Chapter Fifteen
Sexually Transmitted Infections and
HIV/AIDS
Agenda
 Discuss Attitudes and STIs
 Review Information about Sexually
Transmitted Infections
 Discuss Human Immunodeficiency Virus
(HIV) and Acquired Immune Deficiency
Syndrome (AIDS)
 Review Cross-Cultural Aspects of AIDS
 Discuss Preventing STIs and AIDS
Introduction
 Over 65 million people in the U.S. are living
with an incurable STI
 19 million STI infections occur each year, half
to those to people 15-24 years old
 There are more than 25 infections that spread
mainly through sexual activity
Design a Campaign
 You have been chosen to develop a
campaign aimed at developing healthy
sexuality for high school students.
 In this particular city the rate of STIs is the
highest in the country.
 Develop the components of your ad
campaign.
 Present your campaign plan to class.
Self Reflection Exercise
Do NOT discuss. Write down your thoughts
privately.
If I found out I was infected with herpes or
genital warts, I would …
If my partner were infected with chlamydia,
I would …
If I found out I had AIDS, I would …
Attitudes about Sexually
Transmitted Infections
Attitudes and the STI Epidemic
 STIs have been viewed as a sign of corrupt
sexuality
 Punishment concept of disease – that a
person got what they deserved
 Negative beliefs and stigma about STIs
currently exist
These negative attitudes can interfere with
getting tested for an STI
Attitudes and the STI Epidemic
 College students believe they are immune to
STIs and engage in high-risk sexual
behaviors
e.g. multiple partners, unprotected
intercourse
 2/3 of STIs occur in people under 25
Sexually Transmitted
Infections: Trends
Reporting
Pregnancy Complications
Protection
Reporting Issues
 All states must report syphilis, gonorrhea,
chancroid, chlamydia, HIV, & AIDS cases
 Many states require that genital warts and
herpes be reported
 Women are more susceptible to gonorrhea,
chlamydia, HIV
 Women have more risk of complications from
STIs because vaginal tissue is fragile
 Women are more likely to be asymptomatic
Pregnancy Complications
 STIs can affect pregnancies
 30-40% of preterm births and infant deaths
are due to STIs
 Some can cross the placenta (syphilis, HIV)
 Some can infect the newborn during delivery
(chlamydia, gonorrhea, herpes, HIV)
 HIV can be transmitted through breastfeeding
 Antibiotics and c-sections can minimize harm
Protection
 Barrier methods can decrease the risk of STIs
 Non-oxynol 9 may increase the risk of
infection by irritating the skin
 Condoms are the most effective contraceptive
that reduces the STI risk
 Condoms cannot cover all of the penis, vulva,
or scrotum
Protection: Partner Issues
 Most effective way of avoiding STIs is to
abstain from oral, vaginal, and anal sex or be
in a long-term, mutually monogamous
relationship with someone free from STIs
 If a person does have an STI, treatment
should include treatment of their sexual
partner(s)
Class Exercise: Condom Line Up
 Penis becomes erect
 Carefully open package and remove
condom
 Buy/Get condoms
 Store condoms in cool, dry place
 Check expiration date
 Decide with partner to have sexual
intercourse
 Check to see which way condom unrolls
 Talk about protection and safer sex
 Lose erection
 Pull back foreskin if uncircumcised
 Place condom on head of penis
 Orgasm and ejaculation
 Gently squeeze air out of tip of condom
 Roll condom all the way down erect
penis
 Intercourse
 Throw away condom in garbage – don’t
flush
 Hold condom at base of penis and
withdraw penis
 Remove condom from penis
 Lose erection
1. Decide with partner to have sexual
intercourse
2. Talk about protection and safer sex
3. Buy/Get condoms
4. Store condoms in cool, dry place
5. Check expiration date
6. Penis becomes erect
7. Carefully open package and remove
condom
8. Check to see which way condom unrolls
9. Lose erection
10. Pull back foreskin if uncircumcised
11. Place condom on head of penis
12. Gently squeeze air out of tip of condom
13. Roll condom all the way down erect
penis
14. Intercourse
15. Orgasm and ejaculation
16. Hold condom at base of penis and
withdraw penis
17. Remove condom from penis
18. Lose erection
19. Throw away condom in garbage – don’t
flush
Sexually Transmitted
Infections
Ectoparasitic Infections
Bacterial Infections
Viral Infections
Ectoparasitic Infections
 Parasites that live on the skin’s surface
 Two sexually transmitted varieties:
Pubic Lice
Scabies
Pubic Lice
 Also called “crabs”
 Small, wingless insects that are difficult to
detect on light-skinned people
 Attach to pubic hair (preferred) by their claws
& drink from tiny blood vessels under the skin
 Cannot survive more than 24 hours off of the
body, however, they reproduce rapidly and
eggs are cemented to the hair
 Highly contagious
Pubic Lice: Prevalence, Symptoms,
Treatment
 Incidence: common
 Symptoms: mild to severe itching (particularly
at night) thought to be due to allergic reaction
from their saliva
 Diagnosis: lice and eggs are visible
 Treatment: kill eggs & lice with Kwell ointment
(shampoo, cream); clothing & sheets dry
cleaned, boiled, or washed in hot water
Scabies
 Mite Sarcoptes scabiei
 Spread via any skin-to-skin contact
 Mites can live up to 48 hours off of the body
 Not visible to naked eye
Scabies: Prevalence, Symptoms, Treatment
 Incidence: millions worldwide
 Symptoms: rash and severe itching
 Diagnosis: examination of the rash and a skin
scraping can confirm diagnosis
 Typically less than 10 mites on the body
during an infection
 Treatment: topical creams; clothing and
sheets washed in hot water
Bacterial Infections
 Gonorrhea
 Syphilis
 Chlamydia and Nongonococcal Urethritis
 Chancroid
 Vaginal Infections
 Pelvic Inflammatory Disease
Gonorrhea
 Also called the “clap” or “drip”
 Survives only in mucous membranes, such as
the cervix, mouth, urethra, rectum, throat,
eyes
 Transmitted when mucous membranes
contact each other
 Incidence: second most commonly reported
infectious disease in the U.S.; 600,000 to 1
million new cases each year
Gonorrhea: Symptoms
 Women: most are asymptomatic, cervix is
most common infection site; urinary
frequency, abnormal bleeding
 Men: 25% are asymptomatic; epididymitis,
urethral discharge, painful, frequent, & urgent
urination
 Swelling, pain, & pus in the joints
 Rectal gonorrhea: bloody stools & pus
Gonorrhea: Diagnosis & Treatment
 Diagnosis: examine for bacteria in a sample
of the discharge; can also run DNA testing of
urine
 Treatment: antibiotics (oral, injection)
Note: there are rare cases when they have
become drug-resistant
Syphilis
 Live in the mucous membranes
 Typically first infects the cervix, anus, penis,
lips, or nipples
 Incidence: 7,177 cases reported in 2003
 Symptoms: 3 stages
Primary/Early
Secondary (after chancres disappear)
Tertiary (remission, but still infectious; can
lead to long term health risks)
Syphilis: Stage 1
1: primary/early syphilis 10-90 days after
infection
Chancres (small, round, red-brown,
painless sores with a hard raised edge &
sunken center) may appear on the
vulva, penis, vagina, cervix, anus,
mouth, lips
Syphilis: Stage 2
2: secondary syphilis after chancres
disappear
Syphilis invades the central nervous
system
Reddish patches on the skin, possible
wart-like growths in area of infection
Lymph glands enlarge
Headaches, fever, anorexia, flu-like
symptoms, fatigue
Syphilis: Stage 3
3: tertiary/late syphilis
Stage of remission and a person feels
fine, though able to transmit the disease
for 1 year
If not treated, this stage can cause
neurological, muscular, sensory, &
psychological difficulties and is
eventually fatal
Syphilis: Diagnosis & Treatment
 Diagnosis: culture taken from a lesion; blood
tests
 Treatment: Penicillin; antibiotics can
temporarily increase the symptoms for a few
hours
Chlamydia and Nongonococcal
Urethritis
 May also cause epididymitis and
nongonococcal urethritis in men
 Incidence: most commonly reported
infectious disease in the U.S.; estimated 2.8
million new cases per year
Highest among African Americans
Higher in young women
Underdiagnosed in men
Chlamydia and Nongonococcal
Urethritis: Symptoms
 Chlamydia is highly contagious
 Symptoms: asymptomatic in 75% of women
and 50% of men
Female symptoms: burning while urinating,
painful intercourse, pain in lower abdomen,
bleeding/spotting, rare for discharge
40% will get PID, 20% will become infertile
Male symptoms: discharge from penis,
burning while urinating, burning & itching at
penile opening, pain or swelling of testicles
Chlamydia and Nongonococcal
Urethritis: Diagnosis & Treatment
 Diagnosis: culture cervical discharge for
women, blood test, urine test for men
 Treatment: antibiotics for 7-10 days; some
cases have become drug-resistant
Vaginal Infections
 There are many common vaginal infections
related to sexual intercourse
Trichomoniasis
Bacterial vaginosis
Candiasis
Trichomoniasis
 Trichomonas vaginalis
 Female symptoms 3-28 days after infection:
increase in yellowish, frothy, & foul-smelling
vaginal discharge; burning/itching in vagina;
asymptomatic
 Male symptoms: asymptomatic, discharge at
tip of penis, burning while urinating or
ejaculating
 Treatment: metronidazole (Flagyl™)
Bacterial Vaginosis
 Most common vaginal infection in women of
childbearing age, though half are
asymptomatic
 Increased susceptibility with: multiple
partners, douching, low concentrations of
beneficial vaginal bacteria
 Treatment: metronidazole or clindamycin
Candidiasis
 Vulvovaginal candiasis; yeast infection
 Caused by a variety of fungi, most commonly
Candida albicans
 Fungi normally common in vagina, but will
multiply when the pH balance is disturbed
 pH changes due to: pregnancy, oral
contraceptives, douching, antibiotics,
diabetes, fecal material contacting the vagina
Candidiasis
 Symptoms: burning, itching, and increase in
vaginal discharge that may be thin, white, and
including white chunks
 75% of women will have at least one yeast
infection
 Recurrences are common
 Treatment: antifungal prescription or over-thecounter drugs (cream is topical or inserted
into the vagina); plain yogurt
Pelvic Inflammatory Disease
 Infection of the female genital tract
 Most often caused by chlamydia and
gonorrhea
 PID can cause long-term complications such
as ectopic pregnancies, chronic pelvic pain,
infertility
 Estimated to affect 1 out of 7 women by age
35 at least once
Pelvic Inflammatory Disease:
Symptoms & Tratment
 Characteristics of a typical PID sufferer:
young, unmarried, multiple partners, had an
STI, early age at first intercourse, minority,
use douches
 Symptoms: acute pelvic pain, high fever,
abnormal vaginal discharge
Often asymptomatic
 Treatment: antibiotics for 14 days
Viral Infections
 Once a virus enters a body, it can reproduce
and the person will have it for the rest of their
life
Although they may not experience
symptoms while the virus lies dormant,
they are still infected
 Common Viral STIs
Herpes
Human Papillomavirus
Viral Hepatitis
Herpes
 Infection with herpes simplex virus (HSV)
 The virus prefers the mouth and face (herpes
simplex I) or the genitals (herpes simplex II)
 The symptoms may be less severe if the virus
infects a less preferred site
 The virus exists in the sores, as well as from
the infected skin without the sores present
(viral shedding)
 HSV can be spread without active symptoms
 A person can reinfect themselves on another
body part
Herpes: Incidence & Symptoms
 Incidence: one of the most common STIs in
the U.S.; 1 million infected each year
 Symptoms: sores that last 8-10 days,
tingling/burning feeling, itching & red swollen
genitals, painful urination, blisters with pus,
fever, headaches, pain, itching, discharge,
fatigue
Over time, outbreak frequency diminishes
Psychological reactions: guilt, anger,
anxiety, helplessness, frustration,
depression, lowered self-esteem
Herpes: Diagnosis & Tratment
 Diagnosis: presence of blisters, sometimes a
scraping will be taken
 Treatment: no cure; therapy with antiviral
drugs (topical, oral, injected) to decrease
outbreaks, prevent complications, & reduce
viral shedding; ice pack; cooling or drying
agent; L-lysine; decrease sugar & nuts
Vaccines are undergoing trials
Human Papillomavirus
 Over 30 types of HPV
 Almost all cervical cancers can be attributed
to HPV and HPV can also cause genital warts
 Transmitted through intercourse, oral sex,
vulva-to-vulva sex, anal sex
 Incidence: estimated 50% of sexually active
people will get HPV
Related factors: intercourse before 16, 2+
sexual partners in a year, Hispanic women
Human Papillomavirus: Symptoms &
Treatment
 Symptoms: asymptomatic; genital warts in
10% of HPV cases (highly contagious); foulsmelling discharge; itching & pain
 Diagnosis: visual inspection of warts,
biopsies, Pap test
 Treatment: chemical topical solutions,
cryotherapy, electrosurgical interventions,
laser surgery
May resolve itself or need many treatments
Viral Hepatitis
 3 types & their transmission routes:
Hepatitis A (HAV) – fecal-oral contact;
vaccine-preventable
Hepatitis B (HBV) – high-risk sexual
behaviors
Hepatitis C (HCV) – sexual behavior, drug
use, unscreened blood transfusion
 Incidence:
HAV: 1/3 in the U.S.
HBV: 1.25 million in the U.S.
HCV: 3.9 million in the U.S.
Viral Hepatitis: Symptoms
 HAV: fatigue, abdominal pain, loss of
appetite, diarrhea
 HBV: asymptomatic, nausea, vomiting,
headaches, jaundice, fever, fatigue, darkened
urine, liver enlargement, chronic liver disease
 HCV: asymptomatic, mild illness, chronic liver
infection
Viral Hepatitis: Diagnosis & Treatment
 Diagnosis: blood test
 Treatment: 3 drugs that interfere with the life
cycle of the virus and induces an immune
response
Vaccines are available for HAV and HBV
Recommended for high risk individuals
HIV/AIDS
Incidence
Knowledge and Attitudes about AIDS
Symptoms
Diagnosis
Treatment
Prevention
Families and AIDS
CNN Video: Fighting AIDS in Africa
Overview of HIV and AIDS
 AIDS is caused by HIV
 HIV is transmitted through bodily fluids
(semen, vaginal fluid, blood) during vaginal &
anal intercourse or by sharing needles
 The virus may remain dormant, however, it is
often fatal if untreated
 Origin of HIV is unknown
HIV and AIDS: Progression
 HIV attacks T-lymphocytes (T-helper cells) in
the blood, lowering the body’s ability to fight
infections
 Immune system releases antibodies & many
white blood cells to fight the HIV infection
 The lowered immune system response
means many opportunistic diseases infect
people with AIDS that a healthy person can
easily fight
Incidence of HIV/AIDS
 Since 1981, 1.5 million Americans have
become infected; 35-42 million worldwide
 Women are the fastest growing group in the
U.S. because vaginal tissue is more easily
damaged during intercourse, although men
drive the spread of HIV
 Can be transmitted to a baby during
pregnancy, labor & delivery, & breastfeeding
 71% of new AIDS cases are in minorities
Video: “One + One”
 Discuss your response to this video.
 What did you learn about HIV/AIDS?
Knowledge and Attitudes about AIDS
 More knowledge about AIDS in the U.S. has
not been correlated with practice of safer sex
or behavior changes
 3 unique aspects of AIDS:
Fear of transmission
Social worth of those with the disease
Incomprehensible magnitude of the
disease
 AIDS remains stigmatized in the U.S.
Symptoms
 Decline in T-helper cells takes 3 years if
depressed, and 5+ years if not depressed
 AIDS develops within 8-10 years without
treatment
 Early symptoms are flu like (fever, headaches,
fatigue, sore throat, swollen lymph nodes)
 Later symptoms: weight loss, severe diarrhea,
night sweats, oral candidiasis, gingivitis, oral
ulcers, fever, dizziness, confusion
 Opportunistic diseases: pneumonia,
toxoplasmosis, cryptococcosis, cytomegalovirus,
Kaposi’s sarcoma
Diagnosis
 Tests typically look for antibodies that fight
HIV, though some may look for HIV in blood
 Antibody tests can require 2 weeks for the
result
 Rapid tests are less effective
 False negative and false positive results are
possible with all tests
CNN Video: New HIV Testing Procedure
Treatment
 Before treatment, a viral load test and CD4+ T cell
count are taken to determine how much HIV is in the
system and to provide a baseline to assess the
effectiveness of treatment
 HAART – highly active antiretroviral therapy
Blend of 3+ HIV drugs (drug cocktails)
Can involve taking 25+ pills a day at different
times on a strict schedule
Expensive: $10,000 to $15,000 per year
Side effects: fatigue, fever, rashes, nightmares,
headaches, nausea, diarrhea, increased
cholesterol, diabetes, lowered bone density, liver
problems
Prevention
 Requires behavior change
 Many schools now include AIDS education
 HAART has been related to an increase in
high risk sexual practices in homosexual
men, but not among heterosexuals
 If infected, inform past partners that they
should be tested
 Research into high risk behaviors is needed
 First AIDS vaccine was found ineffective
Families and AIDS
 Due to the social stigma, caretakers often
have no one to turn to
 Adolescents that were told their parents had
AIDS had more emotional distress and
engaged in more high risk sexual practices
Cross-Cultural Aspects of AIDS
 95% of HIV cases lack access to treatment
 AIDS has largely affected children
 Areas throughout the world:
Asia and the Pacific
Europe and Central Asia
Sub-Saharan Africa
Latin America and the Caribbean
The Middle East and North Africa
Other Issues
Asia and the Pacific
 Over 7 million with HIV, many are young
 Rising number of infections in India & China
 China lacks an adequate supply of condoms
 3% of Cambodia is infected
 Indonesia’s rise in IV drug use adds to the
HIV epidemic
 Thailand has shown a decrease due to the
copy of antiretroviral drugs for patients and a
100% condom use program for prostitutes
Europe and Central Asia
 2 million people
 Large increase of HIV infections in the
Russian Federation, mainly because of IV
drug use
Sub-Saharan Africa
 Most of the people with HIV live in Africa
 70% of HIV-positive people live in subSaharan Africa
 Most people are not receiving HAART
therapy due to costs, and they are also not
being treated for opportunistic diseases
 Male-female power disparity is problematic
 HIV-positive men believe sex with a virgin will
cure them
Latin America and the Caribbean
 2 million adults and children
 Many countries offer free or low cost
antiretroviral therapy to those with HIV/AIDS
 They are able to reproduce the drugs that are
not patented outside of the U.S.
The Middle East and North Africa
 480,000 people
 Due to IV drug use, men having sex with
men, prostitution, low condom usage
Prevention
Preventing STIs and AIDS
 If sexually active, you should get tested
 Have partner tested if in a sexual relationship
 Carefully choose partners
 Use barrier methods, such as condoms
 Avoid high-risk sexual behaviors if not in a
monogamous relationship
 Early detection & treatment is important
 Notify your sexual partners
 Talking about STIs – honesty & trust