The Secret Epidemic: STIs on Campus

1. The Secret Epidemic:STIs on Campus A Presentation of the American College Health Association American College Health Association

2. Discussion Points for Today • Sexually Transmissible Infections (STIs) • Three Common STIs among Teens and Young Adults • The Most Common STI among Teens and Young Adults • What to do if you think you have an STI

3. Infections—Generally Speaking • What are they? • Overgrowths of bacteria, viruses, fungus (yeast), or protozoal pathogens • How are they spread? • Inhalation of infected air, contact with infected body fluids, contact with infected skin (rashes, lesions) • How can they be prevented? • Avoiding contact with infected air, fluids, and skin

4. Sexually Transmissible Infections (STIs) • Also known as • Sexually Transmitted Diseases (STDs) • Venereal Diseases • What are your risks?

5. Sexually Transmissible Infections • Bacterial Infections • Chlamydia • Gonorrhea • Syphilis • Viral Infections • Herpes • Hepatitis B • Molluscum contagiosum • HIV • Human papillomavirus

6. Common STIs among Teens and Young Adults • Human Papillomavirus (HPV) (virus) • Warts on genitals and anus (men and women) • Warts and pre-cancers on cervix (women) • Often asymptomatic, presenting no visible symptoms • Communicable or non-communicable when asymptomatic • Chlamydia (bacteria) • Infected cervix, tubes, epididymis • Sometimes no symptoms at all

7. Common STIs among Teens and Young Adults • Herpes (HSV I & II) (virus) • Painful ulcers • Often no symptoms at all • Molluscum Contagiosum (virus) • Pimple-like lesions • Often confused with pimples or folliculitis

8. “Risky Contact” for the Spread of STIs • You don’t have to have sexual intercourse to contract an STI • Many STIs are spread by direct skin contact • Everyone who has “risky contact” is at risk • Teens and young adults are more “at risk” than other populations

9. “Risky Contact” for the Spread of STIs • Condoms do NOT completely protect from infections spread by skin contact, because they do not cover all infected areas of the skin Infection with these organisms does not require penetration during intercourse if there is other “risky contact.” HPV Herpes Molluscum

10. “Risky Contact” for the Spread of STIs • Avoid “risky contact,” which is any contact with skin or fluids that may contain the viruses and bacteria that cause STIs • Don’t share intimate apparel such as swimwear or underwear

11. Who gets STIs? • Anyone who has “risky contact” with a person with an STI • One contact might be all it takes to get an STI • The more contacts, the greater the risk

12. STI Prevention • Abstinence works best • Avoid genital touching • Many teens and young adults are now choosing abstinence • Abstinence reflects feelings of self worth and self esteem • Not everyone is “doing it” • Sexual activity is NOT a requirement for friendship or social acceptance

13. The Most Prevalent STIs Chlamydia • Women: infects urethra, cervix • Often no symptoms • Sometimes pain with urination or lower abdominal pain • Infection can spread to tubes and ovaries • Can cause infertility • Men: infects urethra, epididymis • Can cause pain with urination • Swelling and pain of the testicles Spread by body fluids Semen Vaginal Anal

14. Epididymitis due to Chlamydia - the swelling of this infection is seen above the right testicle

15. Hydrosalpinx resulting from Chlamydia - closed, swollen and water-filled left tube in a young woman

16. The Most Prevalent STIs Genital herpes • Men and women: genital skin • Extremely painful lesions • Often no symptoms • Women: cervix • Abnormal vaginal discharge • Often no symptoms • May infect newborns during delivery Spread by skin contact Genital-Genital Hand-Genital Oral-Genital

17. Penis with vesicles (blisters) from genital herpes

18. External genital skin of female with herpes ulcers

19. The Most Prevalent STIs • Molluscum • Can appear anywhere on the skin • Bumps that look like pimples • Can become infected with bacteria Spread by body skin contact Genital-Genital Hand-Genital Oral-Genital

20. Molluscums of lower abdomen

21. External genital skin of female with huge molluscums

22. Human Papillomavirus (HPV) • Over 100 types of HPV • More than 20 types of HPV can infect genital skin • Men and women: genital and anal warts • Women: lesions on the cervix and vagina Spread by skin contact Genital-Genital Hand-Genital Oral-Genital

23. Human Papillomavirus (HPV) • HPV: Genital Warts • Men and women: external genital skin, anus, in urethra • Women: cervix, vaginal walls • Condoms offer some protection, but don’t cover all of the skin that can be infected

24. Papillary genital warts of female

25. Papillary genital warts of female

26. Flat genital warts of male

27. Papillary genital warts of male

28. Papillary genital warts of male

29. Papillary genital warts of male anus

30. HPV Treatments Treatments for External Genital Warts • Patient-applied prescription remedies • Aldara™ (imiquimod) Cream, 5% • Condylox™ gel 0.5% (podofilox) • Procedures performed in the doctor’s office • Freezing–cryoprobe or liquid nitrogen • Caustic chemicals–TCA, BCA, podophyllin • Laser

31. HPV and Pre-Cancers • Cervix and anus: some HPV types cause lesions that can be pre-cancers • If not treated, they can eventually become cancers • The Pap smear detects lesions on cervix • Cells scraped from cervix are examined under a microscope • If they have ever had sexual contact, women need yearly Paps

32. Genital warts on cervix of female

33. Pre-cancer changes on cervix

34. HPV—Treatments of the Cervix and Anus • Cervix: destruction of lesion by freezing, laser, loop excision • These treatments are about 90% successful • Anus: similar to external genital warts • Aldara™, Condylox™, freezing, caustic chemicals, laser

35. HPV Protection • Consistent condom use can cut down, but not eliminate, the transmission of HPV • Many HPV-associated lesions resolve spontaneously, but they may return • Warts can be treated and removed, but the virus may remain in latent form • See your health care provider for an accurate diagnosis and appropriate treatment

36. What about HIV/AIDS? • HIV usually leads to AIDS • AIDS is fatal—newer treatments prolong life, but not to a full life expectancy • Having an STI can increase the risk of acquiring HIV • 2 in 1,000 young adults are HIV positive • 92 in 1,000 young adults have chlamydia or HPV HIV is spread by body fluids Semen Vaginal Anal

37. If you think you have an STI • See a health care professional • Be honest about your sexual behavior • Ask for explanations • If you do have an STI, notify your partner

38. Testing for STIs • There is no single test that detects all STIs • No test is perfect (every test can fail to detect an infection) • Screening tests (used when no symptoms are present) • HPV (visual examination; Pap smear tests the cervix only) • Chlamydia, gonorrhea (tests of genital secretions or urine) • HIV, syphilis (specific blood tests) • There is no reliable test for herpes when symptoms are absent

39. STI Prevention • Alcohol and Drugs contribute to becoming infected with an STI • Combined with sexual activity, the use of alcohol and other drugs is strongly associated with: • Sexual activity when you are not really ready • The spread of STIs • Unwanted/unplanned pregnancy • Acquaintance/date rape

40. Remember: Abstinence works best • Avoid genital touching • Many teens and young adults are choosing abstinence for now (this does NOT mean life-long celibacy) • Abstinence reflects feelings of self worth and self esteem • Not everyone is “doing it” • Sexual activity is NOT a requirement for friendship or social acceptance

41. For more information about STIs, contact your health service or other health care professional. Visit the National HPV & Cervial Cancer Prevention Resource Center at www.ashastd.org/hpv/hpvrc/toc.html or contact ACHA at (410) 859-1500