Human Sexuality November 28, 2012 Chapter 15: Sexually Transmitted Infections

1. Human Sexuality November 28, 2012Chapter 15: Sexually Transmitted Infections

2. What is an STI? • Sexually transmitted infection: an infection that can be transmitted through sexual interaction (not just intercourse!) • Some STIs can be cured, and others cannot • Can cause embarrassment, compromised health, pain, infertility, and even death! • Half of all STIs in the U.S. are believed to occur among 15- to 24-year-olds • Most STIs can be prevented!

3. Factors contributing to STIs • Multiple sexual partners • Having sex without a condom • Increased use of oral contraceptives (?) • Lack of information about STIs in young people and their health care providers • Many STIs do not have obvious symptoms!

4. Most STIs are bacterial or viral

5. Bacterial infections are easier to treat than viral ones • Bacterial infections can be treated with antibiotic drugs, such as penicillin; these drugs have NO EFFECT on viruses!

6. bacterial infections

7. Chlamydia • Most common bacterial STI in the U.S. • Rates of infection are highest among teenagers, especially girls • Transmitted primarily through vaginal, anal, or oral sexual contact; can also be spread by fingers to other parts of the body, like the eyes

8. Chlamydia symptoms in women • Chlamydia usually affects women in one of two ways: • Infection of the lower reproductive tract can cause inflammation of the urethra or infection of the cervix; this form usually causes few or no symptoms • Infection of the upper reproductive tract causes pelvic inflammatory disease (PID): (also caused by gonorrhea infection) infection of the uterus, fallopian tubes, or ovaries, and can cause disrupted menstruation, chronic pelvic pain, lower back pain, fever, nausea, vomiting, and headaches • PID can also leave scar tissue that can result in ectopic pregnancy or infertility

9. Chlamydia symptoms in men • Chlamydia symptoms in men may include: • Discharge from the penis • A burning sensation during urination • Itching around the opening of the penis • Pain & swelling of the testicles (less common) • About half of men have minimal symptoms

10. Trachoma: a complication of chlamydia • Trachoma: an eye infection caused by the chlamydia bacterium • World’s leading cause of preventable blindness • Can be spread from infected moms to newborns as shown here • Chlamydia can also cause pneumonia in babies or premature delivery • The CDC recommends chlamydia testing for all pregnant women

11. The good news: • Chlamydia is very curable • 7 days of treatment with the antibiotic azithromycin can knock out most cases of uncomplicated chlamydia • All sexual partners of an infected person should be tested!

12. Gonorrhea • Caused by bacterial infection • Also known as “the clap” • Second in prevalence only to chlamydia in the U.S. • Highest incidence among lower socioeconomic groups • Transmitted by penile-vaginal, oral-genital, oral-anal, or genital-anal contact

13. Symptoms and complications in females • In females, most gonorrhea infections occur in the cervix, and may not cause any symptoms • May experience painful or burning sensation during urination, or increased vaginal discharge • Complications: can spread to the upper reproductive tract and cause PID

14. Symptoms and complications in males • Symptoms in men typically appear 2-5 days after contact with an infected person • Most common signs are a bad-smelling cloudy discharge from the penis and burning during urination • Symptoms may clear up on their own, which may or may not mean the immune system has defeated the bacteria! • Complications: untreated infection may spread to other organs, causing fever, painful bowel movements, discomfort, and eventually infertility

15. Other complications in both sexes • In 2% of cases, the bacteria can enter the bloodstream and spread throughout the body, causing widespread symptoms including possibly permanent joint damage • Gonorrhea can also cause eye infections in infants, similar to chlamydia; adults can also transmit this infection to their own eyes with their hands • Gonorrhea spread through non-vaginal-penile sex can result in infection of the throat or anus. This is most often asymptomatic

16. Gonorrhea can also be treated with antibiotics • Since 1976, strains of gonorrhea have emerged that are resistant to the common antibiotics penicillin & tetracycline • Strains are increasingly also becoming resistant to the antibiotic fluoroquinolone, used subsequently • A new class of antibiotics, called cephalosporins, are now used to treat gonorrhea; also treats chlamydia, which frequently co-occurs

17. Nongonococcal urethritis • Nongonococcal urethritis: any inflammation of the urethra that is NOT caused by gonorrhea infection • Known to be caused by 3 different bacteria • Common among men—actually more common than gonorrhea in the U.S. • Symptoms include discharge from the penis and burning during urination • Treatable with antibiotics

18. Syphilis • Caused by the bacterium Treponemapallidum • Rates have been rising in recent years, especially among men who have sex with men • Transmitted primarily from open lesions to mucous membranes of the vagina, mouth, or anus or to cuts in the skin • Can be transmitted by penile-vaginal, oral-genital, oral-anal, or genital-anal contacts

19. Untreated syphilis progresses in 4 stages • Primary stage of syphilis is characterized by the appearance of a painless sore called a chancre • Usually appears ~3 weeks after initial infection • Usually occurs on the penis, vagina, or cervix, but can be elsewhere on the genitals or in the mouthor rectum • Generally heals without treatment within 3–6 weeks

20. Secondary stage of syphilis • Usually occurs 2–8 weeks after exposure • Skin rash appears on the body, most often on palms of hands and soles of feet • Typically does not hurt or itch • Can also have flulike symptoms

21. Latent syphilis • The latent phase of syphilis infection is characterized by no observable symptoms • Can last for years! • After 1 year in the latent stage, infected individuals are typically no longer able to transmit the infection to partners, although pregnant women can transfer it to their babies

22. Tertiary syphilis • About 15% of individuals who do not receive effective treatment for syphilis will enter the tertiary stage • Usually occurs 10–20 years after initial infection • Symptoms include heart failure, blindness, paralysis, skin ulcers, liver damage, and severe mental disturbance • May be treatable in some cases

23. Treatment of syphilis • Syphilis can usually be treated by antibiotic injections, most commonly penicillin • May need greater number of treatments for later-stage syphilis

24. viral infections

25. Herpes • Caused by the herpes simplex virus • 8 different but related herpes viruses can infect humans, HSV-1 and HSV-2 are commonly transmitted sexually • HSV-1: usually results in lesions around the mouth (cold sores) • HSV-2: usually results in genital lesions • BUT, you can have oral-genital transmission of both of these

26. Prevalence • More than 100 million Americans have oral herpes and at least 45 million have genital herpes • Genital herpes is more common in women than in men (~1 out of 4 adult women and ~1 out of 8 adult men in the U.S. have genital herpes)

27. Preventing transmission of herpes • Genital herpes is spread through penile-vaginal, oral-genital, genital-anal, or oral-anal contact • Condoms can prevent transmission from a man who only has lesions on his penis, but vaginal secretions containing the virus can still come in contact with a man’s scrotum • Sexual contact should be avoided when herpes lesions are present • BUT, herpes can be transmitted even when lesions are not present, so condoms should always be used! • You can also spread herpes from one part of your own body to another with your hands

28. Genital herpes (HSV-2) symptoms

29. Recurrence of herpes symptoms • Herpes cannot be cured; typically the virus will live in the nervous system and can “flare up” • Flare ups can be caused by emotional stress, anxiety, depression, acidic food, ultraviolet light, fever, menstruation, being run-down, poor nutrition, and injury to the affected skin region

30. So I have herpes, so what? • Herpes is merely irritating for most people who have it; however, complications can occur in women: • HSV-2 may contribute to cancer of the cervix • Pregnant women can transmit HSV-2 to babies passing through the birth canal; such an infection can cause severe illness and even death in babies. Luckily this is rare! • Transmission of HSV-2 to the eye can cause eye damage

31. Treatment • No cure for herpes! • Two basic treatment strategies: • Suppressive therapy: drugs are given all the time to prevent flare-ups • Reduces transmissibility of the virus between flare-ups • Episodic treatment: drugs are given when flare-ups occur

32. Low-Cost reproductive health care options in the East Bay • Planned Parenthood 510-300-3800 (Oakland) • Asian Health Services 510-986-6830 (Oakland) • Native American Health Center 510-535-4400 (Oakland) • La Clinica de la Raza 510-535-4000 (Oakland) • Berkeley Free Clinic 510-548-2570 (Berkeley) • STD community hotline 1-800-227-8922