Sexually Transmitted Diseases If you have a sexually transmitted disease, you will know it. True or False? False. Many people with STDs have no symptoms and do not know they are infected; however, they can still pass an infection on to their partners. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 2 Worldwide, HIV infection is spread primarily via which of the following? A. B. C. D. Injection drug use Sex between men Mother-to-child transmission Heterosexual sex D. The vast majority of HIV infection cases worldwide result from heterosexual contact, and nearly two-thirds of all new cases occur in teenage girls and young women. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 3 Of the developed countries, which one has the highest rate of sexually transmitted diseases? A. B. C. D. Germany United States Canada France B. The United States has the highest rate of STDs of any developed nation. If current trends continue, 50% of all Americans will contract a sexually transmitted disease by age 25. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 4 A man with an STD is more likely to transmit the infection to a female partner than vice versa. True or False? True. For many STDs, infected men are at least twice as likely as infected women to transmit an STD to their partner. And many STDs are more physically damaging to women than to men. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 5 After you have had an STD once, you become immune to that disease and cannot get it again. True or False? False. Reinfection with STDs is very common. For example, if you are treated and cured of chlamydia and then you have sex with your untreated partner, the chances are very good that you will be infected again. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 6 What is an STD? • Sexually Transmitted Diseases (STDs) are serious, sometimes painful and can cause a lot of damage. • Some STDs infect your sexual and reproductive organs. Others cause general body infections • Sometimes you can have an STD with no signs or symptoms. Other times the symptoms go away on their own. Either way you still have an STD until you get treated. • Some STDs cannot be cured. But most STDs can be cured if you get treated. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 7 The Major STDs • Seven different STDs pose major health threats – – – – – – – HIV/AIDS Hepatitis Syphilis Chlamydia Gonorrhea Herpes HPV Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 8 Which type of infection is it? • Infections are either viral, bacterial or fungal infections. Virus: Bacteria: •HIV/AIDS •Chlamydia •Herpes •Gonorrhea •HPV (warts) Fungal: •Hepatitis •Canidiasis Protozoa: Spirochetes: •Trichomoniasis •Syphilis All infections are treatable but viral infections are not curable. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 9 How is an STD spread? • STDs are spread during close, sexual activity and during all types of intercourse. • Some STDs are also spread by contact with infected blood. • Most STD germs need to live in warm, moist areas. That’s why they infect the mouth, rectum and sex organs (vagina, vulva, penis and testes). Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 10 Acquired Immunodeficiency Syndrome (AIDS) • Leading cause of death in many parts of the world. – Worldwide, AIDS is the leading cause of death for people age 15-59 • Approximately 65 Million people around the world are infected with Human Immunodeficiency Virus (HIV). • More than 25 million have died worldwide • Human immunodeficiency virus (HIV) is the virus which causes AIDS. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 11 Approximate number of people living with HIV/AIDS in 2006 Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 12 AIDS and HIV • AIDS – a disease caused by a virus, HIV – Acquired – to get or catch – Immune – to be protected from disease – Deficiency – a lack of effort – Syndrome – a group of symptoms • HIV – the virus that causes AIDS – Human – it doesn’t infect animals, only man – Immunodeficiency – lowers your resistance to infection – Virus – a very small germ Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 13 HIV Infection and AIDS • By 2004, an estimated 1,000,000 Americans were believed to be living with HIV, with an estimated annual incidence of 40,000 cases • Estimated 1.5 million Americans have died – 2006, researchers discovered a group of chimpanzees in Cameroon that carry SIVspc – 1930s Genetic evidence shows that SIV first spread to humans • What is a HIV Infection? – HIV attacks and invades CD4 T-cells, monocytes and macrophages (white blood cells). – AIDS opens the possibility for a opportunistic infections. – Once initial symptoms resolve, the asymptomatic period may last from 2 to 20 years. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 14 Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 15 Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 16 Transmitting the Virus • HIV lives only within cells and body fluids. • 3 primary means of transmission are: (1)Specific kinds of sexual contact, (2) direct exposure to infected blood, and (3) HIV-infected women to her fetus. • How can you be infected with HIV? – Sexual contact (body fluids) – Direct contact with infected blood (such as with IV drug use, using dirty needles and sharing needles). – Mother-to-Unborn Child transmission. • But NOT through casual contact. • Can you tell if a person is infected with HIV? – No, an infected person can appear completely healthy. © 2008 McGraw-Hill Companies. All Rights Reserved. Chapter eighteen 17 Populations of Special Concern for HIV infection • Most common exposure has been sexual activity between men; injection drug use, and heterosexual contact. • African American men and women are vastly overrepresented among people newly diagnosed with AIDS. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 18 “HIV Positive Man… “ Answer the following questions by underlining or highlighting the answers in the article. 1. How many girls did Williams allegedly have sex with? 2. How many girls are infected with the AIDS virus? 3. His sex partners may have infected how many other people? Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 19 Who has been infected? • Blood and Blood Products used in Blood Transfusions before 1985 were not tested for infection – Arthur Ashe – blood transfusion during surgery – Ryan White – hemopheliac who was given infected blood product during a transfusion – Elizabeth Glaser – blood transfusion during surgery • Others through sexual activity and IV drug use – – – – – – – Freddy Mercury – IV drug use Rock Hudson – sexual activity Magic Johnson – sexual activity Tommy Morrison – sexual activity Easy E – sexual activity Pedro Zamora – sexual activity Greg Louganis – sexual activity 20 Symptoms of HIV Infection • Few days or weeks, half the people will develop (Flu like symptoms) – Fever, fatigue, rashes, headache, swollen lymph nodes, body aches, night sweats, sore throat, nausea and diarrhea. • Specialized test HIV RNA assay • Opportunistic Infections – Pneumocystis Carinii pneumonia (protozoal infection) – Kaposis sarcoma – Tuberculosis Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 21 Routes of HIV transmission among adults Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 22 Diagnosing HIV Infection • Most common is tests for the presence of antibodies to the virus. – HIV antibody test – ELISA (first test) if positive then the – Western blot (second test) • IF HIV-positive then check the status of the T4 cells. • What is the difference between HIV and AIDS? – The HIV infection is considered AIDS when the T4 cell count gets less than 200/mm3 blood. • New diagnostic test – HIV Replication Capacity. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 23 Treatment for AIDS • There are only Treatments (NO CURE). – Antiviral drugs. • Reverse transcriptase inhibitors. – Zidovudine (AZT). • Protease inhibitors. – Highly active antiretroviral therapy (HAART). – Structured intermittent therapy. • Fusion inhibitors – Enfuvirtide (Fuzeon) – Inhibit the fusion of viral and cell membranes – Usually consists of an AIDS cocktail – as much as 20 pills a day • Treatments for opportunistic infections Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 24 Prevention • Abstinence. • If you have sex you must use a condom. • Do Not share drug needles or do drugs. • You can also Participate in an HIV educational program. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 25 Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 26 Questions: • Can you get AIDS by donating blood? • Can you get AIDS by getting a tattoo? • Can you get AIDS by getting a body piercing? • Can you get AIDS the first time you have sex? • Once you become HIV positive can you ever be negative? Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 27 National Statistics • CDC (Center for Disease Control) estimates that 19 million STD infections occur annually, almost half of them among youth ages 15 to 24. • Because many cases are not reported or even diagnosed, it is estimated that there are over a million new cases of each year. National Statistics cont. • Chlamydia remains the most commonly reported infectious disease in the United States. In 2003, 877,478 chlamydial infections were reported to CDC. • Gonorrhea is the second most commonly reported infectious disease in the U.S., with 335,104 cases reported in 2003. National Statistics cont. • There were more than 32,000 cases of Syphilis in 2003. Also, the total number of reported Primary and Secondary cases of Syphilis increased from 6,862 to 7,177 in 2003. Herpes Simplex Virus • Herpes is a virus; Remains in the body for life • Two forms - Herpes simples virus-1 and -2. – Type 1 is associated with cold sores and fever blisters. – 50-80% of U.S. adults have anitibodies to HSV-1 – Both can be sexually transmitted. – HSV-1 and 2 can cause miscarriages or still births along with serious health issues of newborns • Symptoms – 90% have no symptoms – Recurring rash, painful ulcerations or cold sores/fever blisters – Primary outbreak - pain and discomfort around infected area, itching, burning during urination. – 2-20 days after infection - may be years before outbreak. – Burning during urination, fever, headache Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 31 Genital Herpes • • • • The first outbreak usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. Other signs and symptoms during the primary episode may include a second crop of sores, and flu-like symptoms, including fever and swollen glands. When signs do occur, they typically appear as one or more blisters on or around the genitals, rectum, or mouth. There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. Genital Herpes • Most people diagnosed with a first episode of genital herpes can expect to have several outbreaks within a year. You can get herpes anywhere . . . Source: Cincinnati STD/HIV Prevention Training Center Herpes 34 Herpes • Transmission – Touching, sexual intimacy - including kissing, sexual intercourse, sharing infected linens • Diagnosis – Examination of sores and culturing of fluid taken from sores • Treatment – No cure - symptoms are relieved by prescription drugs • Protection – Abstinence – Refrain for sex during an out break – Having protected sex with a condom* Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 35 Human Papilloma Virus • Also known as HPV or Genital Warts • Caused by a Virus; there are several types of HPV • More than 80% of sexually active individuals will have been infected with HPV by the age of 50 • Can cause cervical cancer and other diseases • Symptoms – Small bump on the skin or a large, warty growth – Cauliflower-like mass – May cause irritation and bleeding • Transmission – Intimate sexual contact with an infected person – Direct contact with infected bed linen, towels, clothes © 2008 McGraw-Hill Companies. All Rights Reserved. Chapter eighteen 36 Genital Warts Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 37 Genital Warts Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 38 HPV (genital warts) • Diagnosis – Appearance of the lesions – Women who are positive should have a Pap test very 12 months • Treatment – Topical medications can be used with sores and warts – Warts can be removed by cryosurgery, electrocautery or laser surgery but may later come back – There is no cure! • Protection – Abstinence – Having protected sex with a condom – Gardasil vaccine for young girls can help for some Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 39 Hepatitis B Virus (HBV) • Another virus with no cure; Preventable with vaccination • Can cause liver disease and death • Transmission – Unprotected sexual contact; 750,000 total acquired sexually – Sharing needles, IV drug use – Can be found in semen, saliva, blood and urine • Symptoms – Extreme fatigue, headache, fever, hives, lack of appetite, nausea, vomiting, tenderness in lower abdomen • Diagnosis and Treatment – Blood Test to know status – Abstinence and have protected sex only – Don’t use drugs Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 40 “STD rates high among Shore teens” – The Daily Times 4/16/12 Answer the following questions by underlining or highlighting the answers in the article. 1. Wicomico County ranks _______ state-wide in numbers of STD cases. 2. What is abstinence? 3. If someone has an STD will they always have signs or symptoms? Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 41 “Vaccinating boys against HPV makes good sense” The Daily Times 10/15/12 Find the answers to the following: 1. HPV has been known to cause cancers in what areas of the body? 2. What is the name for the HPV vaccination that is currently available for both girls and boys? 3. How many HPV-related cancers occur in men each year? 42 Gonorrhea • 700,000 new cases every year in the U.S. • Bacterial infection – Can cause other problems such as • sterility, arthritis and heart problems, PID, ectopic pregnancy, premature labor and still birth, arthritis, rashes • Symptoms – Women – Can be asymptomatic • Frequent burning urination, menstrual irregularities, pelvic pain, discharge. – Males • thick yellow-white discharge, painful urination. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 43 Gonorrhea • Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery. Gonorrhea Disseminated Gonococcal (Gonorrhea) Infection Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides 45 Gonorrhea • Transmission – Sexual contact • Diagnosis – Microscopic exam of discharge • Treatment – Oral antibiotics – People often have chlamydia at same time. • Protection – Abstinence – Protected sex with condoms Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 46 Chlamydia Trachomatis • Most prevalent bacterial STD in the U.S. • Can cause sterility in men and women – WOMEN - infects the cervix and urethra, fallopian tubes & ovaries; Can cause PID and bladder infections. – MEN- Epididymitis, urethra and testes; Can cause urethritis, bladder infections, watery discharge. • Symptoms – Can be asymptomatic – Discharge, pain and burning while urinating, vaginal bleeding, painful intercourse, abdominal pain, nausea, fever, inflammation of rectum or cervix, swelling and pain in the testes. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 47 Chlamydia • • • Chlamydia is known as a “silent” disease. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure. Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. Men with signs or symptoms might have a discharge whitish discharge from their penis or a burning sensation when urinating. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner. Chlamydia • Transmission – Sexual contact, babies can be infected inside the birth canal • Diagnosis – Examination of tissue samples or urine • Treatment – Both partners treated fully with antibiotics • Protection – Abstinence – Condoms and safe sex Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 49 Pelvic Inflammatory Disease PID • Progressive infection that harms a woman’s reproductive system. • Can lead to sterility, ectopic pregnancy and chronic pain - treated or not. • Caused by chlamydia and gonorrhea. • Symptoms – long and painful menstrual periods, discharge, spotting, low abdominal pain, fever, chills, nausea, vomiting, pain during intercourse Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 50 Gonorrhea Pelvic Inflammatory Disease (PID) Source: Cincinnati STD/HIV Prevention Training Center 51 Pelvic Inflammatory Disease PID • Treatment – Antibiotics, bed rest, sexual abstinence during treatment, surgery may be necessary to remove scarring • Diagnosis – Pelvic Exam, cultures, laparoscopy • Protection – Abstinence – Condoms and safe sex Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 52 Syphilis • Caused by spirochetes • Syphilis organism remains in the body for life and leads to disfigurement, neurological disorders, or death. • Symptoms – – Primary phase- 3 weeks - 90 days - painless sores and wet ulcers (chancre) and swollen glands. – Secondary Phase - 3-6 weeks - up to 2 years body rash, mild fever, fatigue, sore throat (Flu like symptoms), and hair loss. – Late phase (tertiary)- Damage to organs and nervous system. Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 53 Primary Syphilis • • • The primary stage of syphilis is usually marked by the appearance of a single sore, but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. Syphilis Oral Primary Syphilis Chancre Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides 55 Secondary Syphilis • This stage typically starts with the development of a rash on one or more areas of the body. • In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue Late Syphilis • Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. • In the late stages of syphilis, it may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints Late Stage Syphilis Ulcerating Gumma Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides Syphilis 58 Syphilis • Transmission – Unprotected sexual contact; from infected mother to baby • Diagnosis – Culture of discharge; blood test • Treatment – Effective antibiotics • Protection – Abstinence – Protected sex with condoms Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 59 Other STDs • Trichomoniasis (protozoa) – Direct contact with infected people, bed linens and towels • Pubic Lice (Crabs) – Direct contact with infected people, bed linens, towels, toilet seat • Bacterial vaginosis (BV) • Scabies • Candiasis (fungi) • Nongonococcal Urethritis (NGU) Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 60 Pubic Lice • Signs and symptoms of pubic lice include • Itching in the genital area • Visible nits (lice eggs) or crawling lice Pubic Lice • Pubic lice have six legs, but their two front legs are very large and look like the pincher claws of a crab; this is how they got the nickname "crabs." Pubic lice are tan to grayish-white in color. • A lice-killing shampoo made is recommended to treat pubic lice. What You Can Do • Educate Yourself • Prevention – Use a barrier defense such as a condom – Know your potential partner – Abstinence until monogamous • Diagnosis and Treatment – – – – – Get vaccinated Be alert for symptoms Get tested Inform your partners Get Treated • Ask. Are you ready to have sex? Chapter eighteen © 2008 McGraw-Hill Companies. All Rights Reserved. 63 Sexually Transmitted Diseases