2. November 4, 2013 NURS 330 Human Reproductive Health

3. Agenda for 11/4/13 §Mid-term l Return and Review §10/21/13 In-Class Assignment l Return and Review §Review Grades §Lecture on STDs §11/4/13 In-Class Assignment

4. Mid-term §42 Students §Average: 82 §≤70: 6 Students §70 ˃ 80: 9 Students §80 ≥ 90: 18 Students §› 90 : 9 Students

5. Grades DateAssignmentPossible Points 10/7/13In-Class #15 10/14/13In-Class #210 10/21/13In-Class #35 10/28/13Mid-term100 Total Possible Points (through 10/28/13)120 11/4/13In-Class #45 11/18/13In-Class #510 11/18/13Essay50 11/25/13In-Class #65 12/2/13In-Class #710 12/9/13Final Exam200 Total Points400

6. What Are STDs? §Sexually – relating to having sex, personal intimate contact (e.g., rubbing of genitals, masturbating a partner), etc. §Transmitted – passed by means of, spread by §Disease – being sick (with or without symptoms), body not working properly So, an STD = a disease/infection you can get from or give to someone else by having oral, vaginal, or anal sex or other intimate contact with him/her. Source: County of Los Angeles STD Program

7. Health Consequences of STDs Source: County of Los Angeles STD Program

8. STDs in the United States The CDC estimates that there are approximately 19 million new cases each year in the US 1 There are an estimated 65 million people in the US living with a viral STD 2 More than half of all people will have an STD/STI at some point in their lifetime. 2 One in two sexually active persons will contact an STD/STI by age 25. 2 The cost of STDs to the U.S. health care system is estimated to be as much as $15.9 billion annually 1 1 Source: Centers for Disease Control and Prevention, cdc.gov 2 Source: American Social Health Association, www.ashastd.org

9. BACTERIAL STDs ChlamydiaGonorrheaSyphilis Transmission Pre-cum, semen, vaginal secretions Perinatal Pre-cum, semen, vaginal secretions Perinatal Skin-to-skin; genital to genital rubbing Symptoms NOTHING or Discharge from penis, vagina NOTHING or Discharge from penis, vagina 1-chancre 2-skin, genital rash 3- organ damage Complications PID in females Epidimytis in males PID in females Epidimytis in males Blindness, paralysis, heart problems, etc Diagnosis Urine sample Urethral, cervical swab Urine sample Urethral, cervical swab Blood sample Treatment Curable with antibiotics Source: County of Los Angeles STD Program

11. CHLAMYDIA Risk factors: Unprotected oral, vaginal or anal sex Source: County of Los Angeles STD Program

12. GONORRHEA Risk factors: Unprotected oral, vaginal or anal sex Source: County of Los Angeles STD Program

13. SYPHILIS Oral, vaginal or anal sex (protected or unprotected) Source: County of Los Angeles STD Program

14. VIRAL STDS HPVHERPESHEP B Transmission Skin-to-skin; genital to genital rubbing Skin-to-skin; genital to genital rubbing; social kissing Blood, pre-cum, semen, vaginal secretions Symptoms NOTHING –or- High Risk: Cervical changes Low Risk: Warts in, on around genitals NOTHING –or- Blisters in, on around genitals (HSVII) or mouth (HSV I) NOTHING –or- Fatigue, flu-like symptoms, jaundice Complications Cervical Cancer Psychosocial Complications of the liver Diagnosis HPV test Pap smear screening Blood test, blister sample Blood sample Treatment Not curable Vaccine available Not curable Vaccine available Source: County of Los Angeles STD Program

15. Human Papilloma Virus (HPV) Vaginal or anal sex (protected or unprotected) Source: County of Los Angeles STD Program

16. Pap Smears §Screens for pre-cancerous cells in cervix §When to start l 3 years after sexual debut or at age 21, whichever comes first l Remember, you do NOT have to be sexually active to get a pap smear §Does not necessarily test for STDs l You have to ask for specific STD tests l It is important to be your own health advocate §How often should I get pap smears? l It varies, depending on your pap results l Your doctor or nurse will let you know Source: County of Los Angeles STD Program

17. HPV Vaccine §Vaccine l Gardasil® by Merck approved in 2006 Provides protection against four HPV types which together cause 70% of cervical cancers and 90% of genital warts Three shots over six-month period Licensed for use in girls/women 9-26 years old In October 2009, FDA approved for use in boys/men 9-26 years old l Another HPV vaccine by GSK currently in final stages of development Would provide protection against two HPV types that cause most (70%) cervical cancers Source: County of Los Angeles STD Program

18. HERPES Risk Factors: Oral, vaginal or anal sex (protected or unprotected) Source: County of Los Angeles STD Program

19. HEPATITIS B Risk factors: Unprotected sex, sharing needles, tattoos, sharing household items such as razors, toothbrushes Source: County of Los Angeles STD Program

20. OTHER YeastBacterial Vaginosis (BV ) Trichomoniasis CauseNot an STD. Caused by an overgrowth of yeast. Sexual transmission possible.Overgrowth of bacteria. STD SymptomsWomen - Thick, cloudy discharge from vagina, itching Men – rash on penis White or yellow discharge, fishy odor Bubbly, frothy discharge. Irritation upon urination ComplicationsNo major complications Excessive scratching can cause irritation in genital area Increases chance of HIV infection; If pregnant, a woman runs the risk of pregnancy complications Increased risk of getting HIV Can cause Complications during pregnancy DiagnosisVaginal cultureWhiff testVaginal culture TreatmentAnti-fungal creamPrescription Drugs Source: County of Los Angeles STD Program

21. STD Prevention Review §Abstinence §Use latex or polyurethane condoms (male or female) and barriers as much as possible §Water-based lubricants l Reduces friction §Get tested regularly §Reduce number of sex partners §Reduce frequency of risky situations §Spectrum of sexual risk, depending on the STD l e.g., oral sex may be considered low risk for HIV but not for syphilis §Talk to partners §Vaccines - Hepatitis B, HPV §Get to know your bodies! Source: County of Los Angeles STD Program

22. November 11, 2013 – Holiday November 18, 2013 – Essay Due

23. In-Class Assignment