Some Truth About Sex & STIs

1. Some Truth About Sex & STIs

2. Viral vs. Bacterial Bacterial: If bacteria or a parasite causes an infection, it can be treated with antibiotic or antimicrobial medication Viral: If a virus causes an infection, it is possible for it to remain “asymptomatic” for periods of time (meaning there are no symptoms). Viral STIs can be treated with medications, but not cured.

3. STDs or STIs? What’s the difference? • Sexually Transmitted infection (STI) has replaced the term Sexually Transmitted Disease (STD) Why? • STI a more encompassing term that includes infections that are asymptomatic; or show no symptoms

4. What is an STI? Sexually Transmitted Infections are infections generally spread by close sexual contact and sexual intercourse. They can spread by contact with an infected partners: • Skin • Genitals • Body Fluids • Mucous Membranes eg. eyes, mouth

5. Why is it important to learn about STIs? • It helps one be able to take care of one's own body • Untreated STIs can cause problems for a person's health and future ability to have children • It helps a person to discuss STIs with a partner • It helps us recognize myths like “It’s easy to tell if a person has a STI/HIV because he/she will look sick” that could prevent a person from using effective prevention methods or seeking needed treatments

6. Background Where Do People Go for STI Treatment? • Population-based estimates from National Health and Social Life Survey Private provider 59% Other clinic 15% Emergency room 10% STD clinic 9% Family planning clinic 7% Source: Brackbill et al. Where do people go for treatment of sexually transmitted diseases? Family Planning Perspectives. 31(1):10-5, 1999

7. Background Knowledge About STIs Among Americans Source: Kaiser Family Foundation, 1996

8. Background Percent of Women Who Said Topic Was Discussed During First Visit With New Gynecological or Obstetrical Doctor/Health Care Professional

9. Talk Talk Talk • Communicating with your potential partner and abstinence is the # 1 method of prevention. Two key questions & one statement: • (1) Who have you been with? • (2) Have you been tested? • (3) Let’s both get tested.

10. Sexually Transmitted Diseases/Infections • Common STDs or STIs • HPV and Cervical • Genital Warts • Gonorrhea • Pubic Lice • Chlamydia • Syphilis • Herpes • PID

11. HPV and Cervical Cancer HPV and Cervical Cancer • Infection is generally indicated by the detection of HPV DNA • HPV infection is causally associated with cervical cancer and probably other cell cancers (e.g. anal, penile, vulvar, vaginal) • Over 99% of cervical cancers have HPV DNA detected within the tumor • Routine Pap smear screening ensures early detection (and treatment) of pre-cancerous lesions

12. HPV (Human Papilloma Virus) • It is a viral infection of skin causing the growth of skin-colored, cauliflower-like masses of various sizes and shapes as shown by the arrows in this picture. 

13. HPV and Cervical Cancer HPV Penile Warts Source: Cincinnati STD/HIV Prevention Training Center

14. Normal Cervix Source: Claire E. Stevens, Seattle STD/HIV Prevention Training Center

15. HPV and Cervical Cancer HPV Cervical Warts Source: Cincinnati STD/HIV Prevention Training Center

16. HPV and Cervical Cancer Possible HPV on the Tongue Source: Cincinnati STD/HIV Prevention Training Center

17. Genital Warts Signs • Several weeks to months after being exposed to a sexual partner with HPV, these painful growths occur on damp or moist surfaces in either sex • Common locations include the anus (left) and the penis (right)

18. Genital Warts Treatment • Like most viral infections, there is no cure for Human Papillomavirus.  • Treatment consists of destroying the infected cells, but it often comes back due to infection of normal-appearing nearby skin.

19. Gonorrhea • Gonorrhea is a common infection of the genitourinal tract (specifically the urethra and cervix) caused by a bacteria • Gonorrhea discharge from the penis (left) • Gonorrhea discharge from the vagina (right)

20. Gonorrhea Facts • About 1 million new infections are reported each year in the United States.  • Young men aged 20 - 24 have the highest rate followed by those 15 to 19 years old. • In women, the highest rate are in adolescents aged 15 - 19 years old

21. Men Burning when urinating Pus discharge from penis Women Greenish/yellow vaginal discharge Bad vaginal itch Gonorrhea (signs & symptoms)

22. Gonorrhea Treatment • Gonorrhea used to be 100% curable with Penicillin.  • Because antibiotics have been used so commonly (often given out for simple colds - where they don't do anything) the gonorrhea bacteria has developed RESISTANCE!  • We now use a more potent antibiotic to cure gonorrhea.

23. Pubic Lice • Body lice are tiny parasitic insects (Pediculus hub manus corporis) that spread through close contact with other people. • There are 3 types of lice: head lice, body lice, and pubic lice.

24. Pubic Lice • They feed on human blood, and they lay their eggs and deposit their fecal matter on the skin (they may also lay their eggs in clothing). Infestation by body lice causes intense itching.

25. Pubic Lice Symptoms • Intense itching • Red bumps on the skin

26. Pubic Lice Prevention • Good personal hygiene and effective treatment of infected persons will prevent lice from spreading to others. • Communicating with your potential partner and abstinenceis the only means of prevention. Two key questions & one statement: (1) Who have you been with? (2) Have you been tested? 3) Let’s both get tested. • Condoms DO NOT protect you from contracting crabs.

27. Chlamydia (What is it?) • Chlamydia is actually a group of different infections caused by different strains of the Chlamydia bacterium.  • Chlamydia trachomatis causes various sexually transmitted diseases.  • Chlamydia is currently the most common STD.

28. Males Females Chlamydia (How does it look?)

29. Clinical Manifestations Chlamydia Discharge

30. Chlamydia Facts • The most common sexually transmitted disease. • 4 million people are infected annually!

31. Chlamydia Treatment • A number of antibiotics in the Erythromycin family will kill and hence cure Chlamydial infections.  • The key is to get diagnosed, because quite commonly those infected are not aware. • If left untreated, it will cause permanent damage to the fallopian tubes, uterus, and surrounding tissues which may lead to infertility in women.

32. Syphilis • Syphilis is an ancient illness firstdescribed in the 15th century.  It is a sexually transmitted disease caused by a bacteria.  • This infection has been increasing in the world, infecting 20 people out of every 100,000.  • It has been especially prevalent in large cities.

33. Syphilis Lesion – Oral Sex

34. Syphilis Chancre – Withdrawal*Ejaculation into open sore

35. Three Stages of Syphilis (Stage 1) • Male: In the first stage ("primary syphilis"), one or more painful skin ulcers (chancres), form at the site of inoculation.

36. Three Stages of Syphilis (Stage 1) • Female: In the first stage ("primary syphilis"), one or more painful skin ulcers (chancres), form at the site of inoculation.

37. Syphilis (Stage 2) • Two to eight weeks after the chancre heals, "secondary syphilis" begins. • In this stage bacteria spreads throughout the body causing many possible types of rash, including the palm rash seen in the photo left.

38. Secondary Syphilis - Rash

39. Syphilis (Stage 3) • Often occurs 15 years or so after the initial chancre (stage 1), and slowly gets worse and worse.  • It affects the brain and spinal cord, often causing mental illness and paralysis.  • It can also affect the heart causing inflammation of the aorta, and the deeper skin causing "gummas" which are rubbery lumps in the skin.

40. Treatment of Syphilis • Penicillin (an antibiotic drug) is still the first choice treatment in stage one and two of this illness, and usually cures the disease.  • Careful follow-up by the doctor is needed to be sure the disease is cured and does not return. 

41. Herpes (What is it?) • Herpes is a viral infection of the skin caused by the Herpes Simplex Virus (HSV).  • Classically, HSV-1 caused a mouth and lip rash (i.e., cold sore - pictured below), while HSV-2 caused the genital herpes. 

42. Herpes Facts and Statistics continued • About 80-85 percent of American adults have type 1 oral herpes (cold sores).

43. Herpes • Type 2 

44. Herpes • Type 3 (Chicken Pox)

45. Neonatal Herpes Courtesy of Dr. Félix Omeñaca Terés, Hospital Materno Infantil La Paz, Madrid, Spain

46. Herpes Facts & Statistics • One out of five of the total adolescent and adult population is infected with genital herpes (yet at least 80 percent of those with herpes are unaware they have it). • Infection is more common in women (approximately one out of four women) than in men (almost one out of five). • Male-to-female transmission is more efficient than female-to-male transmission due to a woman’s vaginal exposure. • Approximately two-thirds of people who acquire STDs in the United States are younger than 25.

47. Drips Pelvic Inflammatory Disease (PID) • l0%-20% women with GC develop PID • In Europe and North America, higher proportion of C. trachomatis than N. gonorrhoeae in women with symptoms of PID • CDC minimal criteria • uterine adnexal tenderness, cervical motion tenderness • Other symptoms include • endocervical discharge, fever, lower abd. pain • Complications: • Infertility: 15%-24% with 1 episode PID secondary to GC or chlamydia • 7X risk of ectopic pregnancy with 1 episode PID • chronic pelvic pain in 18%

48. Drips Pelvic Inflammatory Disease Source: Cincinnati STD/HIV Prevention Training Center

49. STD Prevention • The only sure-fire, 100% way of preventing STDs is…Abstinence and communication with your potential partner. • Abstinence—choosing to avoid all harmful sexual activity (including drug abuse) until you’re mature enough to face the physical and emotional consequences. • When/if you feel you’re ready to engage in sexual activity, communicate with your potential partner. Remember the two key questions and one statement: (1) Who have you been with? (2) Have you been tested? 3) Let’s both get tested. • Use condoms (correctly) each and every time before sex. Several studies of correct and consistent condom use clearly show that latex condom breakage rates in this country are less than 2 percent. • For condoms to provide maximum protection, they must be used consistently (every time) and correctly.