Current Overview of Sexually
Transmitted Diseases (STDs)
NICOLE PERRY
CONCORDIA UNIVERSITY
NEBRASKA
What is the difference
between a STI and a STD?

STI: Sexually transmitted infection

STD: Sexually transmitted disease
Common STDs


Bacterial diseases

Chlamydia (CT)

Gonorrhea (GC)

Syphilis
Viral diseases

Human Papillomavirus (HPV)

Genital herpes (HSV-2 or HSV-1)

Hepatitis B
Common STDs
Estimated U.S. Annual Incidences

Human Papillomavirus: 5.5 million

Trichomoniasis: 5 million

Chlamydia: 3 million

Genital herpes: 1 million

Gonorrhea: 650,000

Hepatitis B: 120,000

Syphilis: 70,000
Chlamydia Infection


Most common reportable disease in the U.S.
Estimated 3million cases annually




Incidence is highest among sexually active
adolescents and young adults
Most infections are asymptomatic
Leading cause of preventable infertility in
women
Direct and indirect costs estimated
at $1.7 billion annually
Chlamydia — Rates by state:
U.S. and outlying areas, 2002
253.4
274.3
141.6
195.6
204.9
205.4
193.4
316.9
293.4
191.2
269.4
324.7
211.7
258.9
279.3
297.1
387.3 281.2
158.5
325.6
326.1
291.8
407.7
252.3
313.1
335.0
136.3 261.6
289.2
216.6
273.5
356.8
Guam 355.3
351.0
Rate per 100,000
population
415.3
333.4
412.7
607.1
156.7
126.0
171.9
270.1
288.0
168.3
338.1
318.9
307.2
282.0
414.8
VT
NH
MA
RI
CT
NJ
DE
MD
263.2
<=150.0
(n= 4)
150.1-300.0 (n= 29)
>300.0
(n= 20)
373.2
Puerto Rico 78.7
Virgin Is. 190.6
Chlamydia
Age- and sex-specific rates: U.S.,
2002
Men
3,000
Rate (per 100,000 population)
2,400
1,800
1,200
600
0
10.2
408.4
691.5
331.6
163.2
82.1
46.0
19.7
6.4
2.1
130.4
Age
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-54
55-64
65+
Total
Women
0
600
1,200
1,800
2,400
3,000
142.1
2,619.1
2,570.1
875.8
328.7
123.9
55.5
20.8
5.6
2.5
456.5
Chlamydia Infection
Signs and symptoms
Chlamydia may be difficult for you to detect because earlystage infections often cause few or no signs and symptoms.
When they do occur, they usually start one to three weeks
after you've been exposed to chlamydia. Even when signs
and symptoms do occur, they're often mild and passing,
making them easy to overlook.
Signs and symptoms may include:
•Painful urination
•Lower abdominal pain
•Vaginal discharge in women
•Discharge from the penis in men
•Pain during sexual intercourse in women
•Testicular pain in men
Chlamydia: KEY POINTS

Most common bacterial (curable) STD in the U.S.

Most cases in women and men give no symptoms

Leading cause of PID and infertility in women

All sexually active women 25 y.o.a. and younger should be
tested at least annually
Gonorrhea Infection

Caused by Neisseria gonorrhoeae

Overall rates falling, but incidence in certain
groups remains high

Most common in young adults and adolescents

CT co-infection of GC cases remains at about
40%

Resistance to medication is an spreading
problem
Gonorrhea Rates by state
U.S. and outlying areas, 2002
49.6
13.6
11.1
11.2
26.6
62.0
7.3
118.2
34.8
13.2
115.1
148.6
50.6
108.2
91.4
99.5
193.5 121.6
16.7
72.6
81.6
74.0
193.8
80.4
102.1
135.1
53.9
160.0
147.8
93.3
171.5
228.1
Guam 31.7
227.5
Rate per 100,000
population
224.6
129.4
254.8
102.2
16.1
9.7
51.1
85.9
95.2
93.8
201.1
176.6
192.9
164.3
241.7
VT
NH
MA
RI
CT
NJ
DE
MD
133.6
<=19.0
(n= 9)
19.1-100.0 (n= 20)
>100.0
(n= 24)
61.1
Puerto Rico 10.8
Virgin Is. 45.1
Gonorrhea
Age- and sex-specific rates: U.S.
Men
750
Rate (per 100,000 population)
600
450
300
150
0
7.4
287.9
538.1
320.4
199.2
131.4
92.1
48.1
17.3
4.4
124.5
Age
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-54
55-64
65+
Total
0
Women
150
300
450
600
750
46.6
675.6
650.3
251.4
113.1
57.4
31.3
10.6
2.1
0.8
125.5
Gonorrhea Infections
Clinical Manifestations
Signs and symptoms
The first gonorrhea symptoms generally appear
within two to 10 days after exposure. However, some
people may be infected for months before signs or
symptoms occur. Signs and symptoms of gonorrhea
may include:
•
Thick, cloudy or bloody discharge from the penis
or vagina
•
Pain or burning sensation when urinating
•
Abnormal menstrual bleeding
•
Painful, swollen testicles
•
Painful bowel movements
•
Anal itching
Gonorrhea: KEY POINTS

Second most common bacterial (curable) STD in
the U.S.

Concentrations of infection in MSM in urban areas

Resistance to medications is a spreading problem
Syphilis
Incidence had been steadily declining in
the U.S. since 1990
 28 U.S. counties account for 50% of the
reported cases
 In 2005, the CDC initiated a nation-wide
Syphilis Elimination Effort, targeting these
areas
 Recently, local outbreaks centered in
urban areas among MSM

Primary and Secondary Syphilis
Rates by state: U.S. and outlying areas, 2002
1.2
0.0
0.2
0.0
0.8
1.2
0.6
0.6
0.0
0.0
2.5
4.9
0.3
0.9
0.4
0.8
0.3
3.0
3.9
1.5
3.9
0.7
2.1
2.1
1.0
1.4
0.1
0.6
1.0
2.2
1.3
3.3
Guam 3.9
3.4
Rate per 100,000
population
5.4
2.8
3.4
0.0
0.3
0.6
1.6
1.2
0.8
2.0
1.4
4.3
3.5
3.0
1.7
VT
NH
MA
RI
CT
NJ
DE
MD
3.9
<=0.2
0.21-4.0
>4.0
(n= 7)
(n= 42)
(n= 4)
0.9
Puerto Rico 7.1
Virgin Is. 0.9
Note: The total rate of primary and secondary syphilis for the United States and
outlying areas (Guam, Puerto Rico and Virgin Islands) was 2.5 per 100,000
population. The Healthy People 2010 objective is 0.2 case per 100,000 population.
Primary and Secondary Syphilis
Age- and sex-specific rates: U.S., 2002
Men
Rate (per 100,000 population)
10.0
8.0
6.0
4.0
2.0
0.0
0.0
1.3
5.5
6.8
8.5
9.9
7.6
4.5
1.7
0.4
3.8
Age
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-54
55-64
65+
Total
0.0
Women
2.0
4.0
0.1
2.2
3.3
2.4
2.2
2.2
1.6
0.8
0.2
0.0
1.1
6.0
8.0
10.0
Regional Syphilis Hotspots

Higher endemic levels in rural South and Phoenix,
AZ

Outbreaks among MSM in many urban areas

SF, LA, Denver, NY, Chicago, District of Columbia,
Miami
Signs and symptoms
Syphilis develops in stages, and symptoms vary with each stage. But
the stages may overlap, and symptoms don't always occur in the same
order. You may be infected with syphilis and not notice any symptoms
for years.
Primary syphilis
The first sign of syphilis is a small sore, called a chancre (SHANGkur). The sore appears at the spot where the bacteria entered your body.
While most people infected with syphilis develop only one chancre,
some people develop several of them. The chancre usually develops
about three weeks after exposure. Many people who have syphilis don't
notice the chancre because it's usually painless and it may be hidden
within the vagina or rectum. The chancre will heal on its own within
six weeks.
Signs and symptoms cont...

Secondary syphilis
Within a few weeks of the original chancre healing, you may
experience a rash that begins on your trunk but eventually
covers your entire body — even the palms of your hands and
the soles of your feet. This rash is usually not itchy and may be
accompanied by wart-like sores in the mouth or genital area.
Some people also experience muscle aches, fever, sore
throat and swollen lymph nodes. These signs and symptoms
may disappear within a few weeks or repeatedly come and
go for as long as a year.

Latent syphilis
If you aren't treated for syphilis, the disease moves from the
secondary to the latent (hidden) stage, when you have no
symptoms. The latent stage can last for years. Signs and
symptoms may never return, or the disease may progress to
the tertiary (third) stage.
Signs and symptoms Cont…

Tertiary or late syphilis
About 15 to 30 percent of people infected with syphilis who
don't get treatment will develop complications known as tertiary,
or late, syphilis. In the late stages, the disease may damage your
brain, nerves, eyes, heart, blood vessels, liver, bones and joints.
These problems may occur many years after the original,
untreated infection.

Congenital syphilis
Babies born to women who have syphilis can become infected
through the placenta or during birth. Most newborns with
congenital syphilis have no symptoms, although some
experience a rash on the palms of their hands and the soles of
their feet. Later symptoms may include deafness, teeth
deformities and saddle nose — where the bridge of the nose
collapses.
Primary Syphilis
Photos: Dr. Joseph Engelman, San Francisco City Clinic
Rash of Secondary Syphilis
Syphilis: KEY POINTS

Serious systemic infection

Many different stages of Syphilis all with different
symptoms

Genital Herpes

Caused by Herpes Simplex Viruses
HSV
1: orolabial herpes
Cold
HSV
Sores
2: genital herpes

Both symptomatic & asymptomatic infections are
common

Can cause serious complications
Signs and symptoms

Most people do not get or recognize symptoms

Any of the following symptoms of a genital HSV infection can
occur in a man or a woman:

Cracked, raw, or red areas around your genitals without pain,
itching, or tingling

Itching or tingling around your genitals or your anal region

Small blisters that break open and cause painful sores. These
may be on or around your genitals (penis or vagina) or on your
buttocks, thighs, or rectal area. More rarely, blisters may occur
inside the urethra -- the tube urine passes through on its way out
of your body.

Pain from urine passing over the sores -- this is especially a
problem in women.
Genital Herpes: KEY
POINTS

About 1/5 of adult Americans have HSV 2

Most do not recognize or get symptoms

New type-specific blood tests can accurately diagnose HSV
2 infection even when no symptoms are present

Treatment to control symptoms and lessen the chance of
transmission are available
Genital Human
Papillomavirus (HPV)

Two disease processes caused by different viral
types

Precancer and cancer of the genital tissues
(abnormal Paps and anal carcinoma)

Skin growths in the anogenital area (genital warts)
Signs and symmptoms
The HPV virus lives in mucous membranes, such as
those in the genital area, or on the skin. If genital
warts show up, it's an indication of HPV infection.
Genital warts take on many different
appearances. They can be raised, flat, pink, or
flesh-colored. They can even be shaped like
cauliflower. Sometimes there is a single wart; other
times multiple warts appear. They can be small or
large. They can be on the anus, cervix, scrotum,
groin, thigh, or penis.
 Genital warts can show up weeks or even months
after sexual contact with a person infected with
an HPV virus. That person may not know he or she
is infected and is responsible for HPV transmission.

What happens once people get
infected with HPV?

For most people, nothing will happen
 The
body’s immune system usually
eliminates HPV infection
 After HPV is found on the cervix, it
becomes undetectable within 2 years in at
least 90% of women

Some people who get “low-risk” types
will develop:
 Visible
genital warts
 Low-grade Pap smear abnormalities that
usually go away on their own
Typical Genital Warts
DOIA Website, 2000
HPV: KEY POINTS

Extremely common virus

Some types cause genital warts

Other types cause cervical and anal cancer

HPV tests can help in managing female patients
with abnormal Paps
Hepatitis B

Hepatitis B is an infectious hepatitis caused by the hepatitis
B virus (HBV). This infection has two possible phases; 1)
acute and 2) chronic.

Acute hepatitis B refers to newly acquired infections.
Affected individuals notice symptoms approximately 1 to 4
months after exposure to the virus. In most people with
acute hepatitis, symptoms resolve over weeks to months
and they are cured of the infection. However, a small
number of people develop a very severe, life-threatening
form of acute hepatitis called fulminant hepatitis.

Chronic hepatitis B is an infection with HBV that lasts longer
than 6 months. Once the infection becomes chronic, it
may never go away completely.
Signs and symptoms

Half of all people infected with the hepatitis B virus have no
symptoms.

Symptoms develop within 30-180 days of exposure to the virus. The
symptoms are often compared to flu. Most people think they have flu
and never think about having HBV infection.

Appetite loss

Feeling tired (fatigue)

Nausea and vomiting

Itching all over the body

Pain over the liver (on the right side of the abdomen, under the lower
rib cage)

Jaundice - A condition in which the skin and the whites of the eyes
turn yellow in color

Urine becomes dark in color (like cola or tea).

Stools are pale in color (grayish or clay colored).