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Epi 723 – Sexually Transmitted Infections and Women’s Reproductive Health

Epi 723 – Sexually Transmitted Infections and Women’s Reproductive Health. Patty Kissinger, Ph.D. Kat Theall, MPH. Sexually Acquired Infections and Women’s Reproductive Health Core Competencies.

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Epi 723 – Sexually Transmitted Infections and Women’s Reproductive Health

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  1. Epi 723 – Sexually Transmitted Infections and Women’s Reproductive Health Patty Kissinger, Ph.D. Kat Theall, MPH

  2. Sexually Acquired Infections and Women’s Reproductive HealthCore Competencies Describe the epidemiology and natural history of the most common sexually acquired pathogens among women Describe the components of women’s reproductive health To identify contraceptive methods and how they influence acquisition of STIs Describe the reproductive rate of an infectious disease epidemic Describe methodological issues of studying treatable versus non-treatable STDs Describe measurement issues in the STD research

  3. Core Competencies (con’t) • Describe epidemiologic methods to study interventions at the individual level and at the community level • Discuss issues in STI behavioral epidemiology • Critically evaluate the literature and identify appropriate study designs • Design a study examining an issue of women’s reproductive health and sexually acquired infections

  4. Day 1

  5. Biological and Social issues of Women and STDs Objectives are to: • Define reproductive health • Discuss the role of epidemiology in STD control • Describe why women are more at risk for STDs then men • Identify the 25 sexually transmitted pathogens • Interpret STD surveillance data

  6. Magnitude of the STI Problem • Annual incidence of curable STDs (which excludes AIDS) is 333 million cases • The top four most common are: gonorrhea (62 million), chlamydia (89 million), syphilis (12 million) and trichomonas (170 million) • An estimated 250 million new infections of STIs occur each year. • 12 million new cases in the United states • 3 million of these cases in US are teenagers • Cost of PID is more than $3.5 million dollars

  7. Problems specific to women? • Women are more vulnerable • Biologically • Culturally • Socio-economically • Majority of STDs are asymptomatic in women • 60-70% for gonococcal and chlamydial infections) • Consequences of STDs are very serious in women, sometimes fatal • Cervical cancer, ectopic pregnancy • For offspring - stillbirth and blindness

  8. Women and STDs • Worldwide women may be less likely to seek healthcare for STDs because it is stigmatizing or they lack the financial resources to do so. • In developing countries where syndromic treatment is common, women will be under-treated.

  9. Human Sexuality Reproduction Sexuality

  10. Sexuality and Reproduction • When one wants sex but no reproduction barrier methods are okay • There is no good method for a women who wants to avoid STDs but also wants to become pregnant

  11. Reproductive Health Biological (age, Hormones, Gentics, parity and gravida Economics Politics and Access to Health Care nutrition Fertility choices STD Gender roles Norms Others?

  12. Reproductive Health Biological (age, Hormones, Gentics, parity and gravida Economics Politics and Access to Health Care nutrition Fertility choices STD Gender roles Norms Others?

  13. Key Points in a woman’s reproductive life

  14. Basic Reproductive Rate of Infection

  15. Comparison of syphilis to HIV HIV .003 * 400 * 2 = 2.4 syphilis .30 * 26 * 2 = 15.6 chlamydia .20 * 16 * 2 = 6.4

  16. Biological reasons that place women at risk for STDs

  17. Vagina is more equipped to support pathogens • Larger surface area • More vascular and has more nutrients • Receptive sex • Most of the reproductive anatomy is inside

  18. Male Anatomy • Yellow papules • sweat glands • redundant prepuce (foreskin) • glands of Tyson secrete keratinous material (smegma) • pearly penile papules (mistaken for HPV)

  19. Female Anatomy • Pebbly papules on labia major • gland under clitoral hood secretes sebacious material (smega)

  20. Adolescent women • More at risk because: • More ectopy • Less acquired immunity • More high risk sex

  21. Stratified squamous epithelium • Covers ectocervix • cells rich in glycogen in sexually mature women

  22. Endocervical canal • Tall columnar cells line endocervical canal • deep invaginations of mucous secreting epithelium exist in cervical stroma and facilitate secretion of mucous

  23. Normal Cervix • Squamous junction is seen • part of the endocervical canals is also seen

  24. Sexually transmitted infections

  25. Modes of STD acquisition • Penile-vaginal • Oral-vaginal • Anal-vaginal • Sex toys, digits

  26. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES - BACTERIA

  27. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES - BACTERIA

  28. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES- BACTERIA

  29. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES - VIRUSES

  30. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES - VIRUSES

  31. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES - OTHER

  32. Gender inequities and sexually transmitted diseases

  33. Interpreting Surveillance Data • Who is getting tested? • Are they representative of the target population? • Is the test good? • Is the reporting good? • Are the graphics numbers or percents?

  34. WHO Report 2003

  35. Surveillance issues • Women more likely to get tested • Women more likely to be index case • Women more likely to be reported

  36. In class exercise • What do you know about the disease? • What does the slide tell us? • What hypotheses can you generate from the information?

  37. Gonorrhea — Reported rates: United States, 1970–2001 and the Healthy People year 2010 objective Note: The Healthy People 2010 (HP2010) objective for gonorrhea is 19.0 cases per 100,000 population.

  38. Gonorrhea — Rates by sex: United States, 1981–2001 and the Healthy People year 2010 objective

  39. Gonorrhea — Rates by region: United States, 1981–2001 and the Healthy People year 2010 objective

  40. Gonorrhea — Rates by state: United States and outlying areas, 2001 Note: The total rate of gonorrhea for the United States and outlying areas (including Guam, Puerto Rico and Virgin Islands) was 126.9 per 100,000 population. The Healthy People year 2010 objective is 19.0 per 100,000 population.

  41. Gonorrhea — Positivity among 15-24 year old women tested in family planning clinics by state: United States and outlying areas, 2001 *States reported gonorrhea positivity data on less than 500 women aged 15-24 years during 2001.SOURCE: Regional Infertility Prevention Program; Office of Population Affairs; Local and State STD Control Programs; Centers for Disease Control and Prevention

  42. Gonorrhea — Rates by race and ethnicity: United States, 1981–2001 and the Healthy People year 2010 objective

  43. Gonorrhea — Age- and sex-specific rates: United States, 2001

  44. Syphilis — Reported cases by stage of illness: United States, 1941–2001

  45. Primary and secondary syphilis — Reported rates: United States, 1970–2001 and the Healthy People year 2010 objective Note: The Healthy People 2010 (HP2010) objective for primary and secondary syphilis is 0.2 case per 100,000 population.

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