Sexually Transmitted
Diseases/Infections
Recent History
• In the first half of 20th
century, STI information:
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Fear driven
Military
Abstinence only
Men vs Women
• Changes in last 50 years
 Less on abstinence only
 More on safe sex practices
 Humor
Vintage Photos (eBaum’s World)
Vintage Photos (eBaum’s World)
Current Campaigns
Current Campaigns
Current Campaigns
• Alberta Health Video
Disclaimer, Warning, &
Support
• Incidence variation
 Per DOH: STIs comprise 75% of communicable
conditions reported in 2010
 State report requirements vary
• WA: chlamydia, gonorrhea, HIV, AIDS, syphilis, herpes,
hepatitis, chancroid, lymphogranuloma venereum, granuloma
inguinale (latter three are rare in US)
• OR: chlamydia, gonorrhea, HIV/AIDS, syphilis,
lymphogranuloma venereum, chancroid, hepatitis (all forms),
pelvic inflammatory disease
• ID: chlamydia, gonorrhea, syphilis, HIV/AIDS
Disclaimer, Warning, &
Support
• Graphic Graphics
• Where to get tested
• More testing sites, Seattle area
General Information
• 20 million new infections cost $16 billion in
•
medical costs (CDC, 2013)
Most STI’s are caused by viral or bacterial
infections
 Bacterial = usually curable
• Complications caused by bacterial infection may
be irreversible
•
 Viral = usually treatable, not curable
STI’s may be asymptomatic, esp. in women
General Information
• Transmission: vaginal sex, anal sex, oral sex
• Other
 Breastfeeding: per US HHS, OK if have chlamydia or
gonorrhea; syphilis and herpes = can transmit via
sores; HIV = can transmit; others = check with
physician
 Kissing: herpes, syphilis (outbreak), hepatitis B
 Injection drug users
 Mother to fetus: syphilis & HIV (about.com)
 Vaginal delivery: gonorrhea, chlamydia, hepatitis B,
herpes
Testing Information
Sexually Transmitted Infection
Test Used
Chlamydia
Swab of discharge, urine test, exam
Gonorrhea
Swab of discharge, urine test, exam
Herpes
Swab from cells, blood test
HIV
Blood test, swab from mouth
HPV
Physical exam for warts, pap exam for
women tests for cervical abnormalities
(no such test for men)
Syphilis
Blood test, sample from sore
Testing Information
Resources
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Avert.org
Planned Parenthood
Mayo Clinic
Iwannaknow.org
Chlamydia
About Chlamydia
• Among the most common STD’s seen in the US
 US: 1,412,791 cases in 2011 (CDC)
 WA State: 23,237 cases in 2011 (DOH)
 King County cases: 5946 in 2010
• 3906 women
• 2039 men
• Bacterial infection
• Chlamydia can be passed via oral, vaginal, anal sex
with an infected partner
Chlamydia Rates (CDC, 2011)
Chlamydia Prevalence by
State (CDC, 2011)
Chlamydia Rates by Age &
Sex, 2011 (CDC)
Chlamydia Rates by
Race/Ethnicity, 2002-2011
(CDC)
Chlamydia Symptoms
• Sometimes no symptoms are present
• Symptoms generally appear within three
weeks of infection
 Abnormal discharge (mucus, pus) from cervix,
penis
 Pain during urination
 Illustration
 Photos (Sexually Transmitted Disease Guide, 6 images)
 Santa Barbara Sociology
Chlamydia Treatment
• Antibiotics
 Take all medication
• Communicate with all sex partners
• Sexual intercourse should be avoided until
treatment plan is finished
• Condoms can help prevent the spread of
chlamydia
Chlamydia Complications
• Conjunctivitis in newborn (eye drops given)
• Reiter’s Disease (sensitive photos)
• Pelvic Inflammatory Disease (Illustration, MD guidelines.com)
 Infection
 Disease-causing organisms migrate to uterus, fallopian tubes,
ovaries
 Untreated, PID leads to scarring, pelvic pain, tubal pregnancy,
infertility
 Treatment includes antibiotics
 Approximately 1 million women affected each year
 Approximately 100,000 women become infertile each year
 Video clip (2:05 via medicalvideos.us)
Chlamydia Complications
• Epididymitis
 600,000 cases a year
 Inflammation of epididymis
• Tube located in back of testicle
• Holds maturing sperm
 Disease-causing microbe enters urethra, travels
 Symptoms include fever, pain, discharge, swelling
 Treatment includes antibiotics, STD treatment if
applicable
 Chronic epididymitis may threaten fertility (rare MayoClinic)
 Sensitive photos, (Seattle STD/AIDS Prevention Training Center)
Lymphogranuloma Venereum
Lymphogranuloma venereum
• From different chlamydia
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•
•
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bacteria
More prevalent in Asia,
Africa, South America, but
increasing in North
America; now required to be
reported in WA
Per DOH, one case in 2011
Painless pimple or lesion on
genitals
Infection spreads to lymph
tissue
Gonorrhea
About Gonorrhea
• Incidence
 US: 321,849 cases reported to CDC in 2011
 WA State: 2,730 cases in 2011
 King County:
• 1570 reported cases in 2010
• 404 in women, 1166 in men
• Bacterial infection
• Gonorrhea can be passed via vaginal, oral, anal
intercourse, mother to child (vaginal delivery)
Gonorrhea Rates, 1941-2011
(CDC)
Gonorrhea Rates by State,
2011 (CDC)
Gonorrhea Rates by Age &
Sex, 2011 (CDC)
Gonorrhea Rates by Race,
Ethnicity, 2002-2011 (CDC)
Gonorrhea Symptoms
• Symptoms usually appear within 10 days of contact
with infected partner
 Some cases are asymptomatic
• Among women: bleeding/pain during intercourse,
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vaginal discharge, burning during urination
Among men: pus-like discharge from penis, burning
during urination, swollen testicles
Anal infection: burning, itching, fresh blood in feces;
painful bowel movements
University of California – Santa Barbara
Illustration
Photos (Sexually Transmitted Diseases Guide)
Gonorrhea Treatment
• Antibiotics
 Take all medication
• Communicate with all sex partners regarding
•
•
infection
Refrain from sexual activity until infection is gone
Condoms can help prevent the spread of
gonorrhea
Gonorrhea Complications
• Gonorrhea passed to newborns during delivery
 Antibiotic eyedrops
• PID
• Epididymitis
• Rarely, gonorrhea may spread bacteria to the
•
body, infecting blood, joints, heart
Those with gonorrhea are more susceptible to
HIV
Human Papillomavirus (HPV)
About HPV
• Incidence, Prevalence:
 Incidence numbers = new cases
 Prevalence numbers = those living with a condition
 Other interpretation = those who may experience a
condition at some point in their lives
 US: Several million a year new cases; 20-40 million
already infected (King County Public Health); 75-90% of
population may expect to have HPV at some point in their
lives
 No required reporting
 The most common STD
About HPV
• Virus; therefore, incurable
 A group of many viruses
 200+ strains
 40+ HPV forms can be sexually transmitted
(CDC)
• Transmission via vaginal, oral, anal sex
HPV Symptoms
• Sometimes HPV provides no symptoms
• Most common symptom is genital warts
 Appearing days, weeks or longer after
infection
 Less common among men
 Illustration
 Photos: common & plantar warts, men,
women , other images (OSU Student Health Services,
afraidtoask.com, MayoClinic.com, avert.org)
Physician Visits: Genital Warts, 19662011 (CDC)
STD Surveillance Network: Genital Warts
(CDC)
HPV Prevention & Treatment
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Genital warts may disappear on their own
Topical ointments/creams provided by physician
Freezing/burning/laser treatments for smaller warts
Communicate with all sex partners regarding HPV
Refrain from sexual activity until warts are gone
Condoms may help prevent HPV transmission (less
definite than other conditions)
HPV Complication: Cancer
• Approximately 30 of the HPV strains are
thought to cause cervical cancer
 HPV-16, HPV-18 thought to cause the most
cervical cancer cases (Gardasil specific to these,
also strains HPV-6, HPV-11, which are
associated with warts )
 WHO/ICO Information Centre: world statistics
 Women should have regular pap tests
• HPV may also increase risk of vulvar, anal,
penile, and oral cancers (ABC News, January 2012, 3:28)
HPV Prevalence, High- and Low-Risk,
Among Females 14-59, 2003-2006
HPV Vaccines
• Vaccines for several HPV strains
 HPV Vaccine Safety (Dr. Mona, FOX News, 4:56)
 Gardasil
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FDA approved for males & females, age 9-26 yrs
3 injections across 6 months
Protects against four high-risk HPV types (6, 11, 16, 18)
Side effects (4:10; CNN, 2009, via YouTube)
 Cervarix (1:04; NHS, 2009, via YouTube)
• FDA approved for females, aged 10-25
• 3 injections
• Protects against HPV types 16, 18
Syphilis
Syphilis
About Syphilis
• Researchers tracing origins (CBC, 5:03)
• Incidence
 US: 13,970 in 2011 (CDC)
• Top 13 states = 75% of cases per CDC
• Data by sex (males on the increase, females on the
decrease)
 King County: 329 early syphilis cases in 2011
• In 2010, 285 - men, 4 - women
 Over 90% among men (MSM)
• Source: 2009 King County STD Epidemiology Report
• Caused by bacteria, therefore curable
• Transmission via vaginal, oral, anal sex
Syphilis Rates, 1941-2011
(CDC)
Syphilis Rates by State, 2011
(CDC)
Early Syphilis Rates by Age
and Sex, 2011 (CDC)
Syphilis Symptoms
• Syphilis is a multi-stage disorder:
 Primary stage - painless, infectious chancre
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Several days-few months after infection
Genitals, mouth, rectum, other areas
Sometimes there is no chancre
Ulcer heals; many may think there is no problem
Illustration: male (MayoClinic)
Photos: oral, male, female, mix (CDC, Univ. of South Carolina
Integrated Biomedical Sciences; University of Quebec; Cincinnati STD/HIV Prevention
Training Center; istdpictures.com)
Syphilis Symptoms
 Secondary stage
 Infectious rash
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3-6 weeks following infection
Hands, soles of feet; other areas
Fever and flu-like symptoms may also be apparent
Rash typically heals after several weeks
More photos, including rash pix (Hardin Library, CDC)
 Condylomata Lata
• Wart-like lesions (on female, male, CDC)
Syphilis Symptoms
• Latent Stage
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Infection hides in body, often central nervous system
Infected person can remain in this stage for years
There may be no symptoms for a long time
Disease begins to attack organs
Latent further divided into early, late, or unknown
stages based on when infection occurred
• Late/Tertiary Stage
 Severe symptoms develop: paralysis/numbness;
blindness; heart disease; dementia
Syphilis Treatment
• Penicillin or other antibiotic
• Communicate with all sex partners regarding
•
•
syphilis
Refrain from sexual activity until infection is
gone
Condoms may help prevent syphilis
transmission
Syphilis Complications
• Late-stage syphilis
• If blood vessels affected,
stroke,other cardiovascular
incident may occur
• Nervous system (brain)
damage
• Al Capone
 Apparently knew, did not
treat
 Became confused,
disoriented
Syphilis
• PBS “Frontline:” The Children of Rockdale County
• Tuskegee Syphilis Experiment
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Began in 1930s
~400 African American males with syphilis observed
When penicillin became available, not provided
Ended in 1972 as a result of a news leak; settlement in
1974; Al Gore overview (1:35, usrf.org)
 Formal apology did not occur until 1997 (1:10, usrf.org)
 Over 100 individuals died from syphilis complications
 PBS “Nova” - “The Deadly Deception” (1:30-9:44/20:41/22:13/23:45/
26:39/31:08 via Youtube)
Syphilis
• Guatemala Experiment (3:07, NBC News)
 March 14, 2011 - lawsuit filed after demands for outof-court settlement were not met
 June 2012 – lawsuit dismissed in federal court
Herpes
About Herpes
• STD caused by the herpes simplex virus
• Incidence
 US: 500,000 to 1,000,000 new cases/year
 WA, 2011: 2149 new cases, 8 neonatal cases (DOH)
 King County: 700 initial infections in 2006
• Prevalence: 45 million adolescents and adults
•
•
have had “genital herpes” (CDC)
Caused by a Herpes Simplex I (HS-1) or Herpes
Simplex II virus (HS-2)
HS-1 generally causes oral lesions; HS-2
generally causes genital lesions; not exclusive
Genital Herpes, Physician Visits,
1966-2011
About Herpes
• Transmission via vaginal, oral, anal sex
• Transmission of virus can also occur through fingers
•
•
(touching a sore, then touching a membrane)
Transmission of virus possible when no sores present
Transmission to fetus possible, but not typically if herpes
was contracted before pregnancy
 If pregnant woman contracts herpes toward end of
pregnancy, transmission to fetus more likely
 If pregnant woman has active herpes, Cesarean
performed
• Transmission may occur outside body contact, but no
proof
Herpes Symptoms
• Most common symptom is blisters
 First (primary) outbreak occurs within a few
weeks of contact
 May continue for a couple weeks, longer for
those with compromised immune system
 May feel painful, itchy, tingle/burn
Herpes Symptoms
• Flu-like symptoms (headache, fever,
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swollen lymph glands, muscle aches, etc)
Burning during urination
About.com video (1:45)
Illustration (catalog.nucleusinc.com)
Photos: oral lesion, male, female (lib.uiowa.edu,
dermnet.com, www.stdservices.on.net)
Herpes Symptoms
• Many people (numbers difficult to estimate;
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some references cite 25-60%) asymptomatic
Recurring outbreaks usually less severe
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Episodes are shorter
Episodes become less frequent
50-80% (HS-1 vs HS-2) will experience recurrence
Asymptomatic shedding of virus less prevalent
Herpes Treatment
• No cure; herpes simplex remains in body for life
 2009 research revealed re HS-1
• Published in Nature Immunology
• A cellular combat process against HS-1 has been identified
 Infected cell can stimulate immune system to fight HS-1
 “Hidden” infected cells can show themselves when infectious
state thrives (low-grade fever)
• Information from work might be used to develop therapies
 HS-1, HIV, other viral infections
• Information from work might be used to keep virus hidden
Herpes Treatment
• Symptoms are treatable
 Antiretroviral medications, usually prescribed for genital
herpes, may also be prescribed for oral cold sores
 Supplements (lysine)
 Abreva
 Avoid touching sores
 Keep affected area clean
 Wash hands
 Communicate with all sex partners regarding herpes
 Refrain from sexual activity until outbreak is gone
 Condoms may help prevent herpes transmission (during
outbreak blisters are highly contagious)
Herpes Complications
• In otherwise healthy individuals, herpes
does not cause serious complications
• Among those with compromised immune
systems, herpes outbreaks can be very
severe, last a long time
• Having herpes increases one’s
vulnerability to HIV
HIV and AIDS
About HIV and AIDS
• Human Immunodeficiency Virus (HIV) causes
•
Acquired Immune Deficiency Syndrome
(AIDS)
Incidence:
 WA, 2011: 514 new cases (1/3 = later stage)
 King County - HIV: ~300-400 each year; AIDS:
~100-200; ~6,500 to 8,000 living with HIV (WA
State/Seattle-King County HIV/AIDS Epidemiology Report, 1st Half of 2011)
 US: 56,300 new HIV cases in 2006 (CDC,
presentation)
About HIV and AIDS
• Transmission via vaginal, oral, anal sex,
needle sharing, mother to infant, rarely via
blood transfusions or healthcare settings
 One 1990s incident of transmission between
infected health care worker (dentist) and five
patients
 Per CDC (2011), 57 cases of HIV transmission to
healthcare workers through 2001,with no cases
since 1999
About HIV and AIDS
• HIV not transmitted via:
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Toilet seats
Mosquito bites
Sharing eating utensils
Food
Shaking hands, hugging
Donating blood
• No scientific evidence HIV is transmitted
other ways
About HIV and AIDS
• Currently, HIV does not survive well in the
•
environment
HIV found in sweat, tears, saliva - but no
documentation of transmission
 2009: pre-chewed food thought to cause three HIV
transmission between caregivers and children
• Blood in saliva (bleeding gums)
• An issue where pre-chewing food for infants is common
(Africa)
• No known risk in the workplace, school, etc.
• AIDSinAfrica.com
• HIV and AIDS in the World (PBS)
HIV Symptoms
• Symptoms unreliable in diagnosing HIV
• First symptoms experienced may be flu-like
(fever, headache, muscle aches, fatigue, etc)
 Symptoms may occur days to weeks after infection
 Symptoms may last days or weeks
• Diagnosis requires testing for HIV antibodies
HIV Symptoms
• After early flu-like symptoms disappear:
 There may be no symptoms for a long time
 Virus replicates
• As HIV leads to AIDS:
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Boils, warts, herpes infections, skin rashes
Fatigue
Diarrhea
Frequent fevers
Yeast infections
Weight loss
HIV Treatment
• Medications provided as a “cocktail”
 Antiretroviral drugs interfere with HIV’s ability to reproduce
 Entry inhibitors may prevent HIV from entering a cell
 Reverse transcriptase inhibitors interfere with the
beginning of HIV’s reproductive cycle
 Protease inhibitors interfere with the end of HIV’s
reproductive cycle
 Integrase inhibitors interferes with HIV genetic material
moving into a CD4 cell, halting replication
• Research continues on vaccine
• Clinical trial results 2010 - antiretrovirals may
prevent HIV transmission
HIV Complications
• AIDS
 Status of HIV is monitored through CD4 count
and viral load every few months
 If HIV progresses, CD4 count reduces, viral
load increases
 Normal CD4 often referenced as 500-1000
 AIDS diagnosis requires CD4 of 200
 Low viral load ~40-500
 High viral load ~5,000-10,000 (can be higher)
AIDS Symptoms
• AIDS diagnosis includes specific white cell count
and diagnosis of one of over two dozen
opportunistic infections
• Nearly all organs are affected
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Respiratory problems
Seizures, lack of coordination
Confusion, forgetfulness
Gastrointestinal pain, cramping, vomiting
Weight loss
Fever
Severe diarrhea
HIV/AIDS Program, Seattle
• 400 Yesler Way, 3rd floor
• http://www.kingcounty.gov/healthservices
/health/communicable/hiv/about.aspx
• hivstd.info@metrokc.gov
• HIV & Testing resources:
http://www.hivtest.org/
Hepatitis
About Hepatitis
• Virus
• Types B, C, D often due to sexual
transmission
 Type B, WA State, 2011: 35 acute cases; 1100-1400
chronic cases (DOH)
 Type C, WA State, 2011: 41 acute cases; 5700 chronic
cases (DOH)
 Type D, WA State, 2011: no numbers reported, “rare”
Hepatitis Symptoms
Hepatitis Treatment
Hepatitis Complications