SEXUALLY
TRANSMITTED
DISEASES
Lynne D. Feldman, MD, MPH – District Health Director
Elsie Napier, RN, FNP – District Program Manager
Brenda Mims, RN – Infectious Disease Coordinator
South Health District, 8-1
STD Presentation
Presentation to
Valdosta State University / Student Health
Brenda Mims, RN – Infectious Disease Coodinator
DCH Mission
ACCESS
Access
to affordable,
quality health
care in our
communities
RESPONSIBLE
Responsible
health planning
and use of
health care
resources
HEALTHY
Healthy
behaviors and
improved
health
outcomes
DCH Initiatives
FY 2009 and FY 2010
FY 2009
FY 2010
Medicaid Transformation
Medicaid Transformation
Health Care Consumerism
Health Care Consumerism
Financial & Program Integrity
Financial & Program Integrity
Health Improvement
Health Improvement
Solutions for the Uninsured
Workforce Development
Workforce Development
Customer Service
PeachCare for KidsTM Program
Stability
Emergency Preparedness
Customer Service
Disclosure Statements
•
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To obtain nursing contact hours for this session, you must be present for the
entire hour and complete an evaluation.
Neither the planners of this session nor I have any financial relationship with
pharmaceutical companies, biomedical device manufacturers, or
corporations whose products and services are related to the vaccines we
discuss.
There is no commercial support being received for this event.
The mention of specific brands of vaccines in this presentation is for the
purpose of providing education and does not constitute endorsement.
The GA Immunization Program utilizes ACIP recommendations as the basis
for this presentation and for our guidelines, policies, and recommendations.
For certain vaccines this may represent a slight departure from or off-label
use of the vaccine package insert guidelines.
Goal
• To promote Sexually Transmitted Disease
awareness, prevention and education.
Objectives
•
After the completion of this presentation participants should be able
to:
1.
2.
3.
4.
5.
6.
7.
Define Sexually Transmitted Diseases (STDs);
Describe how STDs are transmitted;
Name at least three of the most commonly diagnosed STDs;
Identify signs and symptoms of STDs;
Understand the effects of STDs on pregnancy;
Describe recommended CDC treatments for STDs;
Understand the STD reporting and follow-up process.
Sexually Transmitted Diseases
(STDs)
•
Definition
– An infection passed during sex by means of sexual contact, including vaginal
intercourse, oral sex, and anal sex.
• Until the 1990’s these illnesses/diseases were commonly known as venereal diseases.
Veneris – the Latin name for Venus, who is considered the Roman goddess of love.
• Can have no symptoms
• Infect the following areas:
– Mouth
– Rectum
– Sex organs ( vagina, vulva, penis, testes)
Can You Name these STD?
STDs
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CHLAMYDIA
GONORRHEA
Genital Warts
HEPATITIS A, B. & C
Bacterial Vaginosis
Scabies
Epididymitis
Nongonococcal Urethritis
Pediculosis Pubis
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GENITAL HERPES/HPV
HIV/AIDS
SYPHILIS
Trichomoniasis “Trich”
Genital & Perianal Warts
Lymphogranuloma Venereum
Vulvovaginal Candidiasis
Pelvic Inflammatory Disease
Chlamydia
•
What is Chlamydia?
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Mode of transmission
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May present as non-gonococcal urethritis (NGU) syndrome in males or mucopurulent cervicitis syndrome
in females
Known as the “silent” disease
Abnormal vaginal bleeding (between menstrual periods)
Burning sensation during urination
Back pain and/or pain during intercourse
Treatment
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–
•
Spread during vaginal, anal or oral sex with someone who has Chlamydia
Symptoms
–
•
Sexually transmitted infection
A common STD caused by the bacterium Chlamydia Trachomatis
Can be transmitted through vaginal, anal or oral sex as well as to a child from the mother during birth
Can cause sterility
Antibiotic (Usually Azithromycin or Doxyclycline)
Partner should also be treated to prevent re-infection
Prevention
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Abstinence
Condoms
Monogomy
Chlamydia
Chlamydia
Treatment For Chlamydia
• Chlamydia can be treated with the following
medications:
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Azithromycin
Doxyclycline
Amoxicillin
Erythromycin
Gonorrhea
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What is Gonorrhea?
– Sexually transmitted disease caused by Neisseria Gonorrhoeae
– Can also grow in the mouth, throat, eyes, and anus
Mode Of Transmission
– Spread during vaginal, anal or oral sex with someone who has Gonorrhea
Symptoms
– Many men may have no symptoms
• Some symptoms may take up to 30 days to appear
– Burning sensation during urination
– White, yellow or green discharge from the penis or vagina
– Painful or swollen testicles
– Vaginal bleeding between periods
– Painful bowel movements
– Many with Gonorrhea also have other STDs
Treatment
– Antibiotics
– Drug resistant strains are increasing
Prevention
– Abstinence
– Condoms
– Monogomy
Gonorrhea
Treatment For Gonorrhea
• Gonorrhea can be treated with the following
medications:
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Ceftriaxone (Rocephin)
Cefixime
Azithromycin
Doxycycline
Erythromycin
Genital Warts
•
What is Genital Warts
– Small, sexually transmitted growths that is caused by Human Papillona Virus
– Flesh-colored (look like miniature cauliflower florets)
– Can be visible in the vagina, urethra, cervix, vulva, penis, anus
•
Mode of Transmission
– Spread during vaginal, anal or oral sex, and sometimes by genital touching, with
someone who has genital warts
•
Symptoms
– The virus lives in the skin or mucous membranes
– Can cause no symptoms
•
Treatment
– Can be removed
– No Cure (will have the virus for the rest of your life)
•
Prevention
– Condoms
– Monogamy
Genital Warts
Treatment For Genital Warts
• Genital Warts can be treated but not cured:
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Podofilox
Imiquimod
Trichloroacetic Acid
Podophyllin
Gardasil (HPV Vaccine)
Hepatitis
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What is Hepatitis?
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Hepatitis A
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Passed through blood, from mother to baby during birth, during sex (not common)
Hepatitis B & C can become chronic
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Passed through blood, saliva, semen, or vaginal fluids (anal or oral sex), from mother to baby during birth,
sharing needles to inject drugs or for any other reason
Symptoms: Persistent flu-like feelings, tiredness, jaundice, dark urine, light-colored bowel movements
Hepatitis C
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•
Passed in human feces, food and water
Symptoms: Jaundice, Fatigue, Abdominal Pain, Diarrhea, Nausea
Hepatitis B
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A disease that damages the liver
Caused by a virus
Hepatitis A, B, C are most common
Can cause cirrhosis (scarring) of the liver
Liver cancer
Prevention
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Hepatitis A & B vaccine available
Hepatitis C – No Vaccine but medication available to prevent further liver damage
Hepatitis
• Picture of a healthy liver
• Effects of hepatitis on the
liver
Treatment For Hepatitis A, B & C
• Hepatitis A
– No treatment
– There is a vaccine to prevent Hepatitis A
– Goes away by itself in 2-6 months
• Hepatitis B
– Yes / Treatment isn’t always successful
– There is a vaccine that should be started at birth – all ages 0-18 should be
vaccinated
• Hepatitis C
– Treatment with antivirals (interferon – most common) to manage and slow
disease progression
– There is no vaccine for Hepatitis C
Perinatal Hepatitis B
Perinatal Hepatitis B
Prevention Program
• Program Goals
– Ensure all pregnant women are screened for HBsAg at their initial
prenatal screening panel as standard of care
– Be sure Public Health conducts case investigations on all positive HBsAg
pregnant women
– Confirm 90% of all infants born to HBsAg positive women receive HBIG
and the first dose of Hep B vaccine within 12 hours of birth
– Ensure that 90% of all infants born to HBsAg positive women receive the
second dose of vaccine at 1-2 months of age
– Ensure that 80% of all infants born in Georgia to HBsAg positive women
are tested at 9 months to 18 months of age for HBsAg and Hepatitis B
surface antibodies (Anti-HBs)
Genital Herpes
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What is herpes?
– A viral infection characterized by recurring vesicular and ulcerative lesions on the genitals or
adjacent areas that heal spontaneously without scarring.
– Some severe cases of first episode infection last an average of 12 days and aseptic meningitis or
generalized symptoms due to viremia may occur.
Mode of transmission
– Spread through vaginal, anal and oral sex – sometimes by genital touching with someone who has
herpes
Symptoms
– Oral Herpes
• Cold sores or “fever blisters”
– Genital Herpes
• Most have no symptoms
• Most common symptoms – cluster of blistery sores – usually on the vagina, vulva, cervix,
penis, buttocks or anus
• May last several weeks – may return in weeks, months or years
• Fever, blisters, burning feelings if urine flows over sores, itching, open sores
Prevention
– Abstinence
– Do not have sexual contact during outbreaks
– Use condoms between outbreaks
Oral & Genital
Herpes
Treatment For Genital Herpes
• There is no cure for Genital Herpes
• Treatment may include:
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Acyclovir
Famciclovir
Valacyclovir
Valtrex
Acetominophen or Ibuprofen (Oral Analgesic)
Syphilis
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What is Syphilis?
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An STD caused by the bacterium Treponema Pallidum
Called the “great intimidator” because many of the signs and symptoms are indistinguishable from those of other diseases
Stages of Syphilis
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Mode of Transmission
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Spread during vaginal, anal or oral sex, and sometimes by genital touching, with someone who has Syphilis
Symptoms
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Primary
Secondary
Late
Congenital
Primary: Appearance of a sore (chancre) at the spot where syphilis entered the body – could be one or more
Secondary: Skin rash and mucous membrane lesions, fever, swollen lymph glands, sore throat, patchy hair loss,
headaches, weight loss, muscle aches and fatigue
Late: Difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, dementia
Congenital: rash, thinning of the skin
Prevention
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Abstinence
Condoms
Monogamy
Primary Syphilis
Secondary Syphilis
Late Syphilis
Congenital Syphilis
Treatment of Syphilis
• Syphilis can be treated; however, a person will
usually have a “titer” after treatment
– Titer, def.
the concentration of antibodies present in the highest dilution of a serum
sample at which visible clumps with an appropriate antigen are formed. The concentration of
antibodies present in the highest dilution of a serum sample at which visible clumps with an
appropriate antigen are formed.
• Benzathine Penicillin G
• Doxyclycline (Cannot be used on lactating
clients)
Can You Tell Who Has HIV?
HIV
• Human Immunodeficiency Virus
• The virus that causes AIDS
• Damages the body’s immune system which protects
the body from diseases
• Can have for many years without signs or
symptoms
HIV
Modes of Transmission
• During vaginal, oral or anal sex
• Blood-to-blood contact
– (blood with HIV in it comes into
contact with blood or mucous
membranes of another person)
• Sharing needles
• Needles used for tattoos and
piercing or to inject vitamins or
steroids
• Healthcare workers caring for
HIV can get HIV from needlestick injuries
• Mother to baby during
pregnancy, childbirth, or breast
feeding
HIV
• HIV is not passed by:
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Donating blood
Hugging, dry kissing, or sharing food
Telephones, toilet seats, or eating utensils
Tears, saliva, sweat or urine
Mosquitoes or other insects
Coughing, sneezing, or spitting
HIV
• Incubation Period:
– Some people develop symptoms shortly after being
infected
– Sometimes it takes more than 10 years for symptoms to
appear.
Stages of HIV
“Stage 1”
• Primary HIV Infection
– Last for a few weeks
– Have flu-like symptoms
– Body begins seroconversion
• Body responds to the virus by producing HIV antibodies
• Can last 3 weeks to 6 months
Stages of HIV
“Stage 2”
• Asymptomatic Stage
– Having no obvious signs of symptoms
• Immune system still strong enough to prevent symptoms
– Last for an average of 10 years
– People continue to look and feel healthy
• The virus can still be passed to other people
– Unprotected sex, needle sharing
– HIV virus continues to weaken the immune system
Stages of HIV
“Stage 2” Continue
• Symptoms:
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Moderate unexplained weight loss
Recurrent respiratory infections
Fungal nail infections
Herpes zoster
Stages of HIV
“Stage 3”
• Symptomatic HIV Infection
– The virus has become more active in the body and the immune system is
weakened.
– Symptoms:
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Skin Rashes
Fatigue
Night Sweats
Slight weight loss
Mouth ulcers
Thrush (yeast infection)
Fungal skin and nail infections
Stages of HIV
“Stage 3” Continue
– Symptoms
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Unexplained sever weight loss
Chronic diarrhea
Persistent fever
Oral candidiasis
Oral hairy leukoplakia
Bacterial infections
– Pneumonia
•
Stages of HIV
“Stage 4”
AIDS
– CD4 count is less than 200
– Or has a history of an AIDS defining illness
• Opportunistic Infections
– Infections that the immune system would normally prevent.
» Examples:
– Pneumocystis Carinii Pneumonia (PCP)
» A fungal infection of the lungs
– Tuberculosis (TB)
» A bacterial infection often found in the lungs but can spread to other parts
of the body
– Kaposi’s Sarcoma (KS)
» A rare cancer that causes patches of abnormal tissue to grow under the
skin, in the lining of the mouth, nose, and throat or in other organs
– Cytomegalovirus (CMV)
» A common virus that infects most people at some time during their lives but
rarely causes obvious illness. It is a member of the herpes virus family
» Can cause blindness
– Toxoplasmosis
» A disease caused by a single-celled parasite called Toxoplasma gondii
» Can affect the brain
Pneumocystis Carnaii Pneumonia
• There is increased
white (opacity) in the
lower lungs on both
sides, characteristic of
Pneumocystis
pneumonia
Tuberculosis
Kaposi’s Sarcoma
CMV
Normal Retina
Retinas With CMV
Toxoplasmosis
How Does A Person Find Out
Whether Or Not They Are HIV+?
•
Taking the HIV Antibody test
– Giving A Blood Sample
• Blood is drawn and sent to the
lab for processing
• Results back in about two
weeks
– Taking the OraSure Test
• A swab is taken from the cheek
(an additive on the swab pulls
blood from the capillaries inside
the cheek)
• Results back in 2-3 days
– Taking the OraQuick test
• A needlestick test
• Results usually back in about
30 minutes
• If a positive is revealed a
confirmatory test is performed
HIV Testing
• Test for HIV antibodies
– Immune system makes these to fight HIV
– Does not tell if you have AIDS
• If you have antibodies
– Test results are positive
– Have HIV
• If you don’t have HIV antibodies
– Test results negative
– You don’t have HIV
HIV Testing Continued
• The Window Period
– Usually takes up to 3 months after infection for the body
to make HIV antibodies
– In rare cases, it can take up to 6 months
STDs & Pregnancy
Additional
Resources
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Contact Information
Brenda Mims, RN, BSN
Infectious Disease Coordinator
South Health District, Unit 8-1
(229) 245-8711; Ext. 237
bcmims@dhr.state.ga.us