1 / 55

Chapter 8: Sexually Transmitted Infections

Chapter 8: Sexually Transmitted Infections. “Ryan”. 23 year old requests “STD tests” Multiple partners 15+ Worried about recent sexual encounter with unprotected intercourse Visited prostitute in Thailand few months ago No symptoms, except +++worry!

odette-hooper
Download Presentation

Chapter 8: Sexually Transmitted Infections

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 8: Sexually Transmitted Infections

  2. “Ryan” • 23 year old requests “STD tests” • Multiple partners 15+ • Worried about recent sexual encounter with unprotected intercourse • Visited prostitute in Thailand few months ago • No symptoms, except +++worry! • Has had 2 partners since unprotected incidents

  3. “Sarah” • 18 year old student • Binge drinking weekend past and “cannot remember anything” • Woke up with no underwear in parking lot of mall and worried that she might have been assaulted • Worried about pregnancy and STDs

  4. “Paul” and “Phillip” • 22 and 26 year old students • Starting new relationship and want a “clean bill of health” before engaging in intercourse • No symptoms; very conscious of HIV/AIDS

  5. Objectives • Review STD’s as an intimate human problem, afffecting not only the sufferer, but partner(s), and conceptus • Discuss common symptoms and signs of STDs • Discuss what happens during visit with family doctor • Review common STDs • Advice on safer sex

  6. Psychological Consequences • Diagnosis of a chronic disease is trying on patients • Embarrassment • Feeling like sexual leper • Shame, guilt, anger • Depression/Anxiety may develop • Relationship problems, rejection • Accusations of infidelity by partner • Alterations in sexual behaviour • Loss of sexual freedom/spontaneity • Negative sexual self image • Loss of libido • Increased masturbation (“no risk”)

  7. Pathogens of the Human Genital Tract • Sexually transmitted diseases • Chlamydia • Gonorrhea • Herpes • Human papilloma virus (HPV) • Lymphogranulomavenereum • Chancroid • Syphillis • Pediculosis pubis (“crabs”) • Blood borne infections • HIV/AIDS • Hepatitis B and C

  8. Chapter 8: STIs Prevalence? (total # of people affected): difficult to know • 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

  9. Chapter 8: 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

  10. Chapter 8: 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)

  11. Chapter 8: 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)

  12. Chapter 8: 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

  13. Chapter 8: 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 ges 9 and 14, before they become sexually active. Girls chosen due to cervical cancer risk. • Health Canada approved it for boys and men ages 9-26, in February 2010. • HPV causes oral cancer in men via oral sex, rivaling oral cancers due to tobacco and alcohol.

  14. About 40% of college students have HPV at any given time • Worldwide distribution • Incubation period 6 weeks to 12 months • Lifelong infection • Asymptomatic shedding • Most infections cause no symptoms • Lesions clear in 2 years w/o treatment

  15. Cervical cancer is (partially) infectious disease! • new vaccination prevention strategy

  16. Chapter 8: 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

  17. Chapter 8: STIs • Chlamydia (Cont’d): • can cause: • PID • tubal blockage • ectopic pregnancies • infertility • prematurity and low birth weight in infants of affected mothers

  18. Females: • Cervicitis • Salpingitis • Bartholinitis • Urethritis • Hepatitis • Proctitis

  19. Chapter 8: 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 • 50% of chlamydia patients also have gonorrhea

  20. Chlamydia • C.trachomatis, intracellular pathogen, not a virus, not a regular bacterium • Affects only humans • Tropic to specific epithelial cells • Most common STD • 3-5% of college students • Highest incidence in urban women 15-24 years old • All time high incidence in Canada 179 per 100 000 in 2002 • 522 cases in NL (2002)

  21. C. trachomatis also causes other illnesses: • Conjunctivits • There are other species of chlamydia that cause trachoma and pneumonia

  22. Pelvic inflammatory disease is a devastating complication of chlamydial infection • Can lead to infertility, sepsis

  23. LYMPHOGRANULOMA (LGV) • So far mostly men/men • Same type as chlamydia • Much more invasive • Through oral, vaginal, anal sex • Treatable with antibiotics • Symptoms (3-30 days): vaginal painless sore in initial phase • Low grade fever • Fatigue • Muscle and joint aches

  24. Chapter 8: STIs • Genital Herpes: • ± 25% incidence (not reportable) • 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

  25. Chapter 8: 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

  26. (rash) (blisters on fingers, itchy/painful)

  27. Chapter 8: 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. N = 3,000

  28. Chapter 8: 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 in offspring. • No cure, some antiviral drugs lessen severity of symptoms and shorten the outbreak but always contagious.

  29. Chapter 8: STIs • Long term: can lead to meningitis, narrowed urethra UTIs, increased HIV infection, genital scarring, encephalitis (fatal), ocular herpes (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%) • The virus can survive several hours on toilet seats • Vaccine being tested

  30. Gonorrhea • Gonococcus • Only affects humans • Worldwide distribution • Most affected groups: • Females 15-24 • Males 20-29 • 9 cases in NL (2002)

  31. Incubation period: 2-7 days • Period of communicability: months for untreated patients, treatment ends infectiousness within hours • Complications include: • Disseminated gonococcemia • Arthritis • Endocarditis • Meningitis

  32. Treatment Antibiotics

  33. Chapter 8: 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.

  34. Hepatitis B • Worldwide • Incubation: 1-6 months • Infectious through body fluids • Symptoms due to liver dysfunction, hepatitis, cirrhosis

  35. Hepatoma (liver tumour) is a result of HCV infection • First cancer to have “vaccine”

  36. Chapter 8: 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.

  37. Chapter 8: 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)

  38. Chapter 8: 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)

  39. Chapter 8: 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

  40. HIV damages the immune system, particularly CD4 cells • Results in decreased immunological defences • AIDS patients get sick from pathogens that are ubiquitous in environment and cause no problem in people with healthy immune systems • Candida • Pneumocystis • Cytomegalovirus • Increased “opportunistic” infections and increased development of cancers • Kaposi sarcoma

  41. Chapter 8: STIs • TRICHOMONIASIS: • caused by neither bacterium nor virus, but by: Trichomonasvaginalis: • 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).

  42. Chapter 8: 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 • in fertility • Treatment: Yes

  43. Chapter 8: STIs SYPHILLIS • Bacterial infection: curable • Making a comeback in several parts of the world, including Canada. Men/men sex higher. • Early symptom: chancre, a round lesion in the genitals, painless. Harder to see in women: This is the primary stage. • If through oral sex it appears in oral areas. It disappears but the disease continues. • Secondary stage: body rash, not itchy or painful. Also “goes away”  latent stage, could last years or the rest of the person’s life. • Tertiary stage: about 50% get there CNS: insanity, paralysis CVS: death • Pregnant woman can infect fetus

  44. How do I prevent STD’s?

  45. Education about STD’s • Open discussion • Increase knowledge about STD risks and transmission • Start young

  46. Selective • Promiscuity is a risk factor • More sexual partners = more risk

  47. Communication

More Related