Teens and Sexually Transmitted Diseases Lisa Wehr (570) 523-3462 Family Planning Plus of SUN & MJ Counties lisa@familyplanning.cnchost.com

How Common Are STDs? There are at least 19 million new cases of STDs in the United States each year. About half of these occur among youth ages 15 to 24. There are at least 65 million Americans living with an incurable sexually transmitted disease at any given time. The U.S. has the highest STD rate of any industrialized country. One out of two sexually active youth will acquire an STD by age 25. Teens 15-19 who have had sex have the highest STD rates of any age group in this country. The highest rates of gonorrhea and chlamydia are among 15 to 19 year old females. About half of all new HIV infections in the United States occur to young people under 25 years old. Every hour, two adolescents are infected with HIV. Almost 4 million teenagers get some type of sexually transmitted disease each year. That’s roughly 8,000 every day, and 6 every minute.

How Do You Get an STD? You can get sexually transmitted diseases by coming into contact with someone who is already infected. This includes: Having anal, vaginal or oral sex Having close intimate contact (skin to skin genital contact) Coming into contact with someone else’s blood And to a lesser degree: Kissing Sharing certain inanimate objects

Other Risk Factors Multiple lifetime sexual partners – the more partners, the greater the risk Length of relationship – the less you know about a sexual partner, the greater the risk Substance use - mixing use of drugs and alcohol with sexual decision making is never a good idea Advocates for Youth and the University of North Carolina visited these countries to see why the rates were so different. This is what they found. • Adults see intimate sexual relationships as normal and natural for older adolescents, a positive component of emotionally healthy maturation. At the same time, young people believe it is “stupeid and irresponsible” to have sex without protection and use the maxim, “safer sex or no sex.” • public health policies are based on scientific research. Political and religious interest groups have little influence on public health policy. • A national desire to reduce the number of abortions and to prevent sexually transmitted infections, including HIV, provides the major impetus in each country for unimpeded access to contraception, including condoms, consistent sexuality education, and widespread public education campaigns. • Governments support massive, consistent, long-term public education campaigns utilizing the Internet, television, films, radio, billboards, discos, pharmacies, and health care providers. Media is a partner, not a problem, in these campaigns. Campaigns are far more direct and humorous than in the U.S. and focus on safety and pleasure. • Youth have convenient access to free or low-cost contraception through national health insurance. • Sexuality education is not necessarily a separate curriculum and may be integrated across school subjects and at all grade levels. Educators provide accurate and complete information in response to students’ questions. You might think that young people living in these countries would have sex at younger ages. But not so, in the U.S., young people typically initiate sexual intercourse at the same age or even earlier compared to young people in the Netherlands and France.

Common Symptoms D R I P S Discharge – unusual color, texture, amount, odor Rashes or redness – in genital area or on torso/soles of feet/palms of hands Itching and irritation in the genital area Pain – burning with urination, pain with intercourse, pelvic/scrotal pain Sores, bumps, blisters, warts

Most Common STDs in Teens Human Papilloma Virus Chlamydia Trichomoniasis Genital Herpes

Viral STDs Human Papilloma Virus – HPV Are incurable, but treatable, and include… Human Papilloma Virus – HPV Herpes Simplex Virus – HSV-1 & HSV-2 Hepatitis B and C – HBV & HCV Human Immune Deficiency Virus - HIV

Human Papilloma Virus HPV is by far the most common viral STD. HPV lives in the skin and the mucus membranes and is passed through all types of sexual contact, including skin-to-skin genital contact. There are an estimated 6.2 million new cases of Genital HPV every year – 4.6 million of these are among youth under 25. At any given time, there are approximately 20 million people infected with HPV in the United States.

It is estimated that at least 50% of people will have some type of HPV at some point in their lives. HPV is a group of well over 100 different wart viruses. About 40 of them are sexually transmitted. Some are considered low risk – these types can cause genital warts. Some are considered high risk – these can cause abnormal cellular changes that can lead to cervical cancer, and to a lesser extent, cancers of the throat, penis, vulva, vagina, and anus.

Most people who have HPV have no signs or symptoms and don’t know they have it. However, they are still capable of transmitting it to others. Most people get rid of the virus on their own (without treatment) within a few years. However, some people get persistent strains that do not go away. These persistent strains can cause: Genital warts that can multiply and recur after treatment Cervical cancer and other cancers

How Do You Know if You Have It? Unfortunately, there is currently no screening test for HPV. However, HPV can be diagnosed when… A physical examination shows presence of visual genital warts – this is the only way to diagnose HPV in men. A woman’s pap test comes back abnormal. A follow-up HPV digene test can be done to see if she has one of the high-risk types.

Genital Warts Look Like… Genital warts may: Appear within several weeks after sexual contact with an HPV-infected person, or they may take months or years to appear. Look like soft, moist, pink or flesh-colored bumps or swellings. Resemble small cauliflower florets. Appear as a single bump or multiple bumps. Appear on the vulva, in or around the vagina or anus, on the cervix, or on the penis, scrotum, groin, or thigh (anywhere in the boxer shorts area) Disappear, stay the same, or grow and multiply without treatment

What’s Gardasil™? Gardasil™ is the new HPV vaccine that protects against the four most common types of HPV. These types cause 70% of all cervical cancer cases and 90% of genital warts. It has been approved for girls and young women 9-26 years of age. It is ideally given to girls, 11-12 years old, before they engage in type of sexual activity. It is given in a series of three injections with the second and third injections given 2 and 6 months after the first.

Some Other Important Points You can have multiple types of HPV at the same time. Regardless of immunization status, regular pap tests are still extremely important. Abnormal pap tests should always be followed up – be sure to follow your health care professional’s recommendations.

Genital Herpes Caused by both HSV-1 and HSV-2. Extremely common, but more commonly diagnosed in 20-40 year olds than teens. One in five Americans are infected – approximately 45 million are living with the virus – 4 million of whom are youth. There are an estimated 1 - 1.5 million new cases every year.

About Genital Herpes Like HPV, Genital herpes lives in the skin and mucus membranes and can be passed by all types of sexual contact, including skin-to-skin genital contact. Studies have shown that up to 70% of transmission occurs between outbreaks when there are no symptoms. This is due to asymptomatic viral shedding. Diagnosed by visual inspection, lesion specimen, or blood test.

Symptoms include itching or tingling at the outbreak site, blisters, sores, scabbing. Some people have very minor symptoms during outbreaks and have no idea they are infected. Most people have 3-5 outbreaks per year; outbreaks become less frequent with time. Outbreaks can be treated with oral medication or ointment. Daily suppressive therapy is also an option – decreases the number and severity of outbreaks, and reduces the risk of transmission.

Genital Herpes Looks Like…

Hepatitis C Both HBV and HCV are viruses that can attack and destroy the liver – can lead to liver failure and death. Hepatitis B immunizations are required for school-aged children; there is no vaccine for Hepatitis C. Hepatitis C is mainly passed by blood to blood contact, but can be passed through sexual contact when blood is involved. There are about 26,000 new infections each year, and 3.5 million chronically infected. It can take 10-40 years to progress to serious liver problems.

HIV/AIDS AIDS is caused by HIV which is spread through contact with infected blood, semen, vaginal secretions and breast milk. There are approximately 55,000 new cases of HIV each year, and about 1.1 million people living with HIV/AIDS. HIV attacks the immune system, eventually leaving the body vulnerable to disease. AIDS has caused more than 25 million deaths worldwide. Antiretroviral medications are expensive, but can greatly prolong one’s lifespan, and improve quality of life.

Bacterial STDs Chlamydia Gonorrhea Syphilis Bacterial STDs are curable with antibiotics. The three most common are: Chlamydia Gonorrhea 4. Establish dating rules, curfews, standards of expected behavior, preferably by open family discussions. Know where they are at all times. 5. Meet the parents of your foster child’s friends so that you can get to know them and try to establish common rules and expectations. Welcome your foster child’s friends to your house and talk to them openly. Make your house the “hang out” place. 6. Today’s teens spend over 40 hours each week consuming media. Watch TV with them and talk about the values the shows portray. Put the computer and TV in common rooms – not bedrooms – so you can see what they’re watching. 7. Boys get pressured too. Make sure they understand that boys experience the consequences of unintended pregnancy too. Help them understand how they can protect themselves against STDs. Syphilis

Chlamydia Most commonly reported bacterial STD – 3 million new cases each year. AKA “the silent STD” since 75% of women and 50% of men have no symptoms. When symptoms are present, they include discharge, burning with urination, and vaginal or urethral irritation. Left untreated, it can cause painful infections of the reproductive organs and can lead to infertility/sterility in both sexes. Diagnosed by cervical smear, urethral smear, or urine specimen.

Gonorrhea Not quite as common as chlamydia – 700,000 new cases reported each year. Symptoms include discharge, burning with urination, irritation at vaginal/urethra opening. Symptoms more commonly occur with gonorrhea than they do with chlamydia, but are still sometimes absent in women. As with chlamydia, untreated gonorrhea can result in infertility/sterility. Diagnosed by cervical smear, urethral smear, and urine test. Drug-resistant strains are increasing, and successful treatment is becoming more difficult.

Syphilis Least common bacterial STD of the three – 32,000 cases reported each year. Transmission occurs through direct contact with a syphilis sore called a chancre. Syphilis is diagnosed by examining a chancre specimen with a special dark-field microscope or by blood test, and is treated with injections of penicillin.

Syphilis: 3 Stages of Symptoms Primary – a chancre (painless sore) appears at the site of infection – can go away by itself without treatment. Secondary – rough red or reddish-brown rashes can appear on the trunk of the body and/or on the soles of the feet and the palms of the hands – can go away by itself. Latent – can spread to other organs in the body via the blood stream, causing irreparable damage and even death.

Syphilis Looks Like…

Parasitic Infections Parasitic infections are also curable. The most common include: Trichomoniasis Pubic Lice

Trichomoniasis Trich is the most commonly diagnosed curable STD in women – approximately 7 million cases per year. In women, symptoms include a frothy, yellow-greenish discharge with a strong odor and vaginal irritation, itching, and swelling. Men rarely have symptoms, but may notice a slight irritation at the urethral opening. Diagnosed by vaginal or urethral smear and curable with antibiotics (Flagyl/Metronidazole).

Pubic Lice Also known as “crabs,” pubic lice are six-legged creatures that prefer the pubic hair, but can migrate to other areas like eyelashes, underarms, chest hair, etc. In most cases, pubic lice are transmitted by close sexual contact, but they can also be spread through infected clothing, towels, and bedding. The most common symptoms are itchiness, redness, and irritation. Scratching can help lice to spread. Curable with over- the-counter lotions and shampoos.

Pubic Lice and Trich Look Like…

In General, STDs… Can be passed from pregnant woman to fetus/infant through the placenta (syphilis, HIV), during childbirth, or in some cases, after delivery during breastfeeding (HIV). In the newborn, STIs can cause many different problems from being born too early to brain damage to death. Can come back after treatment if you are re-exposed. Can be life-changing. If you are diagnosed with an incurable STD like HIV or Genital Herpes, you have the responsibility to inform any potential sexual partners before you have sex. stillbirth, low birth weight, eye infections, neonatal sepsis (infection in the baby’s blood stream), brain damage, blindness, deafness, respiratory problems, and/or liver problems.

Prevention/Risk Reduction Practice sexual abstinence – avoid all genital contact with a partner. Engage in alternative ways to release sexual tension. Practice sexual monogamy – have only one partner who has no other intimate partners. Limit or reduce your number of sexual partners. Use condoms and/or glyde dams for all sexual acts. Obtain vaccines, when available.