Sexually Transmitted
Diseases
A Plague of Epic Proportions
Worldwide  400 million new cases/year
 The U.S.  15 million/year
 Hits the 15-25 age group hardest
 ¼ by 21!
 Teen women  gonorrhea & Chlamydia
 Genital warts and Aids are huge threats
 Pelvic Inflammatory Disease a frequent
consequence

The Biggest Threats?

Aids/HIV  deadly and dreaded

But other STDs, especially Chlamydia and
genital warts are more prevalent
Why the Epidemic?

An explosion of risk behaviors
multiple partners
unprotected sex

Oral contraceptive use
increase susceptibility
decrease condom use
More Reasons

Public Health failures
meager access to prevention/treatment
MDs don’t ask enough questions

Symptoms are often latent

Shame
Chlamydia

An urogenital infection caused by the
bacteria chlamydia trachomatis
Very common and dangerous
 Increase of 400% from ’87 to ’99
 3-5 million new cases in US each year
 Teens suffer the highest infection rates
 Oral contraceptives & douching increase
 Often transmitted through fingers

Chlamydia Symptoms
Two types
 One infects the lower reproductive tract
with just mild burning
 The other manifests as a PID of the upper
reproductive tract, infecting the uterus,
fallopian tubes or ovaries

Common PID Consequences
For women:
disrupted menstrual periods
chronic low back and pelvic pain
fever/nausea/headaches
Salpingitis infertility and entopic
pregnancies
IUDs to be ineffective
 For men: epididymis and urethra infections

If that wasn’t enough
For many, the symptoms are not
noticeable, can spread unknowingly
 Also causes Trachoma, the world’s
leading cause of preventable blindness
 Many other effects on infants


Fortunately, easily treated with
Doxycycline and Azithromycin
Herpes

The most common viral STD

Two types of interest:
HSV-1 usually lesions or sores on
mouth (cold sores)
HSV-2 lesions on and around the
genitals
How Bad is it?
Huge #s
HSV-1  100 million
HSV-2  50 million
 With 1 million new cases a year
 20-25% US adults over 12
 Unprotected sex with multiple partners?
Guaranteed Exposure

Transmission

Both types can be spread through a
variety of ways
oral sex can spread either type
recently many cases of genital herpes
arose from HSV-1 rather than HSV-2
The Horror of Viral Shedding

While victims with sores can easily spread
the infection, HSV can be transmitted even
in the absence of symptoms through “viral
shedding”
Many spread HSV without even knowing
that they are infected
 Condoms provide some, but not
complete, protection
 Fingers can spread the virus

Symptoms

HSV2
2-14 day incubation
20 days of symptoms:
one or more small, painful red bumps or
“papules” in the genital areas or around
the anus
It gets worse
The papules fill with nasty infectious
particles permeating pus
 They burst to form red, ringed sores
 The sores crust and heal but can still
infect someone for another 10 days


Other symptoms can be present also
As for HSV1
Papules form on the lips, and occasionally
on the inside of the mouth, tongue, or
throat
 Crust over and heal within 10-16 days
 Other symptoms – fever, muscle aches, flu
like maladies, bleeding in the mouth

Recurrence
The infection retreats up nerve fibers
where it can lie dormant, perhaps
permanently
 Usually though, it flares up periodically
with less severe symptoms and a more
rapid course
 Prodromal symptoms warn of eruption and
ability to infect others

Factors which Trigger Recurrences
Emotional stress
 Anxiety
 Depression
 Fever
 Ultraviolet light
 Menstruation
 Fatigue

Complications

Few for men, but for women:
1) Cervical cancer, rare but still calls for an
annual Pap smear.
2) Infection of a newborn
viral shedding can cause infection as the
child passes through the birth canal
cesarean delivery prevents the severe
danger to the child
Treatment of Herpes
Currently nothing can cure herpes
 Three Antiviral drugs help manage it
 Two treatment strategies:
Suppressive – take daily to prevent
Episodic – to minimize an outbreak
 Neither eliminates viral shedding

Genital Warts
 Viral
warts, caused by the virus
human papillomavirus (HPV)
which appear on the genitals
 40
million victims in North America
 Five million new cases/year
Top This
“Most sexually active people will get HPV.”
 Recent survey – 27% of all women, 44%
between 20 & ?
 Even condoms fail to protect!
 Most commonly spread by the
asymptomatic!

A Disgusting Sight, Usually
First appear 3 weeks to 8 months after
contact
 Women  usually on the bottom of the
vaginal opening
 Men  throughout the penis
 Can appear on the anus
 In moist areas – pink/red, soft cauliflower
 Dry – hard, yellow/grey

But Then Again
Many, probably most, do not develop
visible symptoms despite infection
 In other words, you can’t see it, but you
can certainly get it
 From any one of 40+million people

Complications
Bleeding & obstruction of the urethra
 Association with various cancers
 Account for 85-90% of attributable risk for
cervical cancer.
 Can be transmitted to infants at birth

Treatment (?)
Nothing has been shown to remove or
prevent recurrence
 Freezing is 60-70% effective
 More aggressive treatments such as
surgical removal can cause serious side
effects
 Perhaps vaccines will, some day, help
prevent infection
