.

39. Other Factors… • Lack of Access to Health Care:In 2003, 20% of blacks were uninsured. Blacks constitute the single largest group of those without health insurance. This prevents blacks from receiving proper testing and treatment for STD’s. • The CDC also found that youth who lack access to health care may also lack accurate information about STD prevention, testing, and treatment.

40. Cases of STD’s Reported by State Health Departments: US, 1994

41. Top 10 states ranked by rate (per 100,000) of reported Chlamydia cases: US, 2004 Top 10 States by rate (per 100,000) of reported Chlamydia: U.S. 2004

42. Top 10 states ranked by rate (per 100,00) of reported Gonorrhea cases: US 2004

43. Chlamydia Rates in the U.S: 1984 - 2004

44. Chlamydia Age- and Sex-Specific rates: United States, 2004

45. Chlamydia Positivity among 15-24 year Old Women Tested in Family Planning Clinics by State, 2003

47. Gonorrhea Rates by State: United States and outlying areas, 2004

48. Gonorrhea — Rates by sex: United States, 1981–2004 and the Healthy People 2010 target

49. Gonorrhea Age-specific rates among women 10 to 44 years of age:United States, 1981–2004

50. Gonorrhea Age-specific rates among men 10 to 44 years of age:United States, 1981–2004