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STD 411. Good information on prevention in FLASH curriculum Focus on pathophysiology (changes resulting from disease). Anyone who is sexually active.

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Presentation on theme: "STD 411. Good information on prevention in FLASH curriculum Focus on pathophysiology (changes resulting from disease). Anyone who is sexually active."— Presentation transcript:

1 STD 411


3 Good information on prevention in FLASH curriculum Focus on pathophysiology (changes resulting from disease). Anyone who is sexually active can become infected with any STI/STD. Some groups have higher incidences for a variety of reasons (prevention education, risk factors, behavior, etc.), but the diseases don’t discriminate. STI’s continue to circulate in the population because of basic ignorance and taboo. We could go a long way toward eliminating (or at least vastly reducing) infections by providing education and kicking the taboos. Having any STI can make you more susceptible to another STI/STD. Many are transmitted concurrently.

4 STD 411 We will cover the following STI/STDs  Chlamydia  Gonorrhea  Syphilis  Trichomoniasis  HSV  HIV  HPV

5 Chlamydia

6 Chlamydia Most frequently reported STD in the United States. Does that mean the most common? Not necessarily. It is the most widely tested STD, but Trichomonas may be the most common, just not as widely tested. Easiest STI to treat. One dose of azithromycin and test for cure (or reinfection) after 3 months. No sign of drug resistance in the population (good news).

7 Chlamydia Microbe description  Chlamydia trachomatis bacteria – obligate intracellular pathogen which means that it must live inside of the cells.  Several variants of the bacteria cause lymphogranuloma venarium (LGV). This is a more invasive form of chlamydia that invades the lymph system and causes widespread and permanent damage. Pathophysiology  Infection in the conjunctiva (eye) is the leading cause of blindness in infants.  Symptoms may develop in only 30% of those infected. Because of this, it is referred to as a “silent” infection. The ONLY way to know if you are infected is via laboratory testing (unless you have never had any sort of sexual contact).

8 Chlamydia Men  Proctitis (inflammation of the colon and anus) – rectal bleeding, discharge, pain  Urethritis (inflammation of the urethra) – painful urination, discharge, sometimes testicular pain and pelvic tenderness Women  Proctitis (inflammation of the colon and anus) – same as in men  Urethritis (inflammation of the urethra) – painful urination, discharge  Cervicitis (inflammation of the cervix) – abnormal bleeding and discharge, pelvic pain, may lead to pelvic inflammatory disease (PID), chronic pain, infertility ***REMEMBER*** Most infected individuals never experience symptoms. Only laboratory testing can confirm the presence or absence of an infection.

9 Gonorrhea Joe Miller/CDC

10 Gonorrhea Emerging problems with drug resistance. Some strains are resistant to all but one drug. One strain is resistant to all treatments. The current treatment regimen from the CDC includes more than one antibiotic at a time to deliver a 1,2 punch to the bacteria. As with chlamydia, most men and women don’t have symptoms, or symptoms are so mild they are mistaken for another infection such as a UTI.

11 Gonorrhea


13 Microbe description  Neisseria gonorrhoeae – bacteria that infects the mucous membranes of the reproductive tracts of men and women. Can also infect anus, throat, and eyes. Commonly called gonococcus (GC) and “the Clap”. Anyone know why it’s called “the Clap”?

14 Gonorrhea Pathophysiology  Men – when symptoms are present, they may include discharge (greenish/yellowish), painful urination, and testicular pain. If left untreated, systemic dissemination may occur known as disseminated gonococcal infection (DGI). This can cause arthritis, dermatitis, and even death.  Women – many women won’t have symptoms, or symptoms so mild they mistake it for a yeast infection or a urinary tract infection. As with chlamydia, gonorrhea can lead to PID, chronic pain, and infertility. Systemic dissemination (DGI) is also a possibility if left untreated.

15 Syphilis CDC

16 Syphilis Probably the most historically infamous STD. It was thought that this bacteria was brought back to Europe by the crew that went with Christopher Columbus to the “new world”. However, there is evidence that syphilis may have been present in ancient Greece, but not much solid evidence yet. Sometimes called “The Great Pretender” because the symptoms are so similar to other diseases. For a good and cringe-worthy depiction of late-stage syphilis, watch Johnny Depp in “The Libertine”. This is a movie based on the infamous John Wilmot, 2nd Earl of Rochester and member of the court of Charles II.

17 Syphilis Microbe description  Treponema pallidum bacteria – spirochete that enters the body through the skin and invades the blood stream and sometimes the nervous system. Pathophysiology  Men and women experience similar symptoms. Syphilis infection is divided into three stages: Primary, secondary, and latent/late.

18 Syphilis Primary stage – This stage begins with a single sore called a chancre. This is a non-painful sore that appears at the site of infection, usually the genitals. Sometimes the chancre can go unnoticed if it appears inside of the vagina or the anus. The chancre will go away without treatment in about 3-6 weeks, but the bacteria will remain and the disease will progress to the second stage. The primary stage is the infectious stage. Since the bacteria are transferred via the chancre, any sexual partners are at risk of infection.

19 Syphilis Secondary stage – This stage is defined by a rash that can appear anywhere, but the bottoms of the hands and feet are usually affected. This rash is non-itchy, reddish-brown, and rough. Other symptoms may include fever, swollen lymph nodes, sore throat, and weight loss. (Sound familiar?) The chancre is usually gone at this point, but can still be healing when the rash appears.

20 Syphilis Latent/late stage – When the rash disappears, the latent/late stage begins. All symptoms disappear. This can last for many, many years and may cause someone to not seek treatment. The treponemal bacteria are still present, though, and about 15% of infected individuals will progress to late stage syphilis in years after infection. This is when things get dangerous. The bacteria invade and destroy the internal organs including the brain, liver, kidneys, vessels, heart, etc. Muscle coordination, sight, and cognitive processes are affected. If treated, the infection will be cleared, but the damage remains. If left untreated, death is inevitable.

21 Syphilis Neurosyphilis – at any stage of infection, the bacteria can invade the nervous system and cause neurosyphilis. This results in movement disorders similar to Parkinson’s and Huntington’s as well as personality changes and mood disorders.

22 Syphilis Famous cases of syphilis  Al Capone  John Batman, founder of Melbourne, AU  Napolean Bonaparte (suspected)  Cesare Borgia (suspected)  Paul Gauguin

23 Trichomoniasis CDC

24 Trichomoniasis Possibly the most widespread STI, but without widespread testing it is difficult to know the true numbers. Testing problems? More women infected than men. Why? Testing? Symptoms? One of the few STIs that infect more older women than younger women. Vast majority of men and women who are infected do not have recognizable symptoms. According to the CDC, 70% of infected individuals have no symptoms. Treatment is simple. A single dose of an antibiotic that is effective against this parasite.

25 Trichomoniasis Microbe description  Trichomonas vaginalis – single-celled protozoan parasite. Can be passed from penis to vagina, vagina to penis, vagina to vagina. Normally limited to genital infection without spread to throat, anus, etc.

26 Trichomoniasis Pathophysiology  Men – infection of the penis can cause inflammation with pain on urination and ejaculation. Testing is not commonly done because of the limitations of testing. New tests make it much easier with NAAT, but not yet widely available.  Women – infection can affect the cervix, vagina, and urethra and cause inflammation with burning and itching of the genitals. Upon examination, a GYN may notice “strawberry” speckling on the cervix. Testing is mainly done with a wet mount and microscopic observation of the parasite. New NAAT testing makes testing easier and more sensitive. Failure to treat the infection can lead to complications for a fetus including low birth weight and prematurity. Men & women – symptoms can make sex painful and unpleasant.

27 Herpes Simplex Virus (HSV) Transmission electron micrograph (TEM)

28 Herpes Simplex Virus (HSV) One of the few STIs that cannot be cured. Because of this, it is very common in the population. Though it can’t be cured, it can be managed with medication and avoidance of sex during outbreaks.

29 HSV Microbe description  HSV-1 & HSV-2 – Virus. Most know type 1 as oral herpes and type 2 as genital herpes. However, both types can infect both regions. Type 1 is increasing in genital infections because of the mistaken belief that unprotected oral sex is completely safe.

30 HSV Pathophysiology  Both men and women experience ulcerations at the site of infection. The ulcers are usually small blisters that break open after a couple of days and leave painful, itchy sores that can last for days to weeks. Sometimes, the outbreak can be a mild rash that is mistaken for heat rash or dermatitis. The first outbreak is generally the most severe with accompanying fever, swollen lymph nodes, and body aches. The first year of infection generally sees the most recurrent outbreaks. Medication can prevent or decrease the amount of outbreaks and viral shedding.  In rare cases, the virus can travel backwards and into the central nervous system causing damage to nervous and brain tissue. More on viral shedding: The virus can shed even in the absence of a visible outbreak. An infected person can still pass on the infection when they don’t have any active sores. Medication can greatly reduce the probability of viral transfer by preventing the virus from replicating.

31 HSV Pathophysiology (cont.)  Men – Infection can cause shame and social stigma.  Women – In addition to the shame and social stigma, HSV infection can cause pregnancy and childbirth complications. Infection that occurs during pregnancy has a higher probability of transferring to the fetus with fatal consequences. Medication is advised for pregnant women who have a history of herpes infection. If there are signs of an outbreak during delivery, a cesarean delivery is advised to reduce the risk of transmission during birth.

32 Human papillomavirus (HPV) Laboratory of Tumor Virus Biology

33 Human papillomavirus (HPV) Most common STD. It is so common that most people will contract it at some point during their sexual lives. Many infections clear up by themselves (around 90% according to the CDC). Causes complications ranging from genital warts to cancers. Different strains cause different symptoms. The strains that cause warts do not cause cancer and vice versa.

34 HPV Microbe description  Human papillomavirus – more than 40 strains that infect humans.  Two vaccines, Cervarix and Gardasil, available to prevent the most common HPV strains which cause cancer and warts.

35 HPV HPV (the virus): Approximately 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that nearly all sexually-active men and women will get at least one type of HPV at some point in their lives. Genital warts: About 360,000 persons in the U.S. get genital warts each year. Cervical cancer: About 10,300 women in the U.S. get cervical cancer each year. Other cancers that can be caused by HPV, including some vaginal, vulvar, penile, anal, and oropharyngeal cancers: Each year in the U.S., HPV is thought to cause an estimated 2,100 vulvar cancers, 500 vaginal cancers, 600 penile cancers, 2,800 anal cancers in women, 1,500 anal cancers in men, 1,700 oropharyngeal cancers in women,* and 6,700 oropharyngeal cancers in men.* *Note: Other factors, notably tobacco and alcohol use, may also play a role with HPV to cause these cancers. About 21,000 of these cancers are potentially preventable by HPV vaccines. 

36 HIV colored scanning electron micrograph of a T4 cell (green) infected with HIV (red). © NIBSC/Science Photo Library

37 HIV Not going to cover this too extensively because there are a couple of classes in the FLASH curriculum devoted to it. Though not technically an STD (it’s a blood-borne pathogen), the majority of worldwide infections are by sexual contact…..specifically heterosexual contact. Women are more susceptible to infection due to physiological differences. HIV is generally considered a manageable chronic condition instead of the death sentence it used to be. However, most people don’t consider the side-effects of the treatments. Skin conditions, cognitive problems, headaches, digestive problems, etc. are common with antiretroviral medications. Resistant strains are becoming more common and could become more widespread. Transmission rates are increasing. Why?

38 HIV David Kirby 1990, Ohio – by Therese Frare

39 Questions?

40 Resources sandDisease/SexuallyTransmittedDisease.aspx sandDisease/SexuallyTransmittedDisease.aspx communicable/std.aspx communicable/std.aspx center/stories/?topic=stories-hiv-aids-stds center/stories/?topic=stories-hiv-aids-stds

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