1. Chapter 5
Sexually Transmitted Infections and Sexually Related Diseases (part 1 of 2)

2. STIs! What are they and who gets them?
U.S. has highest STIs of any industrialized country
Half of new infections are in 15 – 24 year olds
1 in 2 Americans will contract at least one STI in their lifetime
Infected people may or may not be promiscuous
The U.S. has the highest rate of STIs of any industrialized country.
Half of new infections are in 15 – 24 year olds.
1 in 2 Americans will contract at least one STI in their lifetime.
People who become infected may be promiscuous or may have had only one sexual partner.

3. Cause vs. Transmission STD causes Bacteria Parasites Viruses
STD transmission
Rarely transmitted to others except by intimate, sexual contact

4. Personal Reflections
How would you feel if you found out you had a sexually transmitted infection (or, if you have been infected, how did you feel)? Would you feel differently than you would if you had contracted the flu? Why? How would you tell your partners of their possible infection?

5. Where did they come from?
Some STIs have existed for thousands of years.
STD infection and contagion to others can occur without symptoms!
Regardless of where they came from they are hear now and we must deal with them.
Many people are unaware that they can be infected with an STI and be contagious to others without having any symptoms.

6. Gonorrhea: Incidence and Symptoms
Yearly incidence
Infection sites
Asymptomatic percentages
Symptoms
Bacterial - 700,000 new cases yearly
Can infect urethra, vagina, rectum, mouth, throat and/or eyes (warm mucous membranes).
20 – 25% of infected men are asymptomatic.
60 – 80% of infected women are asymptomatic.
Thick, painful, pus-like white or yellowish discharge begins 2 – 10 days after infection.
Burning pain during urination is common in those who have symptoms.

7. Call it “the clap” or “the drip” but call a doctor!
If left untreated, gonorrhea can:
spread
move to bloodstream and joints
cause pelvic inflammatory disease (PID)
Diagnosis via urine test; antibiotics prescribed
If left untreated, gonorrhea
spread into internal reproductive system and bladder
move into the bloodstream to the joints
lead to pelvic inflammatory disease (PID)
Diagnosis via urine test; antibiotics prescribed

8. Chlamydia: Damage If Not Treated
Yearly incidence
Infection sites
Symptoms
Consequences
In men, infection of the prostate and epididymis and possible sterility.
Up to 40% or women with chlamydia will develop pelvic inflammatory disease, which may lead to tubal pregnancies and sterility.
Increase in stillbirths, premature deliveries, and blindness in newborns.
In tropical countries lymphogranuloma vernereum (LGV) may result in painful swelling of the genitals.

9. Chlamydia and Nongonococcal Urethritis Incidence and Symptoms
Yearly incidence
Infection sites
Symptoms
Consequences
Bacterial – at least 2.8 million cases annually
Symptoms similar to gonorrhea, but milder
Irritation and burning of the urethra
Discharge tends to be clear and thin rather than pus-like.
Especially prevalent in teens and young adults.
80% of women and a large portion of men are asymptomatic.

10. If you think you’ve been exposed…
Simple urine test can diagnose chlamydia; antibiotics prescribed
50% – 75% of PID cases caused by untreated chlamydia or gonorrhea
Symptomatic and asymptomatic cases can permanently scar fallopian tubes

11. Syphilis: Incidence and Symptoms
Yearly incidence
Infection sites
Symptoms
Consequences
Only 34,000 U.S. cases in 2005 but 12 million worldwide, mostly in southeast Asia and Africa.
Besides being sexually transmitted, syphilis can pass through any little cut or scrape and move into the bloodstream.
Primary stage – painless but ugly chancre sore within 2 – 4 weeks after infection. It disappears on its own within 10 – 14 days.

12. The Highly Contagious First Stage
Chancre sore appears where the bacteria first entered the body, usually on the penis, vulva, cervix, lips, tongue, or anus.

13. Secondary Stage Syphilis
4 to 6 weeks after chancre disappears
painless, itchless rash all over body

14. Other Second Stage Symptoms
Large, oozing sores around genitals
Sore throat, low-grade fever, nausea, loss of appetite, aches and pains, and hair loss
Allergic-like reaction
Eventual disappearance even without treatment
Large, oozing sores may form around the genitals.
Sore throat, low-grade fever, nausea, loss of appetite, aches and pains, and even hair loss.
Syphilis is known as the “great imitator” because it may seem like an allergic reaction or the measles.
These symptoms often “encourage” infected persons to seek medical assistance, but these symptoms too, will eventually disappear on their own without treatment.

15. Latent and Tertiary Stage Syphilis
Decreased contagion after year
Bacteria attacking internal organs (heart, blood vessels, brain, spinal cord)
In tertiary stage about 1/3 experience more serious, potentially fatal organ damage, large ulcers on skin and bones, paralysis, deafness, insanity

16. Congenital Syphilis Process Complications Treatment
spirochete can travel through the placenta to the fetus, leading to miscarriage, stillbirth, or a baby born with “congenital syphilis”
Complications include deformed bones and teeth, blindness, deafness and organ abnormalities that can result in early death.
Babies can be treated with antibiotics to stop further damage; earlier damage is permanent.

17. Less Common Bacterial STIs
Chancroid
Granuloma inguinale
Shigellosis
Chancroid – painful chancre, swollen lymph nodes in the groin
Granuloma inguinale – more common in tropical areas; painless pimple that ulcerates and spreads, killing tissue, fatal if untreated
Shigellosis – from exposure to infected feces; acute diarrhea, fever, pain

18. Personal Reflections
How would you feel if your best friend told you that he or she had and STI? Or if your teenage son or daughter told you that s/he had an STI? Or if your partner told you that s/he had an STI acquired from a previous relationship?

19. Herpes Incidence Genital Herpes HSV-1 and HSV-2 Oral Herpes
Genital Herpes – 1,000,000 new cases yearly
Total Americans living with genital herpes = 45,000,000, which is 1 in 5 aged 12 and older.
Because this is a viral infection it is not curable.
Both HSV-1 and HSV-2 can infect the genitals.
Oral Herpes – 100 million Americans have it; always assume that a fever blister or cold sore on or around the mouth could be a herpetic infection. It is easily spread by a casual kiss, even between parent & child.

20. Herpes: Transmission Skin-to-skin contact
Shared eating/drinking items with oral herpes
“Autoinoculation”
Asymptomatic virus shedders
Skin-to-skin contact, but also be wary of shared eating/drinking items with oral herpes
“Autoinoculation” from one site to another
Transmission during an outbreak (until the site is completely healed and normal looking) or in the “prodromal” period just prior to an outbreak
Asymptomatic virus shedders

21. Herpes: Primary Attack (16 days)
Prodromal stage 2 – 20 days after contact
Tingling, itching, or burning at infection site
Pain running down buttocks or thighs
Rash, followed by painful, fluid-filled blisters, running sores, scabs
Flu-like symptoms
Prodromal stage, 2 – 20 days after contact
Tingling, itching, or burning at the site of infection
Pain running down the buttocks or thighs
Then a rash, followed by very painful, fluid-filled blisters that will break open into running sores, which will eventually crust over
Flu-like symptoms, aches, fever, swollen lymph glands, pain during urination (for genital cases)

22. Herpes outbreaks are painful!

23. Herpes: Recurrent attacks
HSV lies dormant in nerve cell ganglia
Recurrent attacks generally shorter and less severe
About 1/3 never have another attack
About 1/3 have occasional attacks
About 1/3 suffer regular, recurrent attacks
About 1/3 never have another attack
About 1/3 have occasional attacks
About 1/3 suffer regular, recurrent attacks
Recurrent attacks are generally less severe and only 5 – 10 days; be aware of prodromal symptoms to protect yourself and your partner
HSV lies dormant in nerve cell ganglia

24. Herpes: Asymptomatic Infections
Mild symptoms not always recognized
Contagions still exists
Most herpes type 2 transmissions occur during asymptomatic periods
In many people symptoms of genital herpes are mild; so mild that they do not recognize them as herpes.
This may be true of 75% - 90% of those with Herpes Simplex Type 2, yet they are still contagious.
Most herpes type 2 transmissions probably occur during periods when there are no obvious symptoms.

25. Herpes: Serious Complications
Blindness
Cervical cancer
Herpes encephalitis
Increased risk of miscarriage, premature birth, congenital malformations
Severe neonatal neurological problems and death
Ocular herpes – blindness
Increases the risk of human papillomavirus (HPV) of the cervix becoming cancerous
Herpes encephalitis (brain/spinal cord)
Increased risk of miscarriage, premature birth, congenital malformations
Neonatal herpes – severe neurological problems and death

26. Herpes: Treatment and Prevention
What education, information, and/or advice have you been given about the treatment and prevention of herpes?
Allow the outbreak area to dry and heal completely
OTC and Rx anti-viral medications
Avoid direct contact & shared personal items
Avoid physical and emotional stress (and sunlight for oral herpes)
Condoms and honest communication
A diagnostic blood test is now available
A vaccine effective in 75% of women is available but it is not effective in men.

27. The Personal Side of Herpes
Diagnosis often leads to emotional turmoil
Antivirals can be prescribed
American Social Health Association can provide current information about research, therapy and care
Diagnosis often leads to shock, emotional numbing, isolation and loneliness, and sometimes severe depression.
If you have frequent or long-lasting attacks, talk with your doctor about one of the antiviral drugs.
Contact the American Social Health Association for current information about research, therapy and care.

28. Personal Reflections
Many babies are born with sexually transmitted infections as a result of their mothers being infected during pregnancy. Is having an STI an indication of immorality, irresponsibility, both, or neither? Explain your answer.

29. Hepatitis: Types A, B, and C
Overview
Hepatitis is liver infection caused by viruses
Symptoms range from mild to severe
Symptoms range from mild to severe and include poor appetite, diarrhea, fever, vomiting, pain, fatigue, jaundice, and dark urine.

30. Hepatitis A Infection rate Spread Prevention
Type A is spread by contact with contaminated feces, by eating food prepared by workers with unclean hands, or by eating shellfish taken from contaminated waters.
Type A can be prevented by vaccination.
Infection rates of from 150,000 – 450,000 during the 1970’s – 1990s have fallen to only 34,000 in 2007 due to use of vaccines.

31. Hepatitis B (“Serum Hepatitis”)
Transmission
Most commonly infected population
CDC recommended vaccination
Type B is transmitted by infected blood, saliva, semen and vaginal secretions. About 50% of new cases are transmitted sexually.
The infection is most common in African Americans, male homosexuals, and drug users who share needles. 2/3 of infected pregnant women will pass it to their babies.
The CDC recommends vaccination for all children.

32. Hepatitis C Transmission Chronic infection Treatment
Type C is mainly spread by contaminated blood and rarely during sexual intercourse.
75% remain chronically infected, although many go for 10 – 20 years before showing symptoms.
About 10,000 die each year from severe effects of this disease on the liver.
Unfortunately there is no vaccine available

33. Genital Human Papillomavirus HPV
What is HPV? How is it diagnosed? What are the symptoms? How is it treated?
6.2 million new cases annually, with as many as 82% of sexually active teen girls eventually becoming infected.
The large majority of infections have no visible symptoms and will disappear on their own.
There are many types of HPV; not all cause genital warts. The types that lead to cervical cancer generally do not cause warts.
For those who develop genital warts, symptoms first appear anywhere from 3 weeks to 8 months after infection.

34. HPV: Genital Warts on Males
Warts may cause itching, irritation or bleeding.
In men, warts generally appear on penis, scrotum, and/or anus, but they can also grow within urethra.

35. HPV: Genital Warts on Women
Women are more likely than men to develop visible warts.
Warts can appear on cervix and walls of vagina, as well as vulva and anus.
On this woman, the warts are heavily concentrated on the anus, and are also present on the labia

36. Treatments for HPV Monitoring for signs of cervical cancer
Preventive outpatient surgery when needed
Removal of genital warts
Vaccine (Gardasil)
Women with abnormal Pap tests or positive tests for HPV will need to be monitored for signs of cervical cancer. Preventive outpatient surgery may be needed.
For patients with genital warts, the warts can be removed by a variety of medical techniques by a physician – don’t use OTC wart remover!
A highly effective vaccine (Gardasil) that prevents the HPV types responsible for most genital warts and cervical cancers is available and recommended for all girls by age 11 or 12.

37. Personal Reflections
Have you ever engaged in sex with a new partner while under the influence of alcohol? If your answer is “yes,” did your use of alcohol result in your engaging in unprotected sex? If it did, what will you do in the future to prevent this?

38. Molluscum Contagiosum
Painless dome-shaped growths
Caused by pox virus, spread by skin-to-skin contact
Transmission usually sexual in adults
Can be removed by physician
Usually disappear within 6 – 9 months
Painless dome-shaped growths caused by a pox virus, spread by skin-to-skin contact.
It is common among children, but in adults transmission is usually sexual.
If the growths are large, numerous, or just don’t go away they can be removed by a physician.
No harm, just ugly – they usually disappear on their own within 6 – 9 months.

39. Please continue to part 2