1. Sexual Health Update Produced by: Mike Huckabee, PhD, PA-C DIRECTOR: UNMC Physician Assistant Program Lincoln Pediatric Group

2. Sex can be great Pleasure Pleasure Intimacy Intimacy Procreation Procreation

3. But did you know? This year nearly 19 million Americans will become newly infected with a sexually transmitted disease (STD) or sexually transmitted infection (STI). This year nearly 19 million Americans will become newly infected with a sexually transmitted disease (STD) or sexually transmitted infection (STI). Costs $16 billion annually. Costs $16 billion annually. 1/2 occur in people under 25 yrs of age. 1/2 occur in people under 25 yrs of age. More than 25 significant STDs/STIs today. More than 25 significant STDs/STIs today.

4. Do you know? Answer: Human papillomavirus (HPV) Question: Which STD/STI will have the highest rate of new infections this year? Question: What does HPV cause? Answer: Cancer

5. Who is at risk? Lancaster County, NE Lancaster County, NE –2009 Risk Behavior Survey High school students who have ever had sex = 37% High school students who have ever had sex = 37% 63% are abstinent. 63% are abstinent. –(State: 59%, National: 54%) More than 1 sex partner: 19.3% More than 1 sex partner: 19.3%

7. Chlamydia Most common bacterial STI. Most common bacterial STI. No symptoms in 85% of infected women and 40% of infected men. No symptoms in 85% of infected women and 40% of infected men. 1.2 million Americans diagnosed/yr (CDC-2010). 1.2 million Americans diagnosed/yr (CDC-2010). Major cause of pelvic inflammatory disease. Major cause of pelvic inflammatory disease.

11. Chlamydia—Rates by Sex, United States, 1990–2009 NOTE: As of January 2000, all 50 states and the District of Columbia had regulations that required chlamydia cases to be reported.

12. Chlamydia—Rates by Age and Sex, United States, 2009 3,8003,0402,2801,52076000 1,5202,2803,0403,800 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–54 55–64 65+ Total 13.8 735.5 1,120.6 573.3 286.0 141.3 81.9 36.0 219.8 2.9 11.0 127.9 3,329.3 3,273.9 1,234.0 511.7 205.8 88.4 32.0 593.4 2.1 9.1 MenWomen Rate (per 100,000 population) Age

13. Chlamydia Treatment/Prevention Treated by oral antibiotics. Treated by oral antibiotics. If used 100% of the time, condoms reduce the risk of Chlamydia by about 50%. If used 100% of the time, condoms reduce the risk of Chlamydia by about 50%. A life-long, faithful, sexual partner offers 100% prevention. A life-long, faithful, sexual partner offers 100% prevention.

14. Human Papillomavirus (HPV) Highest rate of new STD/year in USA. Highest rate of new STD/year in USA. Typically no symptoms. Typically no symptoms. 20 million Americans infected, 6.2 million more expected each year (NIAID). 20 million Americans infected, 6.2 million more expected each year (NIAID). 74% of all new HPV found in 15-24 year old age group. 74% of all new HPV found in 15-24 year old age group. HPV is the cause of virtually all cervical cancer. HPV is the cause of virtually all cervical cancer.

15. Cervical Cancer Cervical cancer occurs in 12,000 US women each year. Cervical cancer occurs in 12,000 US women each year. It kills over 3,700 US women/yr. It kills over 3,700 US women/yr. 2 nd most common cancer in women worldwide (275,000 deaths/yr). – 2008 WHO GLOBOCAN Report 2 nd most common cancer in women worldwide (275,000 deaths/yr). – 2008 WHO GLOBOCAN Report

16. Anatomy of Cervix

18. HPV Infections Over 100 types of HPV, 40 types cause genital infections. Over 100 types of HPV, 40 types cause genital infections. 15-18 types cause cancer. 15-18 types cause cancer. 2 types that do not cause cancer cause genital warts. 2 types that do not cause cancer cause genital warts.

19. Genital Warts Treatment Topical medications applied by a clinician or at home. Topical medications applied by a clinician or at home. When warts resolve, infection may remain. When warts resolve, infection may remain. Warts may return months after treatment. Warts may return months after treatment.

20. HPV Prevention HPV sheds through skin. HPV sheds through skin. –Condoms do not prevent transmission. HPV vaccine (Gardasil) HPV vaccine (Gardasil) –Prevents infection by 4 HPV strains, 2 related to cancer and 2 related to warts. –Series of 3 shots given over 6 months. –Recommended for men & women ages 9-26. Life-long, faithful partner = 100% prevention. Life-long, faithful partner = 100% prevention.

21. Today’s HPV Risks In 70% of women with HPV the infection resolves within 1 year, and 91% resolve within 2 years. In 70% of women with HPV the infection resolves within 1 year, and 91% resolve within 2 years. Infection with high-risk HPV can lead to cancer. Infection with high-risk HPV can lead to cancer. Most HPV infections do not result in cancer and do not require treatment. Most HPV infections do not result in cancer and do not require treatment.

22. Cervical Cancer Incidence Rate, 2007 4.5-6.2 6.3-7.5 7.6-8.4 8.5-11.2

23. Gonorrhea 2 nd most common reportable bacterial STI in America. 2 nd most common reportable bacterial STI in America. Symptoms often occur within 1 week of exposure: Symptoms often occur within 1 week of exposure: –Pain with urination. –Discharge (pus) from penis or vagina. –PID in women, testicle infection in men. –Some have no symptoms.

24. Gonorrhea Treatment/Prevention Treated by oral/injectable antibiotics. Treated by oral/injectable antibiotics. If used 100% of the time, condoms reduce the risk of gonorrhea by about 50%. If used 100% of the time, condoms reduce the risk of gonorrhea by about 50%. Life-long, faithful, sexual partner offers 100% prevention. Life-long, faithful, sexual partner offers 100% prevention.

25. Herpes Simplex Virus (HSV) Common cause of “cold sores.” Common cause of “cold sores.” HSV also transmitted by sexual activity. HSV also transmitted by sexual activity. Ulcers resolve in 2-3 weeks. Ulcers resolve in 2-3 weeks. Recurrence of ulcers common: Recurrence of ulcers common: –90% of people have recurrence in 1st yr. –38% have six recurrences in 1st yr.

26. Herpes Prevalence Most common STI in America. Most common STI in America. 45 million Americans infected, with 1 million more expected this year. 45 million Americans infected, with 1 million more expected this year. –1 in 6 Americans between 14-49. Over time symptoms lessen, easier to ignore. Over time symptoms lessen, easier to ignore. Life-long infection without cure. Life-long infection without cure.

27. Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2009 NOTE: The relative standard errors for genital herpes estimates of more than 100,000 range from 18% to 30%. SOURCE: IMS Health, Integrated Promotional Services™. IMS Health Report, 1966–2009.

28. Herpes Treatment/Prevention Anti-viral medications reduce duration of symptoms, frequency of recurrences and viral shedding. Anti-viral medications reduce duration of symptoms, frequency of recurrences and viral shedding. If used 100% of the time, condoms reduce the risk of herpes by about 30%. If used 100% of the time, condoms reduce the risk of herpes by about 30%. Life-long, faithful, sexual partner offers 100% prevention. Life-long, faithful, sexual partner offers 100% prevention.

29. Typical Condom Use Slippage/breakage occurs 1-4% of time. Slippage/breakage occurs 1-4% of time. Incorrect/inconsistent use more common. Incorrect/inconsistent use more common. In sexually active high school students, 61% used a condom during last sexual intercourse (CDC-2009). In sexually active high school students, 61% used a condom during last sexual intercourse (CDC-2009). 22.9% report using birth control meds to prevent pregnancy (CDC-2009). 22.9% report using birth control meds to prevent pregnancy (CDC-2009).

32. Why do people have sex? Love

34. Pornography Myths Teens are seeking sexual gratification. Teens are seeking sexual gratification. M

35. Pornography Myths Teens are seeking sexual gratification. Teens are seeking sexual gratification. –Teens are bored, looking for escape. M

36. Pornography Myths Teens are seeking sexual gratification. Teens are seeking sexual gratification. –Teens are bored, looking for escape. Pornography is risk-free. Pornography is risk-free. M

37. Pornography Myths Teens are seeking sexual gratification. Teens are seeking sexual gratification. –Teens are bored, looking for escape. Pornography is risk-free. Pornography is risk-free. –Puts family, reputation, and future relationships and career at risk. –Pornography is often illegal. M

38. Pornography Myths  Teens are seeking sexual gratification.  Teens are bored, looking for escape.  Pornography is risk-free.  Puts family, reputation, and future relationships and career at risk.  Pornography is often illegal.  Pornography doesn’t hurt anyone.

39. Pornography Myths  Teens are seeking sexual gratification.  Teens are bored, looking for escape.  Pornography is risk-free.  Puts family, reputation, and future relationships and career at risk.  Pornography is often illegal.  Pornography doesn’t hurt anyone.  Women are victimized, if not kidnapped into forced sex acts.

40. More Teens are Choosing Abstinence More than 50% of high school men and women are virgins. More than 50% of high school men and women are virgins. Approximately 25% of teens who have had sex in the past are currently abstinent. Approximately 25% of teens who have had sex in the past are currently abstinent.

41. Sexual Partners Study of single high school in TX. Study of single high school in TX. Approximately 1000 students, 532 are sexually active. Approximately 1000 students, 532 are sexually active. What does the distribution of sexual partners look like? What does the distribution of sexual partners look like?

42. Male Female 12 9 63 Sexual network for a TX high school 2 286 teens 37 steps from one side to the other

43. Breaking the Chain One person discontinuing sexual activity can break the chain. One person discontinuing sexual activity can break the chain. Secondary virginity reclaims the individual’s freedom from STDs/STIs. Secondary virginity reclaims the individual’s freedom from STDs/STIs.

44. Saving Sex For Marriage It is normal and healthy to have sex only in marriage. It is normal and healthy to have sex only in marriage. Studies show that those who save sex for marriage have: Studies show that those who save sex for marriage have: –No risk of STIs. –No risk of non-marital pregnancy. –Less depression & suicide. –Stronger, better sexual relationships.