Sexually Transmitted Infections (STIs)

2. Sexually Transmitted Infections (STIs) U.S. Data (CDC): • About half the population will have one at some point in their lives • An estimated 19 million people infected each year in the U.S. alone • At greatest risk: age 15-24

3. STDs or STIs • In this age group, most common STIs • Chlamydia • Gonorrhea • HPV • Most have no symptoms early on! • Transmitted by both intercourse (vaginal or anal) and oral sex

4. STDs or STIs • Emotional fall-out: • embarrassment • shame • guilt • despair • fear • These negative emotions can make people go in denial and avoid taking precautions or disclosing to partners.

5. STDs or STIs • Bacterial or viral diseases that are sexually transmitted through genital/oral/anal contact but also other conduits • Bacterial STIs: • can be cured if caught early • Viral: • can NOT be cured

6. STDs or STIs • Difference between most common reportable STI and most common STI • not all STIs are required to be reported • Many if not most (depending on disease and gender) are ASYMPTOMATIC • So: can transmit unknowingly

7. STDs or STIs • Most Common: • HPV human papilloma virus (warts), not reportable • HPV: • over 150 different strains • transmitted not only sexually but by skin to skin in genital, oral and anal contact • cauliflower-like warts in vulva, vagina, penis, pubic area and anus but can be asymptomatic • leads to cervical cancer; recently vulvar precancerous growths, especially women over 40 (e.g. labia, clitoris)

8. STDs or STIs • HPV: (Cont’d) • oral cancer : increase of oral sex • oropharyngeal cancer (mouth and throat) associated with HPV in the oral cavity. Far fewer oral sex partners result in increased cancer risk than with genital partners, rivaling oral cancers due to tobacco and alcohol • can cause penile and anal cancer • 100 MUN female students a year have precancerous changes due to HPV • birth control pill interaction • hormones in contraceptive promotes changes in cervical cells that make it more vulnerable (squamous cells)

9. STDs or STIs • HPV (Cont’d): • smoking interaction: • nicotine metabolites increase cervical cancer risk • early sex (13-15) is a risk factor (more likely to have more partners) • multiple partners, also a risk factor, including multiple partners of partner • effect of alcohol and drugs: • weaken immune system, impair judgment of risk • condoms not very effective in protecting against HPV: • warts can be in areas other than penis or vagina, e.g. pubic area, anus • no cure • it’s estimated that 85% of sexually active people have it, but strong immune system can fight it off

10. STDs or STIs HPV (Cont’d): • A new vaccine for HPV prevention is available since July ’06 Gardasil (contraindication: yeast allergy) • the vaccine prevents four strains of HPV, which happen to be the ones that most commonly (70%) cause cervical cancer. The recommendation is to vaccinate girls between ages 9 and 14, before they become sexually active. Girls chosen due to cervical cancer risk. • Currently tested on boys.

11. STDs or STIs • Chlamydia: • ± 400 per 100,000 depending on location • 600 female • 200 male • most common reportable STI in Canada • very high incidence • more in women, but less reporting from men • age 15-24 women highest rate • 75% women asymptomatic until it spreads to uterus • damage to: • cervix • uterus • fallopian tubes • peritoneum • liver

12. STDs or STIs • Chlamydia (Cont’d): • causes: • PID • tubal blockage • ectopic pregnancies • infertility • prematurity and low birth weight

13. STDs or STIs • Chlamydia (Cont’d): • males: • 50% asymptomatic • 50% have urethral discharge • burning urination • epididymitis • infertility • Reiter’s syndrome (conjunctivitis and arthritis) • if having anal sex: • proctitis and proctocolitis

14. STDs or STIs • Genital Herpes: • ± 25% incidence • Caused by herpes simplex virus, Type I (cold sores) and Type II – both cause the STI • 2010 study: HSV I more common in genital infections in university students • Can be transmitted through kissing, oral, genital or anal sex

15. STDs or STIs • Most are asymptomatic: • if symptomatic: small, painful blisters on genitals • also, fever, painful urination, headaches, vaginal and urethral discharge, enlarged lymph nodes • Oral HSV also includes malaise, muscle aches, lesions in the soft palate, tongue, gums, lips and face

16. STDs or STIs • Genital Herpes (Cont’d): • These symptoms last 3 weeks, then virus goes dormant, but still contagious. Genital herpes lodges at base of spinal cord, while oral herpes infects top of spinal cord and base of brain. Symptoms may recur randomly. • Children of mothers with GH Type II have higher rates of schizophrenia or other psychoses. Correlational data.

17. STDs or STIs • Genital Herpes (Cont’d): • Pregnant women can transfer to fetus, can lead to fatal brain infection even if no genital blisters present at the delivery  C-section recommended. • Correlation between HSV I and cognitive deficits. • No cure, some antiviral drugs lessen severity of symptoms and shorten the outbreak but always contagious.

18. STDs or STIs • Long term: can lead to meningitis, narrowed urethra UTIs, increased HIV infection, genital scarring, encephalitis (fatal), blindness (from rubbing eyes after touching blisters elsewhere) • No cure and always contagious • Recently, a gel developed to protect women from HIV proved effective in protecting against herpes (51%)

19. STDs or STIs GONORRHEA • Used to be a serious problem but penicillin cured it and it ceased to be such a threat. However, it's making a comeback, as we become resistant to antibiotics. • thin mucous discharge that becomes thick and creamy, pus • painful, burning urination • groin glands enlarged and tender • Can cause inflammation of the urethra, bladder, prostate, epididymis, seminal vesicles. If untreated spreads to testes: infertility.

20. STDs or STIs GONORRHEA • Most males are symptomatic, most females are not. In females, affects reproductive tract and anus and rectum. Affects Bartholin glands. Can move up and cause PID. • Can also affect mouth and throat and eyes (mother can transmit to newborn at birth).

21. STDs or STIs • Hepatitis: • ± 3 per 100,000 • Viral disease of the liver. • Types A, B, C, D, E. • Type B most common STI. • Next is Type C.

22. STDs or STIs • Hepatitis (Cont’d): • Hep B: • Through blood, saliva, semen, vaginal secretion, other body fluids, IV drugs, piercing, tatoos. • Symptoms: • Enlarged liver, fever, fatigue, jaundice, vomiting. But some asymptomatic. No cure, can lead to liver degeneration and death. • Liver cirrhosis, cancer: • Second leading cause of cancer world-wide (after smoking). • But – there is a vaccine: prevention. • 200 times more common than HIV.

23. STDs or STIs • Hepatitis (Cont’d): • Hep C: • Can also lead to liver cirrhosis and cancer of the liver. Found in users of IV drugs, nasal coke, tattoos and piercings. Also contaminated water. • Recent increase in incidence (2011 data)

24. STDs or STIs • HIV: • Human Immunodeficiency Virus • HIV/AIDS: • By 2007 almost 80,000 in Canada reported cases. • 67% had died. But now a chronic illness thanks to medications. • AIDS: • Acquired Immune Deficiency Syndrome • Estimate (2009): 65,000 Canadians live with HIV. One third not aware. • Worldwide: 40 million have HIV (estimate)

25. STDs or STIs • AIDS (Cont’d): • Transmission: • body fluids (not saliva) • sex (penis/vagina or penis/anus) • contaminated blood • hypodermic needles • during pregnancy and childbirth • Condoms 87% effective for HIV • No cure but effective treatments make it a chronic illness • Recent studies: health problems of HIV/AIDS patients in middle/old age

26. STDs or STIs • TRICHOMONIASIS: • Caused by neither bacterium nor virus. • Trichomonas vaginalis: • single cell protozoan, a parasite that attaches to vaginal cells. • transmitted mostly through sex, but the organism can survive for some time on toilet seats and other surfaces. • more common in women, very widespread (8,000,000 in North America, 170 million worldwide).

27. STDs or STIs • TRICHOMONIASIS (Cont’d): • Men are asymptomatic, 50% women have symptoms: • vaginal itch • smelly (fishy), frothy vaginal discharge • Can cause: • PID • increased female vulnerability to HIV • people with HIV transmit it more easily if they have trichomoniasis • in pregnancy, premature birth and/or low birth weight • Treatment: • Flagyl (metronidazole) or other antibiotics for protozoa

28. LYMPHOGRANULOMA (LPV) • Same type as chlamydia (bacterial infection) • Affects the lymphatic system • Much more invasive • More common in men, many HIV positive (gay sex a risk factor) • Through oral, vaginal, anal sex • Symptoms (3-30 days): small painless sore in initial phase, in the genitals

29. LYMPHOGRANULOMA (LPV) • Low grade fever, swelling and redness and enlarged lymph nodes in the groin, blood or pus in stools, painful bowel movements, abdominal pain, fatigue, muscle and joint aches • Treatable with antibiotics • Infection can spread to lymphatic system, lower GI tract, internal reproductive organs in women – if not treated early

30. STDs or STIs Safe Sex vs. safER sex • Two monogamous people who have tested negative for STIs or have never had any sexual contact before. • Issue of trust.