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Chapter Fifteen Sexually Transmitted Infections and HIV/AIDS.

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1 Chapter Fifteen Sexually Transmitted Infections and HIV/AIDS

2 Agenda  Discuss Attitudes and STIs  Review Information about Sexually Transmitted Infections  Discuss Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)  Review Cross-Cultural Aspects of AIDS  Discuss Preventing STIs and AIDS

3 Introduction  Over 65 million people in the U.S. are living with an incurable STI  19 million STI infections occur each year, half to those to people years old  There are more than 25 infections that spread mainly through sexual activity

4 Design a Campaign  You have been chosen to develop a campaign aimed at developing healthy sexuality for high school students.  In this particular city the rate of STIs is the highest in the country.  Develop the components of your ad campaign.  Present your campaign plan to class.

5 Self Reflection Exercise Do NOT discuss. Write down your thoughts privately.  If I found out I was infected with herpes or genital warts, I would …  If my partner were infected with chlamydia, I would …  If I found out I had AIDS, I would …

6 Attitudes about Sexually Transmitted Infections

7 Attitudes and the STI Epidemic  STIs have been viewed as a sign of corrupt sexuality  Punishment concept of disease – that a person got what they deserved  Negative beliefs and stigma about STIs currently exist  These negative attitudes can interfere with getting tested for an STI

8 Attitudes and the STI Epidemic  College students believe they are immune to STIs and engage in high-risk sexual behaviors  e.g. multiple partners, unprotected intercourse  2/3 of STIs occur in people under 25

9 Sexually Transmitted Infections: Trends Reporting Pregnancy Complications Protection

10 Reporting Issues  All states must report syphilis, gonorrhea, chancroid, chlamydia, HIV, & AIDS cases  Many states require that genital warts and herpes be reported  Women are more susceptible to gonorrhea, chlamydia, HIV  Women have more risk of complications from STIs because vaginal tissue is fragile  Women are more likely to be asymptomatic

11 Pregnancy Complications  STIs can affect pregnancies  30-40% of preterm births and infant deaths are due to STIs  Some can cross the placenta (syphilis, HIV)  Some can infect the newborn during delivery (chlamydia, gonorrhea, herpes, HIV)  HIV can be transmitted through breastfeeding  Antibiotics and c-sections can minimize harm

12 Protection  Barrier methods can decrease the risk of STIs  Non-oxynol 9 may increase the risk of infection by irritating the skin  Condoms are the most effective contraceptive that reduces the STI risk  Condoms cannot cover all of the penis, vulva, or scrotum

13 Protection: Partner Issues  Most effective way of avoiding STIs is to abstain from oral, vaginal, and anal sex or be in a long-term, mutually monogamous relationship with someone free from STIs  If a person does have an STI, treatment should include treatment of their sexual partner(s)

14 Class Exercise: Condom Line Up  Penis becomes erect  Carefully open package and remove condom  Buy/Get condoms  Store condoms in cool, dry place  Check expiration date  Decide with partner to have sexual intercourse  Check to see which way condom unrolls  Talk about protection and safer sex  Lose erection  Pull back foreskin if uncircumcised  Place condom on head of penis  Orgasm and ejaculation  Gently squeeze air out of tip of condom  Roll condom all the way down erect penis  Intercourse  Throw away condom in garbage – don’t flush  Hold condom at base of penis and withdraw penis  Remove condom from penis  Lose erection 1.Decide with partner to have sexual intercourse 2.Talk about protection and safer sex 3.Buy/Get condoms 4.Store condoms in cool, dry place 5.Check expiration date 6.Penis becomes erect 7.Carefully open package and remove condom 8.Check to see which way condom unrolls 9.Lose erection 10.Pull back foreskin if uncircumcised 11.Place condom on head of penis 12.Gently squeeze air out of tip of condom 13.Roll condom all the way down erect penis 14.Intercourse 15.Orgasm and ejaculation 16.Hold condom at base of penis and withdraw penis 17.Remove condom from penis 18.Lose erection 19.Throw away condom in garbage – don’t flush

15 Sexually Transmitted Infections Ectoparasitic Infections Bacterial Infections Viral Infections

16 Ectoparasitic Infections  Parasites that live on the skin’s surface  Two sexually transmitted varieties:  Pubic Lice  Scabies

17 Pubic Lice  Also called “crabs”  Small, wingless insects that are difficult to detect on light-skinned people  Attach to pubic hair (preferred) by their claws & drink from tiny blood vessels under the skin  Cannot survive more than 24 hours off of the body, however, they reproduce rapidly and eggs are cemented to the hair  Highly contagious

18 Pubic Lice: Prevalence, Symptoms, Treatment  Incidence: common  Symptoms: mild to severe itching (particularly at night) thought to be due to allergic reaction from their saliva  Diagnosis: lice and eggs are visible  Treatment: kill eggs & lice with Kwell ointment (shampoo, cream); clothing & sheets dry cleaned, boiled, or washed in hot water

19 Scabies  Mite Sarcoptes scabiei  Spread via any skin-to-skin contact  Mites can live up to 48 hours off of the body  Not visible to naked eye

20 Scabies: Prevalence, Symptoms, Treatment  Incidence: millions worldwide  Symptoms: rash and severe itching  Diagnosis: examination of the rash and a skin scraping can confirm diagnosis  Typically less than 10 mites on the body during an infection  Treatment: topical creams; clothing and sheets washed in hot water

21 Bacterial Infections  Gonorrhea  Syphilis  Chlamydia and Nongonococcal Urethritis  Chancroid  Vaginal Infections  Pelvic Inflammatory Disease

22 Gonorrhea  Also called the “clap” or “drip”  Survives only in mucous membranes, such as the cervix, mouth, urethra, rectum, throat, eyes  Transmitted when mucous membranes contact each other  Incidence: second most commonly reported infectious disease in the U.S.; 600,000 to 1 million new cases each year

23 Gonorrhea: Symptoms  Women: most are asymptomatic, cervix is most common infection site; urinary frequency, abnormal bleeding  Men: 25% are asymptomatic; epididymitis, urethral discharge, painful, frequent, & urgent urination  Swelling, pain, & pus in the joints  Rectal gonorrhea: bloody stools & pus

24 Gonorrhea: Diagnosis & Treatment  Diagnosis: examine for bacteria in a sample of the discharge; can also run DNA testing of urine  Treatment: antibiotics (oral, injection)  Note: there are rare cases when they have become drug-resistant

25 Syphilis  Live in the mucous membranes  Typically first infects the cervix, anus, penis, lips, or nipples  Incidence: 7,177 cases reported in 2003  Symptoms: 3 stages  Primary/Early  Secondary (after chancres disappear)  Tertiary (remission, but still infectious; can lead to long term health risks)

26 Syphilis: Stage 1  1: primary/early syphilis days after infection  Chancres (small, round, red-brown, painless sores with a hard raised edge & sunken center) may appear on the vulva, penis, vagina, cervix, anus, mouth, lips

27 Syphilis: Stage 2  2: secondary syphilis after chancres disappear  Syphilis invades the central nervous system  Reddish patches on the skin, possible wart-like growths in area of infection  Lymph glands enlarge  Headaches, fever, anorexia, flu-like symptoms, fatigue

28 Syphilis: Stage 3  3: tertiary/late syphilis  Stage of remission and a person feels fine, though able to transmit the disease for 1 year  If not treated, this stage can cause neurological, muscular, sensory, & psychological difficulties and is eventually fatal

29 Syphilis: Diagnosis & Treatment  Diagnosis: culture taken from a lesion; blood tests  Treatment: Penicillin; antibiotics can temporarily increase the symptoms for a few hours

30 Chlamydia and Nongonococcal Urethritis  May also cause epididymitis and nongonococcal urethritis in men  Incidence: most commonly reported infectious disease in the U.S.; estimated 2.8 million new cases per year  Highest among African Americans  Higher in young women  Underdiagnosed in men

31 Chlamydia and Nongonococcal Urethritis: Symptoms  Chlamydia is highly contagious  Symptoms: asymptomatic in 75% of women and 50% of men  Female symptoms: burning while urinating, painful intercourse, pain in lower abdomen, bleeding/spotting, rare for discharge  40% will get PID, 20% will become infertile  Male symptoms: discharge from penis, burning while urinating, burning & itching at penile opening, pain or swelling of testicles

32 Chlamydia and Nongonococcal Urethritis: Diagnosis & Treatment  Diagnosis: culture cervical discharge for women, blood test, urine test for men  Treatment: antibiotics for 7-10 days; some cases have become drug-resistant

33 Vaginal Infections  There are many common vaginal infections related to sexual intercourse  Trichomoniasis  Bacterial vaginosis  Candiasis

34 Trichomoniasis  Trichomonas vaginalis  Female symptoms 3-28 days after infection: increase in yellowish, frothy, & foul-smelling vaginal discharge; burning/itching in vagina; asymptomatic  Male symptoms: asymptomatic, discharge at tip of penis, burning while urinating or ejaculating  Treatment: metronidazole (Flagyl™)

35 Bacterial Vaginosis  Most common vaginal infection in women of childbearing age, though half are asymptomatic  Increased susceptibility with: multiple partners, douching, low concentrations of beneficial vaginal bacteria  Treatment: metronidazole or clindamycin

36 Candidiasis  Vulvovaginal candiasis; yeast infection  Caused by a variety of fungi, most commonly Candida albicans  Fungi normally common in vagina, but will multiply when the pH balance is disturbed  pH changes due to: pregnancy, oral contraceptives, douching, antibiotics, diabetes, fecal material contacting the vagina

37 Candidiasis  Symptoms: burning, itching, and increase in vaginal discharge that may be thin, white, and including white chunks  75% of women will have at least one yeast infection  Recurrences are common  Treatment: antifungal prescription or over- the-counter drugs (cream is topical or inserted into the vagina); plain yogurt

38 Pelvic Inflammatory Disease  Infection of the female genital tract  Most often caused by chlamydia and gonorrhea  PID can cause long-term complications such as ectopic pregnancies, chronic pelvic pain, infertility  Estimated to affect 1 out of 7 women by age 35 at least once

39 Pelvic Inflammatory Disease: Symptoms & Tratment  Characteristics of a typical PID sufferer: young, unmarried, multiple partners, had an STI, early age at first intercourse, minority, use douches  Symptoms: acute pelvic pain, high fever, abnormal vaginal discharge  Often asymptomatic  Treatment: antibiotics for 14 days

40 Viral Infections  Once a virus enters a body, it can reproduce and the person will have it for the rest of their life  Although they may not experience symptoms while the virus lies dormant, they are still infected  Common Viral STIs  Herpes  Human Papillomavirus  Viral Hepatitis

41 Herpes  Infection with herpes simplex virus (HSV)  The virus prefers the mouth and face (herpes simplex I) or the genitals (herpes simplex II)  The symptoms may be less severe if the virus infects a less preferred site  The virus exists in the sores, as well as from the infected skin without the sores present (viral shedding)  HSV can be spread without active symptoms  A person can reinfect themselves on another body part

42 Herpes: Incidence & Symptoms  Incidence: one of the most common STIs in the U.S.; 1 million infected each year  Symptoms: sores that last 8-10 days, tingling/burning feeling, itching & red swollen genitals, painful urination, blisters with pus, fever, headaches, pain, itching, discharge, fatigue  Over time, outbreak frequency diminishes  Psychological reactions: guilt, anger, anxiety, helplessness, frustration, depression, lowered self-esteem

43 Herpes: Diagnosis & Tratment  Diagnosis: presence of blisters, sometimes a scraping will be taken  Treatment: no cure; therapy with antiviral drugs (topical, oral, injected) to decrease outbreaks, prevent complications, & reduce viral shedding; ice pack; cooling or drying agent; L-lysine; decrease sugar & nuts  Vaccines are undergoing trials

44 Human Papillomavirus  Over 30 types of HPV  Almost all cervical cancers can be attributed to HPV and HPV can also cause genital warts  Transmitted through intercourse, oral sex, vulva-to-vulva sex, anal sex  Incidence: estimated 50% of sexually active people will get HPV  Related factors: intercourse before 16, 2+ sexual partners in a year, Hispanic women

45 Human Papillomavirus: Symptoms & Treatment  Symptoms: asymptomatic; genital warts in 10% of HPV cases (highly contagious); foul- smelling discharge; itching & pain  Diagnosis: visual inspection of warts, biopsies, Pap test  Treatment: chemical topical solutions, cryotherapy, electrosurgical interventions, laser surgery  May resolve itself or need many treatments

46 Viral Hepatitis  3 types & their transmission routes:  Hepatitis A (HAV) – fecal-oral contact; vaccine-preventable  Hepatitis B (HBV) – high-risk sexual behaviors  Hepatitis C (HCV) – sexual behavior, drug use, unscreened blood transfusion  Incidence:  HAV: 1/3 in the U.S.  HBV: 1.25 million in the U.S.  HCV: 3.9 million in the U.S.

47 Viral Hepatitis: Symptoms  HAV: fatigue, abdominal pain, loss of appetite, diarrhea  HBV: asymptomatic, nausea, vomiting, headaches, jaundice, fever, fatigue, darkened urine, liver enlargement, chronic liver disease  HCV: asymptomatic, mild illness, chronic liver infection

48 Viral Hepatitis: Diagnosis & Treatment  Diagnosis: blood test  Treatment: 3 drugs that interfere with the life cycle of the virus and induces an immune response  Vaccines are available for HAV and HBV  Recommended for high risk individuals

49 HIV/AIDS Incidence Knowledge and Attitudes about AIDS Symptoms Diagnosis Treatment Prevention Families and AIDS

50 CNN Video: Fighting AIDS in Africa

51 Overview of HIV and AIDS  AIDS is caused by HIV  HIV is transmitted through bodily fluids (semen, vaginal fluid, blood) during vaginal & anal intercourse or by sharing needles  The virus may remain dormant, however, it is often fatal if untreated  Origin of HIV is unknown

52 HIV and AIDS: Progression  HIV attacks T-lymphocytes (T-helper cells) in the blood, lowering the body’s ability to fight infections  Immune system releases antibodies & many white blood cells to fight the HIV infection  The lowered immune system response means many opportunistic diseases infect people with AIDS that a healthy person can easily fight

53 Incidence of HIV/AIDS  Since 1981, 1.5 million Americans have become infected; million worldwide  Women are the fastest growing group in the U.S. because vaginal tissue is more easily damaged during intercourse, although men drive the spread of HIV  Can be transmitted to a baby during pregnancy, labor & delivery, & breastfeeding  71% of new AIDS cases are in minorities

54 Video: “One + One”  Discuss your response to this video.  What did you learn about HIV/AIDS?

55 Knowledge and Attitudes about AIDS  More knowledge about AIDS in the U.S. has not been correlated with practice of safer sex or behavior changes  3 unique aspects of AIDS:  Fear of transmission  Social worth of those with the disease  Incomprehensible magnitude of the disease  AIDS remains stigmatized in the U.S.

56 Symptoms  Decline in T-helper cells takes 3 years if depressed, and 5+ years if not depressed  AIDS develops within 8-10 years without treatment  Early symptoms are flu like (fever, headaches, fatigue, sore throat, swollen lymph nodes)  Later symptoms: weight loss, severe diarrhea, night sweats, oral candidiasis, gingivitis, oral ulcers, fever, dizziness, confusion  Opportunistic diseases: pneumonia, toxoplasmosis, cryptococcosis, cytomegalovirus, Kaposi’s sarcoma

57 Diagnosis  Tests typically look for antibodies that fight HIV, though some may look for HIV in blood  Antibody tests can require 2 weeks for the result  Rapid tests are less effective  False negative and false positive results are possible with all tests

58 CNN Video: New HIV Testing Procedure

59 Treatment  Before treatment, a viral load test and CD4+ T cell count are taken to determine how much HIV is in the system and to provide a baseline to assess the effectiveness of treatment  HAART – highly active antiretroviral therapy  Blend of 3+ HIV drugs (drug cocktails)  Can involve taking 25+ pills a day at different times on a strict schedule  Expensive: $10,000 to $15,000 per year  Side effects: fatigue, fever, rashes, nightmares, headaches, nausea, diarrhea, increased cholesterol, diabetes, lowered bone density, liver problems

60 Prevention  Requires behavior change  Many schools now include AIDS education  HAART has been related to an increase in high risk sexual practices in homosexual men, but not among heterosexuals  If infected, inform past partners that they should be tested  Research into high risk behaviors is needed  First AIDS vaccine was found ineffective

61 Families and AIDS  Due to the social stigma, caretakers often have no one to turn to  Adolescents that were told their parents had AIDS had more emotional distress and engaged in more high risk sexual practices

62 Cross-Cultural Aspects of AIDS  95% of HIV cases lack access to treatment  AIDS has largely affected children  Areas throughout the world:  Asia and the Pacific  Europe and Central Asia  Sub-Saharan Africa  Latin America and the Caribbean  The Middle East and North Africa  Other Issues

63 Asia and the Pacific  Over 7 million with HIV, many are young  Rising number of infections in India & China  China lacks an adequate supply of condoms  3% of Cambodia is infected  Indonesia’s rise in IV drug use adds to the HIV epidemic  Thailand has shown a decrease due to the copy of antiretroviral drugs for patients and a 100% condom use program for prostitutes

64 Europe and Central Asia  2 million people  Large increase of HIV infections in the Russian Federation, mainly because of IV drug use

65 Sub-Saharan Africa  Most of the people with HIV live in Africa  70% of HIV-positive people live in sub- Saharan Africa  Most people are not receiving HAART therapy due to costs, and they are also not being treated for opportunistic diseases  Male-female power disparity is problematic  HIV-positive men believe sex with a virgin will cure them

66 Latin America and the Caribbean  2 million adults and children  Many countries offer free or low cost antiretroviral therapy to those with HIV/AIDS  They are able to reproduce the drugs that are not patented outside of the U.S.

67 The Middle East and North Africa  480,000 people  Due to IV drug use, men having sex with men, prostitution, low condom usage

68 Prevention

69 Preventing STIs and AIDS  If sexually active, you should get tested  Have partner tested if in a sexual relationship  Carefully choose partners  Use barrier methods, such as condoms  Avoid high-risk sexual behaviors if not in a monogamous relationship  Early detection & treatment is important  Notify your sexual partners  Talking about STIs – honesty & trust


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