Sexually Transmitted
Diseases
Presenter Norma Sanchez, CDS II
STD Overview
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STDs affect men and women of all backgrounds and
economic levels.
Most prevalent among teens and young adults with
nearly 2/3 of all STDs occurring in people under age 25.
Contributing factors in the rise of STDs include: young
people have become sexually active earlier, divorce is
more common and sexually active people are more likely
to have multiple sex partners. Important to note that it
is the behavior which puts you at risk not who you are.
Types of STDs
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Bacterial
Chlamydia
Gonorrhea
Pelvic Inflammatory
Disease (PID)
Syphilis
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Viral
Genital Warts
Hepatitis B and C
Herpes
HIV
Warning!
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This section contains graphic images of
infectious diseases –
You have been warned
Chlamydia
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Caused by Chlamydia Trachomatis.
Can be transmitted during vaginal, oral,
and anal sexual contact.
If symptoms appear, they will occur 1-3
weeks after exposure.
Complications: PID, sterility, premature or
still births, blindness.
Picture of a Normal Cervix
Cervical Ectopy
Inflammation of the cervix from
Chlamydia infection
Chlamydia/GC
Chlamydia
Symptoms of Chlamydia
Symptoms in Women:
 Usually asymptomatic
 Abnormal vaginal
discharge
 Pain during sex
Complications, if not
treated:
 Pelvic inflammatory
disease (PID)
Symptoms in Men:
 Usually asymptomatic
 Discharge from the penis
(may be runny, whitish)
 Burning on urination
Complications, if not treated
 Swollen and tender
testicles (epididymitis)
Chlamydia
Chlamydia Symptoms in Men
Source: Seattle STD/HIV PTC
Chlamydia
Chlamydia Symptoms in Women
Mucopurulent Cervicitis
Source: St. Louis STD/HIV PTC
Chlamydia
Testing & Treatment for
Chlamydia
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Easily detected by a urine
test or a swab; and
Easily cured with
antibiotics; but
Any damage to the body
cannot be repaired
Gonorrhea
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Caused by Neisseria gonorrhea.
Symptoms may occur 2-21 days after exposure.
Transmitted during vaginal, anal and oral sex.
Can also be transmitted from infected mother to infant
during birth.
Complications: PID, sterility, blindness, meningitis,
kidney and heart damage, skin rash, ectopic pregnancy.
Symptoms of Gonorrhea
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For Women
Thick yellow or white
discharge from vagina
Bleeding from vagina between
periods
Burning/pain when
urinating/during bowel
movement
Cramps and pain in lower
abdomen
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For Men
Thick yellow or white
drip from the penis
Burning or pain when
urinating
Need to urinate more
often
Gonorrhea
Gonorrhea
Complications in Men
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Swollen or tender testicles (epididymitis)
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Disseminated gonococcal infection (DGI)
Gonorrhea
Swollen or Tender Testicles
(Epididymitis)
Source: Health Awareness Connection, http://www.healthac.org/images.html
Gonorrhea
Disseminated Gonococcal
(Gonorrhea) Infection
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides
Gonorrhea
Gonorrhea Symptoms in Women
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Usually
asymptomatic
Painful urination
Abnormal vaginal
bleeding
Pain during sex
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical
Cervical GC
Gonorrhea
Complications in Women
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Bartholin’s Abscess
Pelvic inflammatory disease (PID)
Disseminated gonococcal infection (DGI)
Gonorrhea
Bartholin’s Abscess
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides
Gonorrhea
Pelvic Inflammatory Disease
(PID)
Source: Cincinnati STD/HIV Prevention Training Center
Gonorrhea
Gonorrhea in Infants
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A mother can pass
gonorrhea to her
baby during
childbirth
Gonorrhea
Testing & Treatment for
Gonorrhea
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Easily detected by a
urine test or swab;
and
Easily cured with
antibiotics; but
Any damage to the
body cannot be
repaired.
Pelvic Inflammatory Disease
(PID)
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Usually caused by Chlamydia trachomatis or Neisseria gonorrhea.
PID occurs when bacteria travel from the vagina through the cervix
and into the uterus, fallopian tubes, or ovaries.
Symptoms:
Pain in the lower abdomen or lower back.
Pain in the abdomen during sex.
Fever, chills, or vomiting.
Unusual bleeding or discharge from the vagina.
Complications: infertility, ectopic pregnancy, scar tissue in the pelvic
organs, chronic abdominal pain.
Syphilis
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Caused by Treponema pallidum.
Transmitted during vaginal, anal and oral sex.
Symptoms may occur 10 days to 3 months after
exposure.
An infected mother can pass the disease to her
unborn child.
Three stages: Primary, secondary, tertiary or
late.
Syphilis
Symptoms of Syphilis
Primary Stage
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A painless sore called a chancre may be
located on the genitals, lips, anus, or other
area of direct contact
The chancre will last 1-5 weeks and heal
without treatment
The person can easily pass it on to sex
partners
Syphilis
Primary Syphilis Chancre in a Man
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
Primary Syphilis Chancre in a
Woman
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Primary Syphilis
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The first symptom is a painless
chancre at site of entry of the
bacteria i.e. mouth, sex
organs, breasts, or fingers
which may occur 3-12 weeks
after exposure.
Sore can last 1-5 weeks but
then disappear.
Swollen glands.
Primary chancre
Primary syphilis
Primary syphilis
Secondary Stage
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If syphilis is not treated in the first stage the
symptom will go away.
About 4 months later (early latent stage)
secondary symptoms will show up.
They may show up 0-10 weeks, average is 4
weeks.
Symptoms may last 2-6 weeks, average is 4
weeks.
Secondary Syphilis
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Rash anywhere, but
primarily on palms and
soles.
Patchy hair loss.
Sore throat.
Swollen glands.
1 week to 6 months
after appearance of
primary chancre.
This set of symptoms
will also eventually
disappear.
Secondary Syphilis
Secondary Syphilis
Secondary Syphilis
Congenital Syphilis
Third Stage of Syphilis
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If a person is not treated during these two
stages syphilis still remains in the body.
It may take several years but syphilis
becomes “latent” which means: to hide.
During this stage syphilis can do damage
to the body.
Tertiary or Late Syphilis
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Approximately 1/3 of
untreated cases of secondary
syphilis will progress to this
stage.
This stage may continue 5-20+
years with no obvious
symptoms.
Can cause lesions on body
organs such as the brain and
heart.
Late Syphilis, Gumma
Special populations
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Women who are pregnant get tested at the
beginning of their pregnancy if seen by a doctor.
A woman may become infected during her
pregnancy and may transmit syphilis to her child
without knowing it.
A baby born from a mother who has syphilis
may die from complications of syphilis.
End of bacterial slides
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There are more bacterial infections but
these are the 3 that are reported to the
Health Department.
 QUESTIONS??????
Viruses
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Viruses are not curable.
The symptoms are treatable and can be
manageable.
The viruses we will talk about are:
Herpes
 Genital Warts
 Hepatitis B and C
 HIV
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Genital Herpes
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Caused by the Herpes
Simplex Virus.
Lives in CNS.
Transmitted through skin to
skin contact.
Symptoms may occur 1-30
days after exposure.
Transmitted during vaginal,
anal, and oral sex.
Transmission can also occur
when blisters are not
present.
No cure, only treatment
available.
Symptoms of Genital
Herpes
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Transmitted through skin to skin contact.
Flu-like symptoms.
Painful blisters/sores at the site of infection,
i.e. mouth, penis, vagina, anus, cervix, lips,
tongue, gums, and eyes.
Blisters can last 1-3 weeks.
Blisters will heal but may reappear
throughout life.
Prodrome effect.
Complications: May cause brain damage or
death in infants.
HSV I
HSV II
Human Papillomavirus (HPV)
HPV
Human Papillomavirus
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Many types of Human Papillomavirus
(HPV), some of which infect the genital
area
Incubation period unclear
Can infect men, women, and newborns
The person can easily pass it on to sex
partners
HPV
Genital HPV: Two Types
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The types of HPV that infect the genital
area are labeled “low-risk” or “high-risk”
depending on whether they can cause
cancer or not.
Low-risk HPV types can cause genital
warts.
High-risk HPV types can cause serious
cervical lesions, cervical cancer, and
other genital cancers.
HPV
Symptoms of Genital HPV Infection
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Usually asymptomatic and brief (6 – 12
months)
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Genital warts (usually infection with low-risk
type of HPV)
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Warts on the penis, vagina, anus or urethra
Rarely may have itching, bleeding, burning, or
pain along with the warts
May go away on their own, stay about the same,
or get worse
HPV
Symptoms of Genital HPV Infection
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Cervical lesions (usually infection with highrisk type of HPV)
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Usually no symptoms
Detected by Pap smear
Most will go away on their own
Some will persist and need to be followed by
health care provider
Most women with high-risk HPV types do not
get cervical cancer
HPV
HPV Penile Warts
Source: Cincinnati STD/HIV Prevention Training Center
HPV
Genital Warts in a Woman
Source: CDC/NCHSTP/Division of STD, STD Clinical Slides
HPV
Perianal Wart
Source: Cincinnati STD/HIV Prevention Training Center
HPV
Testing & Treatment for
Genital Warts
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Genital Warts
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No tests for genital warts
Several types of treatment are available
Warts may come back
Cervical lesions and cervical cancer
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Regular Pap smears are best way to
detect serious lesions and prevent
cervical cancer
Pap smear screening is recommended for
all sexually active women
Genital Warts
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Caused by Human
Papilloma Virus.
Symptoms may occur 1-8
months after exposure.
Transmitted by direct skin
to skin contact.
Can also be passed
although no visible warts
are present.
No cure, only treatment
available for the warts.
Complications: may
cause cervical, vulvar, or
penile cancer.
Symptoms of Genital
Warts
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Small, bumpy or flat warts on the sex
organs and anus.
Itching or burning around the sex
organs.
Some people have no visible warts.
Symptoms of Genital Herpes
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Transmitted through skin to skin contact.
Flu-like symptoms.
Painful blisters/sores at the site of infection, i.e.
mouth, penis, vagina, anus, cervix, lips, tongue,
gums, and eyes.
Blisters can last 1-3 weeks.
Blisters will heal but may reappear throughout
life.
Prodrome effect.
Complications: May cause brain damage or
death in infants.
Condyloma (Warts)
Anal Warts
Penile Warts
Gardisil
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Current vaccine for Gardisil starting for
young girls at age 9.
If on Medi-Cal they can be up to age 20 to
receive a free physical and vaccine.
If not on Medi-Cal and is enrolled through
CHDP it is up to age 18.
3 doses, over a 6 month period
Hepatitis B and C
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Hepatitis - Inflammation of the liver.
Transmitted during vaginal, anal, and
oral sex, sharing razors, toothbrushes,
needles.
Can also be passed from infected mother
to child during birth.
HBV can live on environmental surfaces
for up to 7 days.
Complications: Cirrhosis, liver cancer
and death. Can also cause premature
birth or spontaneous abortion.
Symptoms of Hepatitis
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Nausea, vomiting.
Fatigue.
Loss of appetite.
Jaundice.
Dark-colored urine/light-colored stools.
Enlarged liver/liver pain.
Herpes
Herpes in a Woman
Source: CDC/NCHSTP/Division of STD,
STD Clinical Slides
Source: Cincinnati STD/HIV Prevention Training Ce
Herpes
Herpes in a Man
Source: Cincinnati STD/HIV Prevention Training Center
Herpes
Herpes Complications
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HSV-2 causes serious
problems when it is
passed to newborns
during birth.
Herpes
Testing & Treatment for
Genital Herpes
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Can be detected by:
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culturing the lesion
blood test
Herpes cannot be
cured, but symptoms
can be treated with
medicines called
antivirals.
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You can still spread
herpes even if you
are taking antiviral
medicine!
Genital Herpes
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Caused by the Herpes
Simplex Virus.
Lives in CNS.
Transmitted through skin to
skin contact.
Symptoms may occur 1-30
days after exposure.
Transmitted during vaginal,
anal, and oral sex.
Transmission can also occur
when blisters are not
present.
No cure, only treatment
available.
Herpes
You can get herpes anywhere . .
.
Source: Cincinnati STD/HIV Prevention Training Center
It gets worse!!!
Blue Waffle
Hepatitis B and C
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Hepatitis - Inflammation of the liver.
Transmitted during vaginal, anal, and oral sex,
sharing razors, toothbrushes, needles.
Can also be passed from infected mother to child
during birth.
HBV can live on environmental surfaces for up to 7
days.
Complications: Cirrhosis, liver cancer and death.
Can also cause premature birth or spontaneous
abortion.
HIV
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Human
Immunodeficieny
Virus
HIV is the virus that causes AIDS
AIDS
Acquired
Immune
Deficiency
Syndrome
When your body is no longer able to protect
you from disease because your immune
system has been compromised.
Which bodily fluid is not HIV
infectious?
1.
2.
3.
4.
5.
Semen
Blood
Vaginal Secretions
Saliva
Breast Milk
94%
0%
1
0%
2
3%
3
3%
4
5
BODY FLUIDS
Infectious
1) Blood
2) Semen
3) Vaginal
Secretions
4) Breast milk
Non-infectious
1) Sweat
2) Saliva
3) Urine
4) Tears
5) Mucus
Behaviors/Activities/Events
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1) Unprotected Sexual Intercourse
-Anal, Vaginal, and Oral
2) Sharing Needles
-To inject: IV drug use, steroids, medicine
- What about piercing: ears, nose, body and
tattoos??????
3) Vertical Transmission- Mother to baby
4) Blood Transfusions/Blood Products
5) Accidental Blood to Blood Contact
Barriers
Monogamy - Two people who are lifetime partners
Serial Monogamy - Having multiple monogamous
relationships
If practicing serial monogamy, one should use condoms
LATEX
98% Effective
Male Condoms
Female Condoms
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Acceptance
Bravery
Self-respect
Trust
Integrity
No Sex
Education
No Risk
Confidence
Esteem
Abstinence means no
Sex, Drugs & Alcohol
Abstinence is the only
100% effective way not
to get HIV
Only way to be 100% sure
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Abstinence
Reduced Risk Behaviors
 Monogamy
 Condom
Use (latex 98%,
polyurethane 95%)
 Water based lubricants
 Dental Dams
Harm Reduction
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What is it?
Testing
 The
test looks for the presence
of HIV antibodies.
 Anyone who is sexually active
should be tested for HIV.
 Especially: Youth/Adolescents,
People of Color, and Women.
Testing
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Confidential
Anonymous
Free testing available at the Health Department.
Results are available in 2 weeks.
Test can be done by blood sample.
Mobile Unit available at certain locations offer
OraQuick® Rapid Testing, preliminary results are
ready in 20-30 minutes.
12 and over can test without parent permission.
Results
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Non reactive: What does it mean?
Reactive: What does it mean?
Is it reportable?
Criteria for AIDS Diagnosis
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1. Opportunistic Infection (There are 26). The
most
common are:
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PCP - Pneumo Cystis Carinii Pneumonia
KS - Kaposi’s Sarcoma (MSM)
Esophageal Candidiasis
TB - Tuberculosis (Mycobacterium)
MAC
2. T-cells fall below 200 per cm (Healthy people
have between 800-1600 T-cells)
TESTING
•Confidential
•Anonymous
Free testing available at the Health Department.
Rapid Test results in 30 mins
If you have a preliminary positive, then confirmatory results are
available in 2 weeks
Test will be done by blood sample/draw
Mobile Unit available at certain locations offer OraQuick® Rapid
Testing, preliminary results are ready in 20-30 minutes.
12 and over can test without parent permission.
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Relatively few cases were diagnosed
among Asian, American Indian/Alaska
Native, and Native Hawaiian/other
Pacific Islander females, and females
reporting multiple races, although the
rates for these groups were higher
than the rate for white females.
Woman are always at higher risk for
STD’s and HIV Infection then men
54%
1.
2.
3.
True
False
I don’t know
46%
0%
1
2
3
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CDC estimates that 1 in five people living with
HIV infection in the United States do not know
they are infected.
Getting tested for HIV is the first step to
protecting yourself and others.
Knowing your own HIV status and that of your
male sexual partners is critical because 85% of
newly diagnosed HIV infections in US women
and girls result from sex with an infected male
partner.
Early diagnosis of HIV allows for counseling and
prompt treatment. HIV treatment prolongs life
and reduces the risk of further HIV transmission.
Encouraging your partner to wear a condom
every time you engage in sexual activity is
another important way to protect yourself
Questions and Answers
Hope we didn’t ruin lunch!