2. SEXUALLY TRANSMITTED INFECTIONS AT ILLINOIS STATE UNIVERSITY © 2012 John B. Pryor, Ph.D. Department of Psychology

3. Top 6 STIs at ISU: 1995-2007 1. Genital Warts 2. Genital Herpes 3. Chlamydia 4. Scabies 5. Trichomoniasis 6. Gonorrhea

5. Human Papilloma Virus (HPV) Virus that causes genital warts - 60 known types estimated 16% of Americans infected (21% of women & 12% of men) In more than 90 percent of cases, the infections are harmless and go away without treatment. Related to the occurrence of pre-cancerous cells on the cervix. Persistent HPV infection is found in most cases of cervical cancer. A new vaccine, Gardasil, protects against four HPV types, which together cause 70% of cervical cancers and 90% of genital warts.The FDA recently licensed this vaccine for use in girls/women, ages 9-26 years. Symptomatically treated by chemical agents (podophyllin), cryotherapy, or laser therapy

6. Genital Warts—Initial Visits to Physicians’ Offices, United States, 1966–2010 NOTE: The relative standard errors for genital warts estimates of more than 100,000 range from 18% to 30%. SOURCE: IMS Health, Integrated Promotional Services™. IMS Health Report, 1966–2010.

7. Human Papilloma Virus warts Some carriers are asymptomatic

8. Human Papilloma Virus wart transmission through physical contact

9. Human Papilloma Virus warts Most common sites in men: penis, urethra, bladder, & anus

10. Human Papilloma Virus Most common sites in women: vulva, vagina, cervix, & anus

11. HPV - can be transmitted via oral sex

12. Genital Herpes Caused by a virus Two types: 1) herpes simplex virus type 1( HSV-1) - typically around mouth (cold sores) 2) herpes simplex virus type 2 (HSV-2) - typically found in the genital region. However, either can infect either place.

13. Genital Herpes - incidence HSV-1 antibodies are present in 95% of Americans. Nationwide, 16.2%, or about one out of six, people 14 to 49 years of age have genital HSV-2 infection. Most people who are infected never recognize their symptoms.

14. Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2010 NOTE: The relative standard errors for genital herpes estimates of more than 100,000 range from 18% to 30%. SOURCE: IMS Health, Integrated Promotional Services™. IMS Health Report, 1966–2010.

15. Genital Herpes Transmission - through physical contact with infected area Transmission is possible even when someone is asymptomatic No cure Symptomatic treatment with acyclovir

16. Genital Herpes

17. Genital Herpes leision

18. leisions Genital Herpes

19. Genital Herpes

20. Genital Herpes scars

21. Genital Herpes Some myths about HSV-2: 1) Genital herpes is often transmitted through casual contact. 2) Women who have recurrent HSV-2 should not bear children because of dangers to the developing fetus.

22. Psychosocial Aspects of Herpes Survey of 3100 People with Herpes 84% -reported episodes of depression 70% -indicated feelings of isolation 40% -diminished work performance as the result of lowered self-esteem 35% -decreased sexual desire 25% -self-destructive thoughts 18% -the breakup of long term relationships

23. Chlamydia trachomatis infections are the most commonly reported notifiable disease in the United States. In 2010, 1,307,893 chlamydial infections were reported to CDC.

24. Chlamydia—Rates by Sex, United States, 1990–2010 NOTE: As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases. Total Women Men Rate (per 100,000 population) Year 0 125 250 375 500 625 750 20102008200620042002200019981996199419921990

25. Chlamydia—Rates by Age and Sex, United States, 2010 15–19 20–24 25–29 30–34 35–39 40–44 45–54 55–64 65+ Total MenWomenRate (per 100,000 population) Age 3,7002,9602,2201,48074000 1,4802,2202,9603,700 774.3 1,187.0 598.0 309.0 153.2 91.3 39.3 233.7 2.8 10.9 3,378.2 3,407.9 1,236.1 530.9 220.1 94.7 32.8 610.6 2.1 9.3

27. Chlamydia—Rates by County, United States, 2010 <300.0(n = 1,962) Rate per 100,000 population 300.1–400.0(n = 418) >400.0(n = 762) McLean County, Illinois

28. Chlamydia -caused by a bacteria Up to 75 percent of women and 50 percent of men with uncomplicated chlamydia infection have no symptoms or signs of infection. If symptoms do occur, they typically appear within one week to a month after exposure to an infected person.

29. Chlamydia Symptoms - Men * pain or burning during urination * frequent urination * pain and swelling in the testicles * low-grade fever * burning and itching around the opening of the penis * watery or milky discharge from the penis

30. Chlamydia Symptoms - Women * irregular vaginal bleeding * burning with urination * itching and burning in the genital area * vaginal discharge * lower abdominal pain often accompanied by nausea and fever

31. Chlamydia - possible complications for women scared/blocked fallopian tubes pelvic abscess adhesions

32. Treatment of Chlamydia Curable with azithromycin or doxycycline; does not respond to penicillin. Poorly treated or undiagnosed cases may lead to:  urethral damage  epididymitis (infection of the epididymis)  Reiter’s syndrome (inflammation throughout body; arthritis)  proctitis in men who had anal intercourse  Pelvic Inflammatory Disease (PID)  Problems with pregnancy and risks for newborn infants of infected mothers

33. Up to 40% of women with untreated chlamydia will develop PID. Undiagnosed PID caused by chlamydia is common. Of those with PID, 20% will become infertile; 18% will experience debilitating, chronic pelvic pain; and 9% will have a life- threatening tubal pregnancy. Tubal pregnancy is the leading cause of first- trimester, pregnancy-related deaths in American women. Chlamydia - possible complications for women

34. Scabies Scabies is caused by tiny mites which are at most half a millimeter in length and are difficult to see.

35. Scabies

36. Scabies usually infest areas between the fingers and toes, wrists, elbows, armpits, buttocks, breasts, genitals, and other areas of contact.

37. Scabies Small red bumps or tiny lines (burrows) may appear.

38. Scabies CDC Recommended Regimen - Permethrin cream (5%) applied to all areas of the body from the neck down and washed off after 8-14 hours Transmission - Scabies among adults may be sexually transmitted, although scabies among children is usually not sexually transmitted.

39. Trichomoniasis an estimated 7.4 million new cases yearly caused by a single-celled protozoan parasite symptoms in women include a heavy, yellow- green or gray vaginal discharge, discomfort during intercourse, vaginal odor, and painful urination

40. Trichomoniasis and Other Vaginal Infections—Women— Initial Visits to Physicians’ Offices, United States, 1966– 2010 NOTE: The relative standard errors for trichomoniasis estimates range from 16% to 27% and for other vaginitis estimates range from 8% to 13%. SOURCE: IMS Health, Integrated Promotional Services™, IMS Health Report, 1966–2010.

41. Prevalence of Trichomoniasis Trichomoniasis is the most common curable STI in young, sexually active women. An estimated 7.4 million new cases occur each year in women and men.

42. Trichomoniasis symptoms also may include irritation and itching of the female genital area symptoms in men include a thin, whitish discharge from the penis and painful or difficult urination most men do not experience any symptoms, women also may be asymptomatic

43. Trichomoniasis Sexual transmission is possible even when no symptoms are present. Metronidazole is the drug used to treat trichomoniasis. It is administered in a single dose.

44. Trichomoniasis Trichomoniasis in pregnant women may cause premature rupture of the membranes and pre-term delivery. The genital inflammation caused by trichomoniasis also might increase a woman's risk of acquiring HIV infection if she is exposed to the virus. Trichomoniasis in a woman who is also infected with HIV can increase the chances of transmitting HIV infection to a sex partner.

45. Gonorrhea is caused by the gonococcus, a bacterium that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth, or rectum..

46. GONORRHEA Gonorrhea is the second most commonly reported infectious disease in the United States, with 309,341 cases reported in 2010. Treatment is usually easy with antibiotics Drug resistance is an increasingly important concern in the treatment and prevention of gonorrhea Incidence & treatment

47. Gonorrhea—Rates, United States, 1941–2010

48. Gonorrhea—Rates by Age and Sex, United States, 2010 15–19 20–24 25–29 30–34 35–39 40–44 45–54 55–64 65+ Total MenWomen Rate (per 100,000 population) Age 75060045030015000 300450600750 253.4 421.0 241.3 146.5 85.1 64.2 34.1 94.1 2.4 11.0 570.9 560.7 226.3 107.5 48.2 23.8 9.0 106.5 0.5 1.9

50. Gonorrhea - transmission genital-to-genital contact genital-to-oral contact genital-to-anal contact spread fromvagina to rectum

51. Gonorrhea - Symptoms early symptoms often are mild most women who are infected have no symptoms if symptoms of gonorrhea develop, they usually appear within 2 to 10 days after sexual contact with an infected partner some may be infected for several months without showing symptoms.

52. Gonorrhea - Symptoms for Women a painful or burning sensation when urinating an abnormal vaginal discharge more advanced symptoms, which indicate progression to PID, include abdominal pain, bleeding between menstrual periods, vomiting, or fever

53. Gonorrhea - Symptoms for Men a discharge from the penis a burning sensation during urination symptoms of rectal infection include discharge, anal itching, and sometimes painful bowel movements.

54. Gonorrhea often spreads in social networks where an aymptomatic female with many sexual partners can be a core infector Female (no Symp- toms) Male FemaleMale FemaleMale

55. Gonorrhea discharge

56. Gonorrhea Discharge

57. Both Gonorrhea & Chlamydia can cause future fertility problems in women Possible scarring or blockage of fallopian tubes Chlamydia Gonorrhea