Teaching About STDs This presentation is intended to be used to train teachers, school nurses and County Health Department educators.

This Florida version was adapted from the original by members of: The original slide presentation was developed by: Susie McIntyre, MLS HIV/AIDS Program Public Health-Seattle & King County hivstd.info@metrokc.gov http://www.metrokc.gov/health/apu 206/205-STDS (7837) This Florida version was adapted from the original by members of: Florida Departments of Education and Health for information contact: Sherese J. Bleechington, Corrections Specialist DOH Bureau of HIV/AIDS Phone (850) 245-4444 X 2611 Or Ksena Zipperer, HIV/AIDS Prevention Education Coordinator USF Healthy Schools Project/Florida Department of Education Phone (850) 245-0480 This presentation was reviewed for accuracy by the Florida Department of Health Bureau of HIV/AIDS Carlos Alvarez Education Review Panel   For training purposes only

Elements of effective programs: Tailoring message to the age and experience of the audience; Promote abstinence as the expected standard for youth; Focus on risky sexual behavior; Sound theoretical foundation; Provision of basic facts about avoiding risks of unprotected sex; Acknowledgement of social pressures to have sex; and Practice in communication, negotiation and refusal skills.

Key Teaching Points Youth are at risk for STDs. STDs are preventable. STDs are transmitted by unprotected anal, oral or vaginal sex, or skin-to-skin contact. Sexually active youth should be tested and treated for STDs every 3 months per CDC guidelines.

Youth are at risk for STDs 2010 Florida STD data indicate young people ages 15-24 account for approximately 66.2% of STD infections. Ages 15-19 account for 29.9% of STD infections. Florida’s 2011 Youth Risk Behavior Survey showed that approximately 350,000 (48.2%) of high school students had ever had sex. (Rate for seniors is higher). In 2011, approximately 322,100 Florida students (43.4%) had ever had oral sex. Among the 245,400 Florida students who had sexual intercourse during the past three months before the survey, approximately 154,700 (64.3%) used a condom the last time they had intercourse. In 2011, of all the Chlamydia cases in Florida (male and female) 23,713 cases were reported at a rate of 1,973.9 persons between ages 15 and 19.

Key Teaching Points Youth are at risk for STDs. STDs are preventable. STDs are transmitted by unprotected anal, oral or vaginal sex. Sexually active youth should be tested and treated for STDs every 3 months per CDC guidelines.

Prevention Abstinence Mutual monogamy with uninfected partner Limited sexual contact (non-penetrative) Condoms - correct and consistent use Reduce number of sexual partners Talk with new partners about risk reduction Treatment of curable STDs, regular PAP test, vaccinate Avoid sex if you have symptoms of an STD Notify recent partners if you have an STD Get tested and know your status

Condom Effectiveness WARNING: Condoms may not fully protect you or your partner from getting herpes or HPV. Condoms are not as effective at preventing herpes or HPV transmission as they are at preventing the transmission of other sexually transmitted diseases. You may have sores or viral shedding in the genital region which may not be covered by or protected by condoms (e.g., labia, the scrotum).

Intact Male condoms are 82-98% effective at preventing pregnancy. Condom Effectiveness Intact latex condoms do NOT allow air, water, viruses, or other organisms such as bacteria to pass through. Intact Male condoms are 82-98% effective at preventing pregnancy. (CDC http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm) “The extreme importance of using condoms consistently and correctly is emphasized by a study of 563 discordant couples in Europe. Among the 44 couples who used condoms inconsistently, 6 of the uninfected partners became infected. In contrast, among the 24 couples who reported consistent condom use, none of the uninfected partners became infected.” (Centers for Disease Control and Prevention, HIV/AIDS Prevention Training Bulletin, February, 1993.)

Key Teaching Points Youth are at risk for STDs. STDs are preventable. STDs are transmitted by unprotected anal, oral or vaginal sex. Sexually active youth should be tested and treated for STDs every 3 months per CDC guidelines.

Two Kinds of Sexual Transmission 1) Skin to Skin 2) Body Fluid Infected/ infested skin + Contact with susceptible Þ transmission B-F Body Fluid ( blood, semen, vaginal fluids & breast milk) + Entry into Body needle, open skin, mucous membrane) Þ transmission

STD Transmission B-F S-S Genital Herpes Genital Warts (HPV) Syphilis Pubic Lice Scabies Chlamydia Gonorrhea HIV Hepatitis A Hepatitis B Hepatitis C

HIV and other STDs are connected. Same risk behaviors Infections increase transmission STDs increase susceptibility to HIV STDs increase probability of contracting HIV Feelings of vulnerability and personal concern

Key Teaching Points Youth are at risk for STDs. STDs are preventable. STDs are transmitted by unprotected anal, oral or vaginal sex. Sexually active youth should be tested and treated for STDs every 3 months per CDC guidelines.

Sexually active youth should be tested and treated for STDs. Many STDs do not have symptoms. Untreated STDs can have serious consequences including, but not limited to: Pain Cancer Infertility Ectopic pregnancy Mental illness Death Where can your students get tested? * Add local health department and other testing site contact information here.

Bacterial STDs: Chlamydia, Gonorrhea, Syphilis, PID, Epididymitis, and Bacterial Vaginosis

Syphilis (reportable) Primary Chancre (firm, round, small, and painless) appears at site of infection and heals without treatment Transmission: skin-to-skin contact; mother-to-infant Symptoms: (at left) Time to onset: 10-90 days Pregnancy: perinatal infection may cause blindness or infant death Diagnosis: blood tests Treatment: antibiotics very effective Secondary Other symptoms appear-- rashes, flu-like symptoms such as fever, fatigue, and swollen lymph glands Latent Phase Sometimes called the “hidden” phase because infection continues with no obvious signs or symptoms Late Phase Damage to nervous system and death

Pelvic Inflammatory Disease (PID) Epididymitis Symptoms: Testicular pain and tenderness Should be considered an emergency if the onset of pain is sudden or pain is severe Complications: Sterility Treatment: antibiotics Pelvic Inflammatory Disease (PID) Symptoms: Symptoms may be mild, but complications are serious! Pain in lower abdomen Fever Bleeding between periods Discharge and/or odor Complications: Ectopic pregnancy, chronic pain, maternal death, infertility Treatment: antibiotics

Bacterial Vaginosis Caused by overgrowth of normal bacteria (BV is not always sexually transmitted) Symptoms: abnormal vaginal discharge with an unpleasant odor; discharge, if present, is usually white or gray; burning during urination or vaginal itching Time to Onset: varies Treatment: antibiotics or vaginal cream

Vaginitis “Vaginal Infection” Includes: Bacterial Vaginosis (BV) Trichomonas (parasite) Yeast infections (fungi) Diagnosis of all vaginitis confirmed by microscopic examination

Viral STDs: Genital herpes, Genital Warts, Hepatitis A, B and C, and HIV

Herpes Simplex Virus (HSV) Cold sores Oral-genital frequent Genital lesions Genital-oral infrequent

Genital Herpes (HSV) Transmission: skin to skin; mother-to-baby Symptoms: Often no symptoms for those with symptoms most common symptoms are painful blisters and sores. Sometimes NO blisters are present and the virus can still be transmitted. Time to onset: 2-20 days (times for subsequent outbreaks vary) Pregnancy: 5% transmission when lesions present Diagnosis: culture, antibody test Treatment: symptom relief; antivirals effective

HPV (Human Papilloma Virus) “Genital Warts” Transmission: skin to skin contact; not dependent on visible warts Symptoms: Genital warts usually appear as small bumps or groups of bumps, usually in the genital area (including perineum and anus); some strains cause no visible symptoms. Time to onset: 1-20 months Pregnancy: perinatal infection possible Diagnosis: observation, PAP detects cervical cell changes (but does not diagnose “genital warts”) Treatment: remove visible warts via surgery and/or acid treatment (TCA-Trichloroacetic acid or BCA-Bichloroacetic acid). Gardacil vaccine is available for free through the County Health Departments for individuals who meet treatment age guidelines.

HPV (Human Papilloma Virus) “Genital Warts” More than 30 Types of HPV are sexually transmitted 4 types related to cervical cancer and other less common cancers such as cancer of the vulva, vagina, anus, and penis Genital Warts

HIV: Human Immunodeficiency Virus H - Human - virus can only infect human beings I - Immunodeficiency - failure of the body’s immune system to work properly V - Virus - one of its characteristics is that it is incapable of reproducing by itself. It reproduces by taking over the machinery of the human cell.

AIDS: Acquired Immune Deficiency Syndrome AIDS is the most serious stage of HIV infection. It results from the destruction of the infected person's immune system. A- Acquired: passed from one person to another I- Immune: the body’s defense system against disease D- Deficiency: lack/shortage of or breakdown S- Syndrome: a combination of symptoms and diseases

HIV Facts A person infected with HIV may not show symptoms for five to ten years. People who look completely healthy can still have HIV. HIV can ALWAYS be passed to others, even if they have no symptoms of AIDS. Once HIV begins to destroy the body’s immune system, the affected person becomes at risk for opportunistic infections which can result in death.

How is HIV/AIDS contracted ? The BIG Three : Exchange of Bodily Fluids Sexual Contact (vaginal, oral, anal); does not include casual kissing (unless open mouth sores are present) Sharing hypodermic needles/syringes through IV drug use, tattooing, and body piercing Mother to infant transmission: In utero exchange, during birth, or through breast-feeding after birth ALSO, Less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors

How can you protect yourself? ABSTINENCE is the only certain way to protect yourself against HIV and other STDs. MUTUAL monogamy in your relationships after you have both been tested. SAFER sex- Nobody has a body to die for. If you have sex, LATEX CONDOMS are the most effective protection against HIV and other sexually transmitted diseases (STDs). Use a POLYURETHENE CONDOM if you are allergic to latex. Natural membranes (like lambskin) have small microscopic holes that can let STDs through. Novelty condoms (like ones that glow in the dark) should not be used. Don’t use oil-based lubrication because it will cause the condom to tear. Use water-based lubricants. If you have oral sex, use a dental dam or a condom cut in half. AVOID drug use

You can’t get HIV by: 1. Sitting next to someone 2. Shaking hands, giving a hug or dry kissing* 3. Using restrooms, water coolers or telephones 4. Eating in a restaurant or cafeteria 5. Swimming in a pool or using hot tubs 6. Being bitten by an insect Donating blood * Kissing can spread other STDs (sexually transmitted diseases), such as herpes.

Florida HIV/AIDS Hotline 1-800-FLA-AIDS  English Language Hotline 1-800-545-SIDA  Spanish Language Hotline 1-800-AIDS-101  Creole Language Hotline 1-888-503-7118  TDD/TTY Hotline

Other STDs: Parasitic and Fungal

Trichomonas, aka “Trich” (parasite) Can affect men and women Transmission: sexual contact, exchange of body fluids Symptoms: -women: itching, burning, “fishy” discharge (green, yellow, or gray) -men: usually asymptomatic, but may experience irritation inside the penis, mild discharge, or slight burning after urination Treatment: oral medication

Yeast infection (fungi) Can be present in men and women (Yeast infections are not always sexually transmitted) Caused by overgrowth of common vaginal fungi Symptoms: itching, burning, in women a “cottage cheese” discharge maybe present Treatment: vaginal cream or oral medication

Scabies (parasite) Transmission: sexual contact, clothes, touching Symptoms: itchy rash, especially at night Time to onset: 2-6 weeks from first exposure Diagnosis: microscopic examination of skin scrapings Treatment: creams and lotions

Pubic Lice, aka “Crabs” (parasite) Transmission: sexual contact, clothes, sheets Symptoms: redness and itching in hairy areas Diagnosis: seen easily by naked eye Treatment: over the counter medications and/or lotion, clothes/sheets washed in hot water

Resources http://www.floridashealth.com/disease_ctrl/aids/index.html http://www.doh.state.fl.us/Disease_ctrl/std/index.html http://www.doh.state.fl.us/disease_ctrl/std/trends/florida.html http://www.wemakethechange.com/ http://www.fldoe.org/bii/cshp/Education/HIV_STD/ Default.asp http://www.cdc.gov/std/general/ (Visit this site for photos of patients who exhibit symptoms of advanced infections. The photos are graphic, and are to be used by adults for training purposes.) http: //www.septc.org