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Chapter 15 Sexually Transmitted Infections

Chapter 15 Sexually Transmitted Infections. Sexually Transmitted Infections. Engaging in risky behavior Multiple partners Unprotected (without condom) sex Highest in adolescence and early adulthood, when incidence of STIs is highest Oral contraceptives

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Chapter 15 Sexually Transmitted Infections

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  1. Chapter 15Sexually Transmitted Infections

  2. Sexually Transmitted Infections • Engaging in risky behavior • Multiple partners • Unprotected (without condom) sex • Highest in adolescence and early adulthood, when incidence of STIs is highest • Oral contraceptives • Lack of public health measures and limited access STI prevention and treatment

  3. Bacterial Infections • Chlamydia • Gonorrhea • Nongonococcal Urethritis (NGU) • Syphilis

  4. Bacterial InfectionsChlamydia • Most prevalent STI • Few or no presenting symptoms • Consequences:chronic, contagious trachoma; infertility and sterility; preterm birth; infant conjunctivitis or pneumonia • Trachoma (form of conjunctivitis); Leading cause of preventable blindness • Treatment:doxycycline or azithromycin • All sexual partners should be tested for STIs

  5. Bacterial InfectionsSymptoms of Chlamydia • Women: 2 types of genital chlamydia infections • Infection of mucosa of lower reproductive tract • Few or no symptoms; mild irritation or itching, burning; slight discharge • Infection of upper reproductive tract (PID) • Pain, fever, headache, and nausea • Men: Epididymitis; nongonococcal urethritis (NGU) • Heaviness in testis; small, hard, painful swelling in testis; inflamed scrotum

  6. Bacterial InfectionsGonorrhea • “The Clap” • Consequences • Women: PID; ectopic pregnancy; severe pelvic pain; infant conjunctivitis • Men: Prostate abscesses, painful BMs, difficult urination; possible sterility • Both: Fever, loss of appetite, arthritic pain; can invade heart, liver, CNS, can cause blindness in infants • Treatment • Cephalosporin

  7. Bacterial InfectionsSymptoms of Gonorrhea • Women: Gonococcal Cervicitis • 80% no early symptoms • Yellow-green discharge • Vulval irritation • Men: Gonococcal Urethritis • Discharge • Burning • Swelling

  8. Bacterial InfectionsNongonococcal Urethritis • Symptoms • Women: few symptoms; itching, burning, vaginal discharge of pus • Men: penile discharge, urinary burning • Consequences: • Women: inflamed cervix or PID • Men: can spread to prostate, epididymis, or both • Treatment: Doxycycline or Azithromycin

  9. Bacterial InfectionsSyphilis • Recent increase in rates, primarily among MSM • Pregnant women should be tested • Phases of Development, Symptoms, Consequences • Primary: Red, painless chancre • Secondary: Painless, non-itching skin rash, flu-like symptoms • Latent:No observable symptoms • Tertiary: Severe disorder, death

  10. Bacterial InfectionsTreatment of Syphilis • Early cases (primary, secondary, or latent syphilis of less than 1 year) with benzathine penicillin G or other antibiotic • Later cases (more than 1 year): 1 weekly injection for 3 weeks (benzathine penicillin G or other antibiotic) • All partners tested at 3 month intervals

  11. Viral Infections • Herpes • Genital Warts • Viral Hepatitis

  12. Viral Infections Herpes • Herpes Symplex Virus (HSV) Types 1 & 2 • Transmitted even when no blisters present • 20-25% of Americans have HSV-2 • May or may not be recurrent • Symptoms • painful, red bumps develop into blisters that rupture and form sores • swollen lymph nodes • headache • fever • muscle aches

  13. Viral InfectionsConsequences of Herpes • Risk for cervical cancer • Newborn infected during delivery may die or suffer severe damage • C-section for women with active disease • Can cause eye infection • Psychological distress

  14. Viral InfectionsTreatment of Herpes • Acyclovir may reduce length and severity of outbreak; Valtrex and Famvir may reduce recurring attacks • Suppressive therapy vs. Episodic treatment • Hygiene and stress reduction • No cure; vaccine in development

  15. Viral InfectionsGenital Warts • Human Papillomavirus (HPV) • Epidemic levels • Transmitted even when no warts are evident • Symptoms: • moist, soft cauliflower-like warts; or dry, yellow-gray, hard warts • majority of people have no symptoms

  16. Viral InfectionsGenital Warts • Consequences • Urinary obstruction and bleeding • Greater risk of genital cancers • Respiratory infection in newborn • Treatment • No cure; removal of warts • Recurrence likely • Vaccine against 4 types - Gardasil

  17. Viral InfectionsViral Hepatitis • Three types • Hepatitis A (commonly transmitted sexually) • Hepatitis B (more commonly transmitted sexually) • Hepatitis C (commonly transmitted through blood-contaminated needles) • Hepatitis C most health threatening • Symptoms • Few or none • Flu-like initially • Can become incapacitating: fever, vomiting, abdominal pain • Yellowed whites of eyes and skin

  18. Viral InfectionsViral Hepatitis • Consequences • Liver cancer • 20-25% Hepatitis C infected develop severe complications (liver failure) • Death • Treatment • Bed rest and fluids • Vaccines for Hepatitis A and B • Antiviral combination may help Hepatitis C

  19. Common Vaginal Infections • Bacterial Vaginosis • Candidiasis • Trichomoniasis

  20. Common Vaginal InfectionsBacterial Vaginosis (BV) • Symptoms • Foul smelling, thin flour-paste discharge • Genital irritation or urinary burning • Most men have no symptoms • Consequences • Women: Greater risk of PID; premature rupture of amniotic sac, and preterm labor • Men: Mostly asymptomatic; may develop urethritis or cystitis • Treatment • Oral metronidazole • Recent research: intravaginal application of topical gel or cream are as effective as oral

  21. Common Vaginal InfectionsCandidiasis • Second most common vaginal infection in North America • Symptoms • White, cottage-cheese like, discharge • Intense itching, sore tissue • Consequences • Confused with other infections • Treatment • Vaginal suppositories or creams

  22. Common Vaginal InfectionsTrichomoniasis • Symptoms • Copious, odorous, frothy, white or yellow-green vaginal discharge • Inflamed, irritated, itchy, and sore • Consequences • May increase risk of cervical cancer • Treatment • Both partners; oral Flagyl; topical cream

  23. Ectoparasitic Infections • Pubic lice • Scabies

  24. Ectoparasitic InfectionsPubic Lice • Commonly known as “crabs” • Quite common, especially prevalent among young 15- to 25-year old) single people • Associated with presence of other STIs • Symptoms • Little to severe itchiness • Treatment • 1% permethrin or pyrethrin lotion or cream • Launder clothes and sheets

  25. Ectoparasitic InfectionsScabies • Too tiny to be seen by naked eye • Highly contagious condition • Symptoms • Small, pimple-like bumps; red rash around primary lesion • Intense itchiness, especially at night • Treatment • Topical scabicide • Launder clothes and sheets

  26. Acquired Immunodeficiency Syndrome(AIDS) • HIV (human immunodeficiency virus) • Retrovirus that targets and destroys helper T-4 cells • HIV becomes AIDS when • HIV is present and • CD-4 count is < 200

  27. Incidence of AIDS • Rates rising among teenagers, women, and minorities • MSM transmission had leveled off in 1990s, but is now increasing • U.S. cases increasing among “heterosexual” transmission • Heterosexual contact has always been primary form of HIV transmission worldwide • Women are the fastest growing population with HIV

  28. AIDS and Adolescence • Many young people with AIDS were infected as teenagers • Risk factors for teenagers include • Multiple partners • Engaging in sexual activities without condoms • Lack of access to condoms during teenage years • Substance abuse increases risky behavior • Feelings of invulnerability

  29. HIV Transmission • Transmission occurs in any bodily fluid • Mother-to-child transmission (MTCT) • Depends on viral load • Likelihood greatest when HIV transmitted directly to blood • Low risk: casual contact • High risk: sexual contact, sharing needles

  30. HIV Symptoms and Complications • Brief flu-like symptoms that progress depending on immunosuppression • HIV Antibody Tests • Most develop antibodies in a few months, but it can take 3 years to seroconvert • Usual progression (8 to 11 years) • Full-blown AIDS

  31. HIV Treatment • No cure or vaccine at this time • Combination drug therapy, Highly Active Antiretroviral Therapy (HAART), shows best results for slowing progress • Zidovudine may significantly decrease maternal transmission

  32. HIV Treatment Search for a Vaccine • Vaccine remains best long-term hope for controlling HIV/AIDS pandemic • Two categories of vaccines • Prophylactic • Therapeutic • Several vaccines under clinical trials

  33. HIV Prevention • Prevention is the best solution • Use condoms and avoid multiple partners • Do not share needles • Avoid oral, vaginal, or anal contact with semen • Avoid sexual behaviors involving anus • Avoid oral contact with vaginal fluids • Do not share items that could be contaminated with blood (e.g., razors, toothbrushes) • Avoid sexual contact with sex workers

  34. Preventing STIsPrevention Guidelines • Abstinence • Get to know partner(s) before sex • Obtain prior medical examinations • Always use condoms and spermicide • Avoid multiple sexual partners • Inspect and wash genitals • Obtain routine medical evaluations • Disclose your STI status to partner

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