October 20, 2014 NURS 330 Human Reproductive Health

§October 20, 2014 – STD Lecture §October 27, 2014 – Mid-Term Exam §November 3, HIV Guest Speaker §November 10, Quiz #1

Agenda for 10/20/14 §Review 10/13/14 In-Class Assignment §Lecture l Sexually Transmitted Diseases (STDs) §Distribute Mid-term Study Guide §10/20/14 In-Class Assignment

Review Seven essential features of human reproduction: 1.Liberation of ovum, or egg. 2.Internal fertilization of the egg by sperm. 3.Transport of fertilized egg (or zygote) to the uterus. 4.Implantation of the blastocyst in the wall of the uterus. 5.Formation of a placenta and maintenance of the unborn child during the entire period of gestation. 6.Birth of the child and expulsion of the placenta. 7.Suckling and care of the child, with an eventual return of the maternal organs to virtually their original state. Page 19

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

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

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 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,

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

CHLAMYDIA Risk factors: Unprotected oral, vaginal or anal sex

GONORRHEA Risk factors: Unprotected oral, vaginal or anal sex

SYPHILIS Oral, vaginal or anal sex (protected or unprotected)

Source: County of Los Angeles STD Program

Tertiary/Late Complications Source: County of Los Angeles STD Program

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

Human Papilloma Virus (HPV) Vaginal or anal sex (protected or unprotected)

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

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

HERPES Risk Factors: Oral, vaginal or anal sex (protected or unprotected)

HEPATITIS B Risk factors: Unprotected sex, sharing needles, tattoos, sharing household items such as razors, toothbrushes

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

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!

Mid-Term Exam §Monday, October 27, 2014 §Starts promptly at 6:10pm l You are free to leave after you complete the exam §Covers lectures 9/29/14 through 10/13/14 l Will not include today’s lecture on STDs 50 questions (Multiple choice, T/F, Fill-in-the-blank) §Scantron #882 Required §Study Guide

In-Class Assignment §Separate sheet of paper l Write your Name, Date and In-class Assignment # l Write legibly l Use blue or black ink §Questions will be asked in class §Must turn in your assignment to the instructor