Transcript for the Spread of STIs

Sexually Transmitted Infections
(STIs)
Dr. Assad Rahhal
National AIDS Program
Infections—Generally Speaking
 What are they?
• Overgrowths of bacteria, viruses, fungus (yeast), or protozoal
pathogens
 How are they spread?
• Inhalation of infected air, contact with infected body fluids, contact
with infected skin (rashes, lesions)
 How can they be prevented?
• Avoiding contact with infected air, fluids, and skin
Sexually Transmissible Infections (STIs)
 Also known as
• Sexually Transmitted Diseases (STDs)
• Venereal Diseases
 What are your risks?
Sexually Transmissible Infections
 Bacterial Infections
• Chlamydia
• Gonorrhea
• Syphilis
 Viral Infections
• Herpes
• Hepatitis B
• Molluscum contagiosum
• HIV
• Human papillomavirus
Common STIs
 Human Papillomavirus (HPV) (virus)
• Warts on genitals and anus (men and women)
• Warts and pre-cancers on cervix (women)
• Often asymptomatic, presenting no visible symptoms
• Communicable or non-communicable when asymptomatic
 Chlamydia (bacteria)
• Infected cervix, tubes, epididymis
• Sometimes no symptoms at all
Common STIs
 Herpes (HSV I & II) (virus)
• Painful ulcers
• Often no symptoms at all
 Molluscum Contagiosum (virus)
• Pimple-like lesions
• Often confused with pimples or folliculitis
“Risky Contact” for the Spread of STIs
 You don’t have to have sexual intercourse to contract an STI
• Many STIs are spread by direct skin contact
• Everyone who has “risky contact” is at risk
• Teens and young adults are more “at risk” than other populations
“Risky Contact” for the Spread of STIs
 Condoms do NOT completely protect from infections spread by
skin contact, because they do not cover all infected areas of the
skin
HPV
Herpes
Molluscum
Infection with these organisms does not require penetration
during intercourse if there is other “risky contact.”
“Risky Contact” for the Spread of STIs
 Avoid “risky contact,” which is any contact with skin or fluids
that may contain the viruses and bacteria that cause STIs
 Don’t share intimate apparel such as swimwear or underwear
Who gets STIs?
 Anyone who has “risky contact” with a person with an STI
 One contact might be all it takes to get an STI
 The more contacts, the greater the risk
STI Prevention
 Abstinence works best
• Avoid genital touching
• Many teens and young adults are now choosing abstinence
• Abstinence reflects feelings of self worth and self esteem
• Not everyone is “doing it”
• Sexual activity is NOT a requirement for friendship or social
acceptance
The Most Prevalent STIs
Chlamydia
 Women: infects urethra, cervix
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•
•
•
Often no symptoms
Sometimes pain with urination or lower abdominal pain
Infection can spread to tubes and ovaries
Can cause infertility
 Men: infects urethra, epididymis
• Can cause pain with urination
• Swelling and pain of the testicles
Spread by body fluids
Semen
Vaginal
Anal
Epididymitis due to Chlamydia - the swelling of this
infection is seen above the right testicle
Hydrosalpinx resulting from Chlamydia - closed,
swollen and water-filled left tube in a young woman
The Most Prevalent STIs
Genital herpes
 Men and women: genital skin
• Extremely painful lesions
• Often no symptoms
 Women: cervix
• Abnormal vaginal discharge
• Often no symptoms
• May infect newborns during delivery
Spread by skin contact
Genital-Genital
Hand-Genital
Oral-Genital
Penis with vesicles (blisters) from genital herpes
External genital skin of female with herpes ulcers
The Most Prevalent STIs
 Molluscum
• Can appear anywhere on the skin
• Bumps that look like pimples
• Can become infected with bacteria
Spread by body skin contact
Genital-Genital
Hand-Genital
Oral-Genital
Molluscums of lower abdomen
External genital skin of female with huge molluscums
Human Papillomavirus (HPV)
 Over 100 types of HPV
• More than 20 types of HPV can infect genital skin
• Men and women: genital and anal warts
• Women: lesions on the cervix and vagina
Spread by skin contact
Genital-Genital
Hand-Genital
Oral-Genital
Human Papillomavirus (HPV)
 HPV: Genital Warts
• Men and women: external genital skin, anus, in urethra
• Women: cervix, vaginal walls
• Condoms offer some protection, but don’t cover all of the skin that
can be infected
Papillary genital warts of female
Papillary genital warts of female
Flat genital warts of male
Papillary genital warts of male
Papillary genital warts of male
Papillary genital warts of male anus
HPV and Pre-Cancers
 Cervix and anus: some HPV types cause lesions that can
be pre-cancers
• If not treated, they can eventually become cancers
 The Pap smear detects lesions on cervix
• Cells scraped from cervix are examined under a microscope
• If they have ever had sexual contact, women need yearly Paps
Genital warts on cervix of female
Pre-cancer changes on cervix
If you think you have an STI
 See a health care professional
 Be honest about your sexual behavior
 Ask for explanations
 If you do have an STI, notify your partner
Remember: Abstinence works best
 Avoid genital touching
 Many teens and young adults are choosing abstinence for now
 Abstinence reflects feelings of self worth and self esteem
 Not everyone is “doing it”
 Sexual activity is NOT a requirement for friendship or social
acceptance
STI Prevention
 Alcohol and Drugs contribute to becoming infected with an STI
 Combined with sexual activity, the use of alcohol and other
drugs is strongly associated with:
• Sexual activity when you are not really ready
• The spread of STIs
• Unwanted/unplanned pregnancy
The Connection Between STDs and HIV
Three Main Points
 There is a causal link between infection with STDs and increased
transmission of HIV
 Preventing and treating STDs will reduce the number of new
HIV infections
 You can make a difference by helping people prevent, identify
and treat STDs
What is the STD-HIV Connection?
 Similar behaviors put people at risk of both STDs and HIV
 A current STD can increase risk of getting HIV by 2-5 times
 People with both HIV infection and another STD have increased
HIV viral loads and can more easily infect others with HIV
 People with HIV can have more serious complications of other
STDs
Many STDs Have No Symptoms
 In women: over 50% with gonorrhea and 70% with Chlamydia
had no symptoms
 In men: 68-92% with gonorrhea and 92% with Chlamydia
reported no symptoms
Epidemiologic Evidence
 Researchers have observed a strong association between having
STDs and HIV in a number of studies.
 The association is termed “epidemiological synergy”
 2-5 fold increased risk for HIV infection among persons who
have other STDs.
Why the Increased Risk
 Ulcers and inflamed areas provide an easy portal of entry
 STDs attract T-helper cells to the infected area
 Even asymptomatic STDs can cause abnormal cellular changes
that allow easier passage of infectious agents.
 Some STDs increase viral load and shedding of HIV
Recommendations
 Use condoms with all new sexual partners
 Reduce the number of new sexual partners
 Identify and treat new STDs
 Know that most STDs do not produce symptoms
 People already infected with HIV should be screened routinely
for STDs
American College Health Association
Recommendations (Continued)
 Regular screening for those at risk of STDs
• Those particularly at risk: sexually active young adults, especially
those with multiple partners, those who exchange sex for drugs or
money, and young men who have sex with men
 Easy access for all to STD care and treatment
 Education that douching (vaginal or anal) may increase the risk
of acquiring HIV or another STD
American College Health Association
Conclusions
 There is a direct link between other STDs and HIV transmission
 Early identification and treatment of STDs will reduce HIV
transmission
 You can make a difference by helping people know these facts
and working with those at risk to get screened and treated
American College Health Association
Thank You
HPV Treatments
Treatments for External Genital Warts
 Patient-applied prescription remedies
• Aldara™ (imiquimod) Cream, 5%
• Condylox™ gel 0.5% (podofilox)
 Procedures performed in the doctor’s office
• Freezing–cryoprobe or liquid nitrogen
• Caustic chemicals–TCA, BCA, podophyllin
• Laser
HPV—Treatments of the Cervix and Anus
 Cervix: destruction of lesion by freezing, laser, loop excision
• These treatments are about 90% successful
 Anus: similar to external genital warts
• Aldara™, Condylox™, freezing, caustic chemicals, laser
HPV Protection
 Consistent condom use can cut down, but not eliminate, the
transmission of HPV
 Many HPV-associated lesions resolve spontaneously, but they
may return
 Warts can be treated and removed, but the virus may remain in
latent form
 See your health care provider for an accurate diagnosis and
appropriate treatment
Testing for STIs
 There is no single test that detects all STIs
 No test is perfect (every test can fail to detect an infection)
 Screening tests (used when no symptoms are present)
• HPV (visual examination; Pap smear tests the cervix only)
• Chlamydia, gonorrhea (tests of genital secretions or urine)
• HIV, syphilis (specific blood tests)
• There is no reliable test for herpes when symptoms are absent