Sexually Transmitted Diseases
Incidence of STDs
• Startling statistics
– Most STD’s contracted by 15-29 year-olds
– 1 in 4 treated for STD by age 21
– 25% of U.S. population > 1 STD by age 35
– Largest proportion of AIDS cases infected in teens
or 20s
Incidence of STDs (cont.)
• Why so high?
– more sexual partners
– use of oral contraceptive
– limited access to health care
– practitioners do not ask questions about STDs
– some diseases have no obvious symptoms
– difficulty talking to partner
Bacterial Infections
• Chlamydia
– most prevalent and damaging of STDs
– females: urethritis, cervicitis
• symptoms: few or none; mild irritation or itching;
burning; slight discharge
– pelvic inflammatory disease (PID)
• symptoms: pain; fever; headache; n/v
Bacterial Infections (cont.)
• Chlamydia (cont.)
– males: epididymitis; nongonococcal urethritis
– symptoms: heaviness in testis; small, hard, painful
swelling in testis; inflamed scrotum
Bacterial Infections (cont.)
• Chlamydia (cont.)
– minimal or no symptoms in majority of men and
women
– consequences: infertility & sterility; preterm birth;
infant conjunctivitis or pneumonia
– treatment: doxycycline or azithromycin
• Most recurrent infections result of re-exposure
Bacterial Infections (cont.)
• Gonorrhea
– females: gonococcal cervicitis
• symptoms: 80% no early symptoms; yellow-green
discharge, vulval irritation
– males: gonococcal urethritis
• symptoms: discharge, burning; swelling
Bacterial Infections (cont.)
• Gonorrhea (consequences)
– female: PID, ectopic pregnancy, severe pelvic pain,
infant conjunctivitis
– male: prostate abcesses, painful BMs, difficult
urination, possible sterility
– both: fever, loss of appetite, arthritic pain, can
invade heart, liver, CNS
– can cause blindness in infants
Bacterial Infections (cont.)
• Gonorrhea (consequences) (cont.)
– treatment: dual treatment for chlamydia &
gonorrhea
– resistant bacteria require special treatment
– dual therapy now needed
Bacterial Infections (cont.)
• Nongonococcal urethritis
– female: few symptoms; may be itching, burning,
vaginal discharge of pus
– male: penile discharge, urinary burning
– consequences: inflamed cervix or PID
– treatment: doxycycline or azithromycin
Bacterial Infections (cont.)
• Syphilis
– rates have risen dramatically
– all pregnant women should be tested
– primary: red, painless chancre
– secondary: painless, non-itching skin rash, flu-like
symptoms
– latent: no observable symptoms
– tertiary: severe disorder, death
Bacterial Infections (cont.)
• Syphilis (cont.)
– other consequences: infected fetus can die
– treatment: early cases treated with benzathine
penicillin G or other antibiotic
– 3 weekly injections for later case
– all partners need testing at three month intervals
Viral Infections
• Herpes: herpes simplex; types 1 & 2
transmitted even when no blisters
– 20-25% of Americans have HSV-2
– symptoms: painful, red bumps develop into
blisters that rupture & form sores
– can spread even when no lesions present
– may or may not be recurrent
– prodromal symptoms can warn of recurrence
Viral Infections (cont.)
• Herpes (cont.)
– consequences: risk for cervical cancer
– newborn infected during delivery may die or
suffer severe damage
– C-section for women with active disease
– can cause eye infection
– psychological distress
Viral Infections (cont.)
• Herpes (cont.)
– treatment: no cure; working on vaccine
– acyclovir may reduce length & severity of
outbreak & may reduce recurring attacks
– suppressive vs episodic treatment
– hygiene & stress reduction may provide relief
– vaccine in development
Viral Infections (cont.)
• Genital warts (human papilloma virus)
– epidemic levels
– transmitted even when no warts are evident; >
100 types
– symptoms: moist, soft, cauliflower-like warts, or
dry, yellow-gray, hard warts
• majority of people have no symptoms
Viral Infections (cont.)
• Genital warts (cont.)
– consequences: urinary obstruction & bleeding;
greater risk of genital cancers
– respiratory infection in newborn
– treatment: no cure; removal of warts
– recurrence likely
– Gardisicile vaccine
Viral Infections (cont.)
• Viral hepatitis (3 types)
– needle-sharing & sexual transmission
– Hepatitis C most health threatening
– symptoms: few or none; initially flu like;
incapacitating fever, vomiting, abdominal pain;
yellowed sclera & skin
Viral Infections (cont.)
• Viral hepatitis (cont.)
– consequences: liver cancer; death
– treatment: bed rest & fluids; vaccines are available
for Hepatitis A and B; antiviral combination may
help Hepatitis C
Common Vaginal Infections
• Bacterial vaginosis (Gardnerella)
– symptoms: foul-smelling, thin flour-paste
discharge (white, yellow or green)
– may be genital irritation or urinary burning; most
men have no symptoms
Common Vaginal Infections (cont.)
• Bacterial vaginosis (Gardnerella) (cont.)
– consequences: greater risk of PID; premature
rupture of amniotic sac & preterm labor
– treatment: oral, cream or gel Flagyl
– Some recommend that male should be treated
too
Common Vaginal Infections (cont.)
• Candidiasis (moniliasis, yeast infection):
– symptoms: white, (cottage cheese-like) discharge
with intense itching, sore tissue
– consequences: confused with other infections
– treatment: vaginal suppositories or creams
Common Vaginal Infections (cont.)
• Trichomoniasis
– symptoms: copious, odorous, frothy, white or
yellow-green vaginal discharge; inflamed, irritated,
itchy and sore
– male partners must be treated
Common Vaginal Infections (cont.)
• Trichomoniasis (cont.)
– consequences: may increase risk of cervical cancer
– treatment: both partners; oral Flagyl; topical
cream
Ectoparasitic Infections
• Pubic lice
– symptoms: little to severe itchiness
– treatment: Lindane shampoo; 1% permethrin
rinse
– launder linens & clothing
Ectoparasitic Infections (cont.)
• Scabies
– symptoms: small, pimple-like bumps; red rash
around primary lesion
– intense itching, especially at night
– treatment: topical scabicide; launder or dry-clean
linens & clothing
Acquired Immunodeficiency
Syndrome (AIDS)
• HIV & AIDS
– HIV = a retrovirus that targets & destroys helper T4 cells
– HIV becomes AIDS when
• HIV is present, and
• CD-4 count is < 200
Acquired Immunodeficiency
Syndrome (cont.)
• Incidence
– rates among teenagers, women and minorities
rising
– MSM transmission increasing
– decreasing IDU transmission
– increasing heterosexual transmission,
• especially among women & minorities
Acquired Immunodeficiency
Syndrome (cont.)
• Transmission
– occurs in any bodily fluid
• depends on viral load
– likelihood greatest when HIV transmitted directly
to blood
– low risk: casual contact
– high risk: sexual contact, sharing needles
Acquired Immunodeficiency
Syndrome (cont.)
• Symptoms: brief flulike symptoms that
progress depending on immunosuppression
• HIV antibody tests
– most develop antibodies in a few months but can
take three years to seroconvert
– usual progression (8 to 11 years)
– full-blown AIDS
Acquired Immunodeficiency
Syndrome (cont.)
• Treatment
– no cure or vaccine at this time
– combination drug therapy (HAART) shows best
results for slowing progress
• success dependent on compliance but side effects
severe
– zidovudine may significantly decrease maternal
transmission
Acquired Immunodeficiency
Syndrome (cont.)
• Treatment (cont.)
– the search for a vaccine
• A number of vaccines are in clinical trials
• problems due to disease mutations
• none available for general use now
Acquired Immunodeficiency
Syndrome (cont.)
• Prevention is the best solution
– use condoms and avoid multiple partners
– do not share needles
– avoid contact with bodily fluids
– avoid sexual behaviors involving anus
Acquired Immunodeficiency
Syndrome (cont.)
• Prevention is the best solution (cont.)
– avoid implements that could be contaminated
with blood (e.g., razors)
– avoid sexual contact with sex workers
Preventing STDs
• Guidelines for lowering risk
– abstinence
– get to know partners before sex
– obtain prior medical examinations
– always use condoms properly & spermicide
– avoid multiple sexual partners
– inspect and wash genitals
– disclose your STD status