Immune System

14-1 STD rates by age. Figure 14.1 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. STD rates by age. Figure 14.1 14-1

http://www.who.int/hiv/data/en / “HIV has inflicted the single greatest reversal in human development in modern history” UNAIDS Report for 2008

https://www.youtube.com/watch?v=8D0fxPupD78 http://youtu.be/qI_aftFD_a8

HIV- “an absolute parasite”

Course of HIV Infection AIDS = CD4 cell count under 200.

What is HIV and AIDS? HIV attacks lymphocytes (white blood cells) called T-cells. The virus penetrates T-cells and forces them to make copies of HIV which causes the T-cell to die. Less T-cells result in a weakened immune system and risk for opportunistic diseases. HIV infection and certain opportunistic diseases or HIV infection and a low T-cell count (200 or less) will result in an AIDS diagnosis. © 2008 McGraw-Hill Higher Education. All rights reserved.

HIV/AIDS HIV = Human Immunodeficiency Virus = Retrovirus that attacks and destroys the immune system

AIDS = Acquired Immune Deficiency Syndrome Opportunistic Infections = common bacteria, fungus, viruses,etc. that usually do not have the opportunity to infect people with healthy immune systems

HIV Symptoms if present Sore throat Mouth Sores Muscle stiffness and aches Headaches Diarrhea Swollen Lymph Nodes Fever Fatigue Rash Frequent vaginal yeast infections

Transmission of HIV Blood Semen Vaginal Secretions Breast milk

Treatment No cure Anti-viral therapy suppresses replication of the HIV virus in the body HAART = Highly Active Anti-Retroviral Therapy (AIDs Cocktail)

People at Highest Risk for HIV Infection Those who engage in unprotected sex Those with sexual partners who participate in high risk activities (anal sex) Those who share needles with infected intravenous drug use Infants born to mothers infected with HIV Those who received blood transfusions between 1977-1985

HIV: What is Safe? Safe Casual contact. Hugging. Eating after. Massage. Masturbation. Insects. Unsafe Vaginal sex. Anal sex. Oral sex. Deep kissing. Multiple partners. Sharing needles. © 2008 McGraw-Hill Higher Education. All rights reserved.

Should I Be Tested? You should be tested if: You have had any STD. Shared drug needles. Had sex with a prostitute. Had sex with a man who had sex with another man. Had unprotected sex with three or more partners. Remember that the test looks for HIV antibodies. It could take 3 to 6 months before antibodies appear in the blood. A person should have 6 months with no risk behavior before a test can be accurate. For more information contact your local health department. © 2008 McGraw-Hill Higher Education. All rights reserved.

http://www.webmd.com/hiv-aids/slideshow-aids-retrospective http://www.webmd.com/hiv-aids/staying-healthy-10/slideshow-hiv-myths-facts http://www.webmd.com/video/living-with-aids

From 1981 through 2005, a total of 956,019 cases of AIDS were reported to CDC. Of the 946,578 adults and adolescents reported with AIDS, 524,607 (55%) have died. Of the 9,441 children younger than 13 years reported with AIDS, 5,514 (58%) have died. Slides containing information on leading causes of death in the United States, including HIV infection and AIDS, are available at http://www.cdc.gov/hiv/topics/surveillance/resources/slides/mortality/index.htm.

This slide shows the distribution of AIDS cases, by age at diagnosis and sex. From 1981 through 2005, a total of 956,019 cases of AIDS have been reported to CDC: 81% were in males and 19% in females. Most of the cases were diagnosed when the men and women were 25–44 years of age.

For male adults and adolescents, in 2005 the AIDS diagnosis rate (AIDS cases per 100,000) for non-Hispanic blacks (95.1) was more than 7 times higher than for non-Hispanic whites (12.1) and more than twice as high as the rate for Hispanics (36.0). Relatively few cases were diagnosed among Asian/Pacific Islander and American Indian/Alaska Native males, although the rate for American Indian/Alaska Native males (14.3) was higher than that for non-Hispanic white males. The data have been adjusted for reporting delays.

For female adults and adolescents, in 2005 the AIDS diagnosis rate (AIDS cases per 100,000) for non-Hispanic blacks (45.5) was nearly 23 times higher than that for non-Hispanic whites (2.0). The estimated number of AIDS cases diagnosed among females in 2005 was similar for Hispanics and non-Hispanic whites, but the rate for Hispanics (11.2) was more than 5 times higher than for non-Hispanic whites. Relatively few cases were diagnosed among Asian/Pacific Islander and American Indian/Alaska Native females, although the rate for American Indian/Alaska Natives (4.4) was more than 2 times the rate for non-Hispanic white females. The data have been adjusted for reporting delays.

The pie chart on the left illustrates the distribution of AIDS cases reported in 2005 among racial/ethnic groups. The pie chart on the right shows the distribution of the U.S. population (excluding U.S. dependent areas) in 2005. Non-Hispanic blacks and Hispanics are disproportionately affected by the AIDS epidemic in comparison with their proportional distribution in the general population. In 2005, non-Hispanic blacks made up 13% of the population but accounted for 50% of reported AIDS cases in the 50 states and the District of Columbia. Hispanics made up 14% of the population but accounted for 18% of reported AIDS cases. Non-Hispanic whites made up 68% of the U.S. population but accounted for 30% of reported AIDS cases. More information on the HIV/AIDS epidemic and HIV prevention among blacks and Hispanics is available in a CDC fact sheet at http://www.cdc.gov/hiv/resources/factsheets/index.htm.

Of AIDS cases diagnosed in 2005 for male adults and adolescents, 58% were attributed to male-to-male sexual contact and 18% were attributed to injection drug use. Approximately 16% of cases were attributed to high-risk heterosexual contact and 7% were attributed to male-to-male sexual contact and injection drug use. Most (70%) of the AIDS cases diagnosed in 2005 for female adults and adolescents were attributed to high-risk heterosexual contact, and 27% were attributed to injection drug use. The data have been adjusted for reporting delays and cases without risk factor information were proportionally redistributed.

SIGNS AND SYMPTOMS OF STDs’ WOMEN Pelvic Pain Bleeding from vagina between periods Burning or itching around the vagina Pain deep inside the vagina during intercourse WOMEN AND MEN Abnormal discharge from penis or vagina A burning sensation during urination Sores, bumps, or blisters near mouth, rectum, or genitals Flu like feelings Redness and swelling in the throat Swelling in the groin area

Curable and Incurable STDs Bacterial (curable) Chlamydia Gonorrhea Syphilis Viral (incurable) Genital herpes Genital warts Hepatitis B AIDS http://www.webmd.com/sexual-conditions/slideshow-std-pictures-and-facts © 2008 McGraw-Hill Higher Education. All rights reserved.

TRICHOMONASIS

Chlamydia: bacteria Chlamydia trachomatis Transmission Passed during direct sexual contact and hand to eye. Incubation Poorly defined, probably 7-14 days or longer. Typical Symptoms Up to 80% of women and 50% of men have no symptoms. When symptoms do occur, they are often mild. Symptoms include discharge, itching and burning, painful urination, and flu-like symptoms. Diagnosis Culture tests of discharge collected from around the cervix and in the urethra. Reliable and affordable. Treatment Curable with certain antibiotics (not penicillin). Danger If untreated, can cause Pelvic Inflammatory Disease. © 2008 McGraw-Hill Higher Education. All rights reserved.

Gonorrhea: bacteria Transmission Direct contact between mucous membranes, i.e., genitals, anus, and mouth. Contaminated fingers can pass organism to the eye. People can not get gonorrhea from objects. Incubation Usually 2-14 days. Typical Symptoms Genitals, anus, throat, and eyes can be infected. Symptoms include discharge, burning and itching, painful urination, or a mild sore throat. Up to 80% of women and 20% of men have no symptoms. Diagnosis Microscopic observation of discharge. Culture from site. Treatment Curable with antibiotics. Some strains may become resistant. Danger Can cause PID and sterility in men and women. © 2008 McGraw-Hill Higher Education. All rights reserved.

GONORRHEA CHLAMYDIA GONORRHEA

Syphilis: bacteria Treponema pallidum Transmission Direct contact with infectious sore or lesionous rashes. Incubation 1 to 12 weeks before primary stage. Typical Symptoms Primary: painless chancre sore at site of entry of germ and lasts 1–5 weeks. If not treated, leads to secondary syphilis. Secondary: 2 weeks to 6 months after chancre. Rash, flu-like symptoms, patchy hair loss. Secondary will go away without treatment, but will lead to latent syphilis. Latent: no longer infectious to carry bacteria and lead to tertiary. Tertiary Stage: 3 to 40 years later, damage to body organs such as the brain and heart, paralysis and death. Diagnosis Physical examination, microscopic test from sore, blood tests. Treatment Cured with antibiotics. © 2008 McGraw-Hill Higher Education. All rights reserved.

SYPHILIS PRIMARY STAGE SECONDARY STAGE

Genital Warts: Human Papilloma Virus (HPV) Transmission Direct contact with warts in genital area. May be transmitted without visible warts. Incubation Range from 1-8 months. Typical Symptoms Flat or round bumps with cauliflowerlike appearance occurring on moist areas of genitals and anus. Many have no symptoms. Diagnosis Visual examination, tissue cultures. Pap smears can detect warts not visible. Common cause of cervical cancer. Treatment Freezing, laser, chemical prep, and surgery. May not “cure” the infection. Danger HPV causes cervical cancer. Pap smears are important. © 2008 McGraw-Hill Higher Education. All rights reserved.

HUMAN PAPILOMA VIRUS (HPV) GENITAL WARTS

Cervical Cancer Prevention The vaccine now in use requires a series of 3 shots over a one-year period. It has been approved by the FDA and should be covered by most insurance. The American Cancer Society recommends the vaccine for girls when they are 11 or 12, before they begin having sex. It is also recommended as a “catch up” for women aged 13 to 18, and that women age 19 to 26 talk to their doctor about whether the vaccine is right for them. It is important to realize that the vaccine doesn’t protect against all cancer-causing types of HPV, so Pap tests are still needed. The second way to prevent cancer of the cervix is to have a Pap test. The Pap test can detect HPV infection and pre-cancers. Treatment of these problems can stop cervical cancer before it develops fully into an invasive cancer.

Genital Herpes: Herpes Simplex Virus (HSV) Transmission Direct contact with infectious blisters or sores usually on genitals, anus, or mouth. May also be passed through asymptomatic viral shedding. Incubation 2-12 days Typical Symptoms Painful blisters or sores form, break, crust over, and heal in 2 to 4 weeks. Sores may reappear throughout life, but heal faster, are less painful and occur less frequently. Factors like stress, fatigue, and other illness may bring on reoccurrences. Diagnosis Visual examination and tissue culture. Treatment No cure at present time. Medications (acyclovir) used to relieve pain, shorten outbreak, or prevent infection in open sore. Danger Can be fatal to infants who acquire the disease. © 2008 McGraw-Hill Higher Education. All rights reserved.

HERPES SIMPLEX (HSV-2)

Hepatitis B: virus Transmission Incubation Typical Symptoms Diagnosis Vaginal, anal and oral sex, sharing needles, and mother to baby. Incubation 1 – 9 months but people can carry the virus with no active infection (and spread to others) Typical Symptoms Most have none or mild flu-like feelings, itching, and joint pain. Eventually leads to liver enlargements and failure. Diagnosis Through a blood test. Treatment A vaccine is available. Dangers Progressive destruction of liver cells, cirrhosis, or liver cancer. © 2008 McGraw-Hill Higher Education. All rights reserved.

HEPATITUS A,B,C

Sexually Transmitted Disease Risk Factors Multiple Sexual Partners False Sense of Safety Absence of signs and symptoms Untreated conditions Impaired judgment (Alcohol and Drugs) Lack of immunity Body piercing Value judgments Denial http://www.undispatch.com/who-knew-global-health-could-be-so-funny-video/

PREVENTING SEXUALLY TRANSMITTED DISEASES A. Continual Education and Treatment 1. Stigma 2. Judgmental Attitudes Practicing Safe Sex 1. Abstinence 2. Know partners sexual history (high risk activities) 3. Use condoms with spermicides

PREVENTING SEXUALLY TRANSMITTED DISEASES 4. Barriers to safe sex a. Denial b. Feelings of quilt and being uncomfortable about being sexual c. Succumbing to social and peer pressure to be sexual C. Effective Communication Skills 1. Talk to partner about sexual intercourse 2. Think ahead of time what you will say if your partner wants to have sex and you don’t . 3. What if partner offended that you want to know sexual history?