Transcript STD 411 - Shoreline

STD 411
STD 411
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Good information on prevention in FLASH curriculum
Focus on pathophysiology (changes resulting from
disease).
Anyone who is sexually active can become infected with
any STI/STD. Some groups have higher incidences for a
variety of reasons (prevention education, risk factors,
behavior, etc.), but the diseases don’t discriminate. STI’s
continue to circulate in the population because of basic
ignorance and taboo. We could go a long way toward
eliminating (or at least vastly reducing) infections by
providing education and kicking the taboos.
Having any STI can make you more susceptible to
another STI/STD. Many are transmitted concurrently.
STD 411
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We will cover the following STI/STDs
 Chlamydia
 Gonorrhea
 Syphilis
 Trichomoniasis
 HSV
 HIV
 HPV
Chlamydia
http://visualsonline.cancer.gov/details.cfm?imageid=2331
Chlamydia
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Most frequently reported STD in the United
States. Does that mean the most common? Not
necessarily. It is the most widely tested STD, but
Trichomonas may be the most common, just not
as widely tested.
Easiest STI to treat. One dose of azithromycin
and test for cure (or reinfection) after 3 months.
No sign of drug resistance in the population
(good news).
Chlamydia
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Microbe description
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Chlamydia trachomatis bacteria – obligate intracellular pathogen
which means that it must live inside of the cells.
Several variants of the bacteria cause lymphogranuloma
venarium (LGV). This is a more invasive form of chlamydia that
invades the lymph system and causes widespread and
permanent damage.
Pathophysiology
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Infection in the conjunctiva (eye) is the leading cause of
blindness in infants.
Symptoms may develop in only 30% of those infected. Because
of this, it is referred to as a “silent” infection. The ONLY way to
know if you are infected is via laboratory testing (unless you
have never had any sort of sexual contact).
Chlamydia
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Men
Proctitis (inflammation of the colon and anus) – rectal bleeding,
discharge, pain
 Urethritis (inflammation of the urethra) – painful urination, discharge,
sometimes testicular pain and pelvic tenderness
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Women
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Proctitis (inflammation of the colon and anus) – same as in men
Urethritis (inflammation of the urethra) – painful urination, discharge
Cervicitis (inflammation of the cervix) – abnormal bleeding and
discharge, pelvic pain, may lead to pelvic inflammatory disease (PID),
chronic pain, infertility
***REMEMBER*** Most infected individuals never experience
symptoms. Only laboratory testing can confirm the presence or
absence of an infection.
Gonorrhea
Joe Miller/CDC
Gonorrhea
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Emerging problems with drug resistance. Some
strains are resistant to all but one drug. One
strain is resistant to all treatments. The current
treatment regimen from the CDC includes more
than one antibiotic at a time to deliver a 1,2
punch to the bacteria.
As with chlamydia, most men and women don’t
have symptoms, or symptoms are so mild they
are mistaken for another infection such as a UTI.
Gonorrhea
Gonorrhea
Gonorrhea
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Microbe description
gonorrhoeae – bacteria that infects
the mucous membranes of the reproductive
tracts of men and women. Can also infect
anus, throat, and eyes. Commonly called
gonococcus (GC) and “the Clap”.
 Neisseria
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Anyone know why it’s called “the Clap”?
Gonorrhea
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Pathophysiology
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Men – when symptoms are present, they may include discharge
(greenish/yellowish), painful urination, and testicular pain. If left
untreated, systemic dissemination may occur known as
disseminated gonococcal infection (DGI). This can cause
arthritis, dermatitis, and even death.
Women – many women won’t have symptoms, or symptoms so
mild they mistake it for a yeast infection or a urinary tract
infection. As with chlamydia, gonorrhea can lead to PID, chronic
pain, and infertility. Systemic dissemination (DGI) is also a
possibility if left untreated.
Syphilis
CDC
Syphilis
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Probably the most historically infamous STD. It was
thought that this bacteria was brought back to Europe by
the crew that went with Christopher Columbus to the
“new world”. However, there is evidence that syphilis
may have been present in ancient Greece, but not much
solid evidence yet.
Sometimes called “The Great Pretender” because the
symptoms are so similar to other diseases.
For a good and cringe-worthy depiction of late-stage
syphilis, watch Johnny Depp in “The Libertine”. This is a
movie based on the infamous John Wilmot, 2nd Earl of
Rochester and member of the court of Charles II.
Syphilis
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Microbe description
pallidum bacteria – spirochete that enters
the body through the skin and invades the blood
stream and sometimes the nervous system.
 Treponema
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Pathophysiology
 Men
and women experience similar symptoms.
Syphilis infection is divided into three stages: Primary,
secondary, and latent/late.
Syphilis
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Primary stage – This stage begins with a single sore
called a chancre. This is a non-painful sore that appears
at the site of infection, usually the genitals. Sometimes
the chancre can go unnoticed if it appears inside of the
vagina or the anus. The chancre will go away without
treatment in about 3-6 weeks, but the bacteria will
remain and the disease will progress to the second
stage. The primary stage is the infectious stage. Since
the bacteria are transferred via the chancre, any sexual
partners are at risk of infection.
Syphilis
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Secondary stage – This stage is defined by a
rash that can appear anywhere, but the bottoms
of the hands and feet are usually affected. This
rash is non-itchy, reddish-brown, and rough.
Other symptoms may include fever, swollen
lymph nodes, sore throat, and weight loss.
(Sound familiar?) The chancre is usually gone at
this point, but can still be healing when the rash
appears.
Syphilis
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Latent/late stage – When the rash disappears, the
latent/late stage begins. All symptoms disappear. This
can last for many, many years and may cause someone
to not seek treatment. The treponemal bacteria are still
present, though, and about 15% of infected individuals
will progress to late stage syphilis in 10-20 years after
infection. This is when things get dangerous. The
bacteria invade and destroy the internal organs including
the brain, liver, kidneys, vessels, heart, etc. Muscle
coordination, sight, and cognitive processes are affected.
If treated, the infection will be cleared, but the damage
remains. If left untreated, death is inevitable.
Syphilis
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Neurosyphilis – at any stage of infection, the
bacteria can invade the nervous system and cause
neurosyphilis. This results in movement disorders
similar to Parkinson’s and Huntington’s as well as
personality changes and mood disorders.
Syphilis
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Famous cases of syphilis
 Al
Capone
 John Batman, founder of Melbourne, AU
 Napolean Bonaparte (suspected)
 Cesare Borgia (suspected)
 Paul Gauguin
Trichomoniasis
CDC
Trichomoniasis
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Possibly the most widespread STI, but without widespread testing it
is difficult to know the true numbers. Testing problems?
More women infected than men. Why? Testing? Symptoms?
One of the few STIs that infect more older women than younger
women.
Vast majority of men and women who are infected do not have
recognizable symptoms. According to the CDC, 70% of infected
individuals have no symptoms.
Treatment is simple. A single dose of an antibiotic that is effective
against this parasite.
Trichomoniasis
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Microbe description
vaginalis – single-celled
protozoan parasite. Can be passed from
penis to vagina, vagina to penis, vagina to
vagina. Normally limited to genital infection
without spread to throat, anus, etc.
 Trichomonas
Trichomoniasis
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Pathophysiology
Men – infection of the penis can cause inflammation with pain on
urination and ejaculation. Testing is not commonly done because of the
limitations of testing. New tests make it much easier with NAAT, but not
yet widely available.
 Women – infection can affect the cervix, vagina, and urethra and cause
inflammation with burning and itching of the genitals. Upon examination,
a GYN may notice “strawberry” speckling on the cervix. Testing is
mainly done with a wet mount and microscopic observation of the
parasite. New NAAT testing makes testing easier and more sensitive.
Failure to treat the infection can lead to complications for a fetus
including low birth weight and prematurity.
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Men & women – symptoms can make sex painful and unpleasant.
Herpes Simplex Virus (HSV)
Transmission electron micrograph (TEM)
http://phil.cdc.gov/PHIL_Images/08301998/00014/B82-0474_lores.jpg
Herpes Simplex Virus (HSV)
One of the few STIs that cannot be cured.
Because of this, it is very common in the
population.
 Though it can’t be cured, it can be
managed with medication and avoidance
of sex during outbreaks.
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HSV
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Microbe description
& HSV-2 – Virus. Most know type 1 as
oral herpes and type 2 as genital herpes.
However, both types can infect both regions.
Type 1 is increasing in genital infections
because of the mistaken belief that
unprotected oral sex is completely safe.
 HSV-1
HSV
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Pathophysiology
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Both men and women experience ulcerations at the site of infection. The ulcers
are usually small blisters that break open after a couple of days and leave
painful, itchy sores that can last for days to weeks. Sometimes, the outbreak can
be a mild rash that is mistaken for heat rash or dermatitis. The first outbreak is
generally the most severe with accompanying fever, swollen lymph nodes, and
body aches. The first year of infection generally sees the most recurrent
outbreaks. Medication can prevent or decrease the amount of outbreaks and
viral shedding.
 In rare cases, the virus can travel backwards and into the central nervous system
causing damage to nervous and brain tissue.
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More on viral shedding: The virus can shed even in the absence of a visible
outbreak. An infected person can still pass on the infection when they don’t
have any active sores. Medication can greatly reduce the probability of viral
transfer by preventing the virus from replicating.
HSV
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Pathophysiology (cont.)
 Men – Infection can cause shame and social stigma.
 Women – In addition to the shame and social stigma,
HSV infection can cause pregnancy and childbirth
complications. Infection that occurs during pregnancy
has a higher probability of transferring to the fetus
with fatal consequences. Medication is advised for
pregnant women who have a history of herpes
infection. If there are signs of an outbreak during
delivery, a cesarean delivery is advised to reduce the
risk of transmission during birth.
Human papillomavirus (HPV)
Laboratory of Tumor Virus Biology
Human papillomavirus (HPV)
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Most common STD. It is so common that most
people will contract it at some point during their
sexual lives. Many infections clear up by
themselves (around 90% according to the CDC).
Causes complications ranging from genital warts
to cancers. Different strains cause different
symptoms. The strains that cause warts do not
cause cancer and vice versa.
HPV
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Microbe description
papillomavirus – more than 40 strains
that infect humans.
 Two vaccines, Cervarix and Gardasil,
available to prevent the most common HPV
strains which cause cancer and warts.
 Human
HPV
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HPV (the virus): Approximately 79 million Americans are currently infected with HPV. About 14
million people become newly infected each year. HPV is so common that nearly all sexually-active
men and women will get at least one type of HPV at some point in their lives.
Genital warts: About 360,000 persons in the U.S. get genital warts each year.
Cervical cancer: About 10,300 women in the U.S. get cervical cancer each year.
Other cancers that can be caused by HPV, including some vaginal, vulvar, penile, anal, and
oropharyngeal cancers: Each year in the U.S., HPV is thought to cause an estimated
2,100 vulvar cancers,
500 vaginal cancers,
600 penile cancers,
2,800 anal cancers in women,
1,500 anal cancers in men,
1,700 oropharyngeal cancers in women,* and
6,700 oropharyngeal cancers in men.*
*Note: Other factors, notably tobacco and alcohol use, may also play a role with HPV to cause
these cancers.
About 21,000 of these cancers are potentially preventable by HPV vaccines.
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http://www.cdc.gov/std/hpv/stdfact-hpv.htm
HIV
colored scanning electron micrograph of a T4 cell (green) infected with HIV (red).
© NIBSC/Science Photo Library
HIV
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Not going to cover this too extensively because there are a couple of
classes in the FLASH curriculum devoted to it.
Though not technically an STD (it’s a blood-borne pathogen), the majority of
worldwide infections are by sexual contact…..specifically heterosexual
contact.
Women are more susceptible to infection due to physiological differences.
HIV is generally considered a manageable chronic condition instead of the
death sentence it used to be. However, most people don’t consider the
side-effects of the treatments. Skin conditions, cognitive problems,
headaches, digestive problems, etc. are common with antiretroviral
medications.
Resistant strains are becoming more common and could become more
widespread.
Transmission rates are increasing. Why?
HIV
David Kirby 1990, Ohio – by Therese Frare
Questions?
Resources
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http://www.cdc.gov/std/
http://www.doh.wa.gov/YouandYourFamily/Illnes
sandDisease/SexuallyTransmittedDisease.aspx
http://www.kingcounty.gov/healthservices/health/
communicable/std.aspx
http://sexetc.org/sex-ed/infocenter/stories/?topic=stories-hiv-aids-stds