2SEXUALLY TRANSMITTED DISEASES Lynne D. Feldman, MD, MPH – District Health DirectorElsie Napier, RN, FNP – District Program ManagerBrenda Mims, RN – Infectious Disease Coordinator
3South Health District, 8-1 STD Presentation Presentation toValdosta State University / Student HealthBrenda Mims, RN – Infectious Disease Coodinator
4DCH Mission ACCESS RESPONSIBLE HEALTHY Access to affordable, quality health care in our communitiesResponsible health planning and use of health care resourcesHealthy behaviors and improved health outcomes
5DCH Initiatives FY 2009 and FY 2010 Medicaid TransformationHealth Care ConsumerismFinancial & Program IntegrityHealth ImprovementSolutions for the UninsuredWorkforce DevelopmentPeachCare for KidsTM Program StabilityCustomer ServiceMedicaid TransformationHealth Care ConsumerismFinancial & Program IntegrityHealth ImprovementWorkforce DevelopmentCustomer ServiceEmergency Preparedness
6Disclosure Statements To obtain nursing contact hours for this session, you must be present for the entire hour and complete an evaluation.Neither the planners of this session nor I have any financial relationship with pharmaceutical companies, biomedical device manufacturers, or corporations whose products and services are related to the vaccines we discuss.There is no commercial support being received for this event.The mention of specific brands of vaccines in this presentation is for the purpose of providing education and does not constitute endorsement.The GA Immunization Program utilizes ACIP recommendations as the basis for this presentation and for our guidelines, policies, and recommendations.For certain vaccines this may represent a slight departure from or off-label use of the vaccine package insert guidelines.[Presenter is required to read this information to the audience before the program begins.]To obtain nursing contact hours for this session, you must be present for the entire hour and complete an evaluation.Neither the planners of this session nor I have any financial relationship with pharmaceutical companies, biomedical device manufacturers, or corporations whose products and services are related to the vaccines we discuss.There is no commercial support being received for this event.The mention of specific brands of vaccines in this presentation is for the purpose of providing education and does not constitute endorsement.The GA Immunization Program utilizes ACIP recommendations as the basis for this presentation and for our guidelines, policies, and recommendations.For certain vaccines this may represent a slight departure from or off-label use of the vaccine package insert guidelines.
7GoalTo promote Sexually Transmitted Disease awareness, prevention and education.
8ObjectivesAfter the completion of this presentation participants should be able to:Define Sexually Transmitted Diseases (STDs);Describe how STDs are transmitted;Name at least three of the most commonly diagnosed STDs;Identify signs and symptoms of STDs;Understand the effects of STDs on pregnancy;Describe recommended CDC treatments for STDs;Understand the STD reporting and follow-up process.
9Sexually Transmitted Diseases (STDs) DefinitionAn infection passed during sex by means of sexual contact, including vaginal intercourse, oral sex, and anal sex.Until the 1990’s these illnesses/diseases were commonly known as venereal diseases. Veneris – the Latin name for Venus, who is considered the Roman goddess of love.Can have no symptomsInfect the following areas:MouthRectumSex organs ( vagina, vulva, penis, testes)
14Chlamydia What is Chlamydia? Mode of transmission Symptoms Treatment Sexually transmitted infectionA common STD caused by the bacterium Chlamydia TrachomatisCan be transmitted through vaginal, anal or oral sex as well as to a child from the mother during birthCan cause sterilityMode of transmissionSpread during vaginal, anal or oral sex with someone who has ChlamydiaSymptomsMay present as non-gonococcal urethritis (NGU) syndrome in males or mucopurulent cervicitis syndrome in femalesKnown as the “silent” diseaseAbnormal vaginal bleeding (between menstrual periods)Burning sensation during urinationBack pain and/or pain during intercourseTreatmentAntibiotic (Usually Azithromycin or Doxyclycline)Partner should also be treated to prevent re-infectionPreventionAbstinenceCondomsMonogomy
19Gonorrhea What is Gonorrhea? Sexually transmitted disease caused by Neisseria GonorrhoeaeCan also grow in the mouth, throat, eyes, and anusMode Of TransmissionSpread during vaginal, anal or oral sex with someone who has GonorrheaSymptomsMany men may have no symptomsSome symptoms may take up to 30 days to appearBurning sensation during urinationWhite, yellow or green discharge from the penis or vaginaPainful or swollen testiclesVaginal bleeding between periodsPainful bowel movementsMany with Gonorrhea also have other STDsTreatmentAntibioticsDrug resistant strains are increasingPreventionAbstinenceCondomsMonogomy
23Genital Warts What is Genital Warts Mode of Transmission Symptoms Small, sexually transmitted growths that is caused by Human Papillona VirusFlesh-colored (look like miniature cauliflower florets)Can be visible in the vagina, urethra, cervix, vulva, penis, anusMode of TransmissionSpread during vaginal, anal or oral sex, and sometimes by genital touching, with someone who has genital wartsSymptomsThe virus lives in the skin or mucous membranesCan cause no symptomsTreatmentCan be removedNo Cure (will have the virus for the rest of your life)PreventionCondomsMonogamy
27Hepatitis What is Hepatitis? Hepatitis A Hepatitis B Hepatitis C A disease that damages the liverCaused by a virusHepatitis A, B, C are most commonHepatitis APassed in human feces, food and waterSymptoms: Jaundice, Fatigue, Abdominal Pain, Diarrhea, NauseaHepatitis BPassed through blood, saliva, semen, or vaginal fluids (anal or oral sex), from mother to baby during birth, sharing needles to inject drugs or for any other reasonSymptoms: Persistent flu-like feelings, tiredness, jaundice, dark urine, light-colored bowel movementsHepatitis CPassed through blood, from mother to baby during birth, during sex (not common)Hepatitis B & C can become chronicCan cause cirrhosis (scarring) of the liverLiver cancerPreventionHepatitis A & B vaccine availableHepatitis C – No Vaccine but medication available to prevent further liver damage
28HepatitisPicture of a healthy liverEffects of hepatitis on the liver
29Treatment For Hepatitis A, B & C No treatmentThere is a vaccine to prevent Hepatitis AGoes away by itself in 2-6 monthsHepatitis BYes / Treatment isn’t always successfulThere is a vaccine that should be started at birth – all ages 0-18 should be vaccinatedHepatitis CTreatment with antivirals (interferon – most common) to manage and slow disease progressionThere is no vaccine for Hepatitis C
31Perinatal Hepatitis B Prevention Program Program GoalsEnsure all pregnant women are screened for HBsAg at their initial prenatal screening panel as standard of careBe sure Public Health conducts case investigations on all positive HBsAg pregnant womenConfirm 90% of all infants born to HBsAg positive women receive HBIG and the first dose of Hep B vaccine within 12 hours of birthEnsure that 90% of all infants born to HBsAg positive women receive the second dose of vaccine at 1-2 months of ageEnsure that 80% of all infants born in Georgia to HBsAg positive women are tested at 9 months to 18 months of age for HBsAg and Hepatitis B surface antibodies (Anti-HBs)
33Genital Herpes What is herpes? A viral infection characterized by recurring vesicular and ulcerative lesions on the genitals or adjacent areas that heal spontaneously without scarring.Some severe cases of first episode infection last an average of 12 days and aseptic meningitis or generalized symptoms due to viremia may occur.Mode of transmissionSpread through vaginal, anal and oral sex – sometimes by genital touching with someone who has herpesSymptomsOral HerpesCold sores or “fever blisters”Genital HerpesMost have no symptomsMost common symptoms – cluster of blistery sores – usually on the vagina, vulva, cervix, penis, buttocks or anusMay last several weeks – may return in weeks, months or yearsFever, blisters, burning feelings if urine flows over sores, itching, open soresPreventionAbstinenceDo not have sexual contact during outbreaksUse condoms between outbreaks
37Syphilis What is Syphilis? Mode of Transmission Symptoms Prevention An STD caused by the bacterium Treponema PallidumCalled the “great intimidator” because many of the signs and symptoms are indistinguishable from those of other diseasesStages of SyphilisPrimarySecondaryLateCongenitalMode of TransmissionSpread during vaginal, anal or oral sex, and sometimes by genital touching, with someone who has SyphilisSymptomsPrimary: Appearance of a sore (chancre) at the spot where syphilis entered the body – could be one or moreSecondary: Skin rash and mucous membrane lesions, fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigueLate: Difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, dementiaCongenital: rash, thinning of the skinPreventionAbstinenceCondomsMonogamy
42Treatment of SyphilisSyphilis can be treated; however, a person will usually have a “titer” after treatmentTiter, def. the concentration of antibodies present in the highest dilution of a serum sample at which visible clumps with an appropriate antigen are formed. The concentration of antibodies present in the highest dilution of a serum sample at which visible clumps with an appropriate antigen are formed.Benzathine Penicillin GDoxyclycline (Cannot be used on lactating clients)
45HIV Human Immunodeficiency Virus The virus that causes AIDS Damages the body’s immune system which protects the body from diseasesCan have for many years without signs or symptoms
46HIV Modes of Transmission During vaginal, oral or anal sexBlood-to-blood contact(blood with HIV in it comes into contact with blood or mucous membranes of another person)Sharing needlesNeedles used for tattoos and piercing or to inject vitamins or steroidsHealthcare workers caring for HIV can get HIV from needle-stick injuriesMother to baby during pregnancy, childbirth, or breast feeding
47HIV HIV is not passed by: Donating blood Hugging, dry kissing, or sharing foodTelephones, toilet seats, or eating utensilsTears, saliva, sweat or urineMosquitoes or other insectsCoughing, sneezing, or spitting
48HIV Incubation Period: Some people develop symptoms shortly after being infectedSometimes it takes more than 10 years for symptoms to appear.
49Stages of HIV “Stage 1” Primary HIV Infection Last for a few weeks Have flu-like symptomsBody begins seroconversionBody responds to the virus by producing HIV antibodiesCan last 3 weeks to 6 months
50Stages of HIV “Stage 2” Asymptomatic Stage Having no obvious signs of symptomsImmune system still strong enough to prevent symptomsLast for an average of 10 yearsPeople continue to look and feel healthyThe virus can still be passed to other peopleUnprotected sex, needle sharingHIV virus continues to weaken the immune system
51Stages of HIV “Stage 2” Continue Symptoms:Moderate unexplained weight lossRecurrent respiratory infectionsFungal nail infectionsHerpes zoster
52Stages of HIV “Stage 3” Symptomatic HIV Infection The virus has become more active in the body and the immune system is weakened.Symptoms:Skin RashesFatigueNight SweatsSlight weight lossMouth ulcersThrush (yeast infection)Fungal skin and nail infections
53Stages of HIV “Stage 3” Continue SymptomsUnexplained sever weight lossChronic diarrheaPersistent feverOral candidiasisOral hairy leukoplakiaBacterial infectionsPneumonia
54Stages of HIV “Stage 4” AIDS CD4 count is less than 200 Or has a history of an AIDS defining illnessOpportunistic InfectionsInfections that the immune system would normally prevent.Examples:Pneumocystis Carinii Pneumonia (PCP)A fungal infection of the lungsTuberculosis (TB)A bacterial infection often found in the lungs but can spread to other parts of the bodyKaposi’s Sarcoma (KS)A rare cancer that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat or in other organsCytomegalovirus (CMV)A common virus that infects most people at some time during their lives but rarely causes obvious illness. It is a member of the herpes virus familyCan cause blindnessToxoplasmosisA disease caused by a single-celled parasite called Toxoplasma gondiiCan affect the brain
55Pneumocystis Carnaii Pneumonia There is increased white (opacity) in the lower lungs on both sides, characteristic of Pneumocystis pneumonia
60How Does A Person Find Out Whether Or Not They Are HIV+? Taking the HIV Antibody testGiving A Blood SampleBlood is drawn and sent to the lab for processingResults back in about two weeksTaking the OraSure TestA swab is taken from the cheek (an additive on the swab pulls blood from the capillaries inside the cheek)Results back in 2-3 daysTaking the OraQuick testA needlestick testResults usually back in about 30 minutesIf a positive is revealed a confirmatory test is performed
61HIV Testing Test for HIV antibodies If you have antibodies Immune system makes these to fight HIVDoes not tell if you have AIDSIf you have antibodiesTest results are positiveHave HIVIf you don’t have HIV antibodiesTest results negativeYou don’t have HIV
62HIV Testing Continued The Window Period Usually takes up to 3 months after infection for the body to make HIV antibodiesIn rare cases, it can take up to 6 months