Sexually Transmitted Diseases

1. Chapter 18 Sexually Transmitted Diseases

2. Sexually Transmitted Diseases (STDs) • Also known as Sexually Transmitted Infections (STIs) • Spread of an infection from person to person mainly through sexual activity. • STDs that pose a major health threat: • HIV/AIDS • Hepatitis • Syphilis • Chlamydia • Gonorrhea • Herpes • Human papillomavirus (HPV) • CDC (2008) estimated 65 million Americans were infected with an STD, and about 19 million Americans become newly infected with an STD each year.

3. Table 18-1 Annual New Cases of STDs in the United States

4. Table 18-2 Sexually Transmitted Pathogens and Associated Disease

5. Acquired Immunodeficiency Syndrome (AIDS) • Leading cause of death in many parts of the world. • Worldwide, AIDS is the leading cause of death for people age 15-59 • Approximately 65 Million people around the world have been infected with Human Immunodeficiency Virus (HIV) since the epidemic began. • Nearly 1% of the world’s population • About 3 million infections per year • 1.1 million Americans have been infected and about 500,000 have died since the start of the epidemic. • Human immunodeficiency virus (HIV) is the virus which causes AIDS.

6. What is HIV Infections? HIV attacks and invades CD4 T-cells, monocytes and macrophages. HIV enters a human cell and coverts its own genetic material, RNA, into DNA AIDS opens the possibility for a opportunistic infections. Once initial symptoms resolve, the asymptomatic period may last from 2 to 20 years.

7. Figure 18-1 The general pattern of untreated HIV infection

8. Transmitting the Virus Sexually Transmitted Diseases • HIV lives only within cells and body fluids. • 3 primary means of transmission are: (1)Specific kinds of sexual contact, (2) direct exposure to infected blood, and (3) HIV-infected women to her fetus. • Sexual contact • Direct contact with infected blood. • Mother-to-Child transmission. • Vertical or perinatal, transmission • Not through casual contact.

9. Populations of Special Concern for HIV infection • Most common exposure has been sexual activity between men; injection drug use, and heterosexual contact. • African American men and women are vastly overrepresented among people newly diagnosed with AIDS. • See “HIV/AIDS Among African Americans and Latinos”

10. Figure 18-2 Routes of HIV transmission among adults

11. Symptoms of HIV Infection • Few days or weeks, half the people will develop (Flu like symptoms) • Fever, fatigue, rashes, headache, swollen lymph nodes, body aches, night sweats, sore throat, nausea and diarrhea. • Specialized test HIV RNA assay. • Pneumocystis Carinii pneumonia (fungal infection). • Kaposis sarcoma. • Difficult to treat yeast infections in women • Tuberculosis

12. Diagnosing HIV Infection • Most common is tests for the presence of antibodies to the virus. • HIV antibody test • ELISA (first test) if positive then the. • Western blot ((second test), Immunoflourescence assay)) • IF HIV-positive then check the status of the CD4-t cells. • New diagnostic test – HIV Replication Capacity.

13. Diagnosing AIDS Sexually Transmitted Diseases • Infection defined as an AIDS indicator. • Reporting. • All diagnosed cases of HIV or AIDS must be reported to public health authorities • Treatment (NO CURE). • Antiviral drugs. • Reverse transcriptase inhibitors. • Zidovudine (AZT). • Inhibiting the enzyme reverse transcriptase, uses to integrate its genetic material into human cells. • Protease inhibitors. • Highly active antiretroviral therapy (HAART). • Structured intermittent therapy. • Entry inhibitors • Enfuvirtide (Fuzeon) • Block HIV from entering and infecting cells. • Integrase inhibitor • Blocks the incorporation of newly formed HIV DNA into the host cell’s chromosome. • Post-Exposure prophylaxis. • Treatment for opportunistic infections. • HIV and Pregnancy

15. What about a Vaccine? • Vaccines are being tested in humans • Licensed AIDS vaccine is not estimated to be at least a decade away • Some experts concede the possibility that a vaccine may never be devleoped • How Can You Protect Yourself? • Make careful choices about sexual activity. • Do Not share drug needles. • Participate in an HIV educational program.

17. Chlamydia Trachomatis • Most prevalent bacterial STD in the U.S. • Bacterial infection - • Can cause sterility in men and women • WOMEN infects the cervix and to urethra, fallopian tubes & ovaries, PID, bladder infections. • MEN- Epididymitis, urethra to testes, urethritis, bladder infections, watery discharge. • Symptoms –ASYMPTOMATIC :Discharge, pain and burning while urinating, vaginal bleeding, painful intercourse, abdominal pain, nausea, fever, inflammation of rectum or cervix, swelling and pain in the testes.

18. Chlamydia Trachomatis Spread - vaginal and anal intercourse, from the birth canal to the fetus Diagnosis - Examination of tissue samples or urine Treatment - Both partners treated fully with antibiotics Protection - Condoms and safe sex

19. Gonorrhea • 350,000 new cases reported to the CDC in 2006. • 5.5% increase over 2005. • Bacterial infection -Can cause sterility, arthritis and heart problems • PID, can cause ectopic pregnancy, premature labor and still birth, arthritis, and rashes • Gonococcal conjunctivitis • Eye infection of a infant that can cause blindness if not treated • Symptoms – • Women - Asymptomatic - Frequent burning urination, menstrual irregularities, pelvic pain, discharge. • Males – thick yellow-white discharge, painful urination.

20. Gonorrhea Spread - Vaginal, anal and oral sex. Diagnosis - Microscopic exam of discharge. Treatment - Oral antibiotics - People often have chlamydia at same time. Protection - Condoms and safe sex.

21. Pelvic Inflammatory DiseasePID Progressive infection that harms a women’s reproductive system. Can lead to sterility, ectopic pregnancy and chronic pain - treated or not. Caused by chlamydia and gonorrhea. Symptoms - long and painful periods, discharge, spotting, low abdominal pain, fever, chills, nausea, vomiting, pain during intercourse.

22. Pelvic Inflammatory DiseasePID Treatment - Antibiotics, bed rest, sexual abstinence and maybe surgery to remove scarring Diagnosis - Pelvic Exam, cultures, laparoscopy Protection - Condoms and safe sex

23. Human Papilloma Virus • More than 80% of sexually active individuals will have been infected with HPV by the age of 50. • Vaccine • Is not a treatment for HPV for girls or women who are infected with HPV. • Symptoms • Small bump on the skin or a large, warty growth • Cauliflower-like mass • May cause irritation and bleeding • How is it spread • Diagnosis • Appearance of the lesions • Women who are positive should have a Pap test very 12 months • Treatment • Removed by cryosurgery, electrocautery or laser surgery • Protection

24. Genital Herpes • 1 in 5 adults in the U.S. has genital herpes • Two forms - Herpes simples virus-1 and -2. • HSV 1 (Type 1) is associated with cold sores and fever blisters. • Oral-labial herpes • 50-80% of U.S. adults have antibodies to HSV-1 • HSV 2 (Type 2) • Usually occurs during adolescence and early adulthood • Between 18 -25 years old • Approximately 22% of adults have antibodies to HSV 2 • Remains in the body for life. • Symptoms – 90% have no symptoms • Recurring rash, pain ulceration's. • Primary outbreak - pain and discomfort around infected area, itching, burning during urination. • 2-20 days after infection - may years before outbreak.

25. Herpes Spread - Touching, sexual intimacy - including kissing, vaginal, oral and anal sex Diagnosis - Examination of sores and culturing of fluid taken from sores Treatment - No cure - symptoms are relieved by drugs Protection - Refrain for sex during out break HSV-1 and 2 can cause miscarriages or still births along with serious health issues of newborns

26. Hepatitis B Virus (HBV) • Can cause liver disease and death • Inflammation of the liver • Preventable with vaccination. • Transmission - Semen, saliva, blood and urine • Symptoms - Extreme fatigue, headache, fever, hives, lack of appetite, nausea, vomiting, tenderness in lower abdomen • Diagnosis and Treatment • Blood Test • No cure • Prevention

27. Syphilis • 7000-10,000 new cases of early syphilis in the U.S. • Syphilis organism remains in the body for life and leads to disfigurement, neurological disorders, or death. • Effective antibiotics and condom use. • Symptoms – • Primary phase- 3 weeks - 90 days - painless sores and wet ulcers (chancre) and swollen glands. • Secondary Phase - 3-6 weeks - up to 2 years body rash, mild fever, fatigue, sore throat (Flu like symptoms), and hair loss. • Late phase (tertiary)- Damage to organs and nervous system. • Diagnosis and Treatment • Examination of infected tissues and with blood tests • Treated by antibiotics

28. Other STD’s • Trichomoniasis • “Trich” • Single-celled organism • Bacterial vaginosis (BV) • Abnormal vaginal discharged caused unhealthy species of normal vaginal bacteria • Pubic Lice “Crabs” • Contagious parasitic infections • Scabies • Contagious parasitic infections

29. What You Can Do • Education. • Diagnosis and Treatment • Get vaccinated • Be alert for symptoms • Get tested • Inform your partners • Get Treated • Prevention • Use a barrier defense. • Know your potential partner. • Ask. Are you ready to have sex?

30. Chapter 18 Sexually Transmitted Diseases