Transcript Psychology 3533 Understanding Human Sexuality

Chapter 8:
Sexually Transmitted
Infections
“Ryan”
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23 year old requests “STD
tests”
Multiple partners 15+
Worried about recent
sexual encounter with
unprotected intercourse
Visited prostitute in
Thailand few months ago
No symptoms, except
+++worry!
Has had 2 partners since
unprotected incidents
“Sarah”
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18 year old student
Binge drinking weekend
past and “cannot
remember anything”
Woke up with no
underwear in parking lot
of mall and worried that
she might have been
assaulted
Worried about
pregnancy and STDs
“Paul” and “Phillip”
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22 and 26 year old
students
Starting new
relationship and
want a “clean bill
of health” before
engaging in
intercourse
No symptoms;
very conscious of
HIV/AIDS
Objectives
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Review STD’s as an intimate human problem,
afffecting not only the sufferer, but partner(s),
and conceptus
Discuss common symptoms and signs of STDs
Discuss what happens during visit with family
doctor
Review common STDs
Advice on safer sex
Psychological Consequences
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Diagnosis of a chronic disease is trying on patients
 Embarrassment
 Feeling like sexual leper
 Shame, guilt, anger
 Depression/Anxiety may develop
 Relationship problems, rejection
 Accusations of infidelity by partner
 Alterations in sexual behaviour
 Loss of sexual freedom/spontaneity
 Negative sexual self image
 Loss of libido
 Increased masturbation (“no risk”)
Pathogens of the Human Genital
Tract
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Sexually transmitted diseases
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Chlamydia
Gonorrhea
Herpes
Human papilloma virus (HPV)
Lymphogranuloma venereum
Chancroid
Syphillis
Pediculosis pubis (“crabs”)
Blood borne infections
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HIV/AIDS
Hepatitis B and C
Chapter 8: STIs
Prevalence? (total # of people affected):
difficult to know
 Bacterial or viral diseases that are sexually
transmitted through genital/oral/anal
contact but also other conduits
 Bacterial STIs:
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can be cured if caught early
 Viral:
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can NOT be cured
Chapter 8: STIs
 Difference
between most common
reportable STI and most common STI
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not all STIs are required to be reported
 Many
if not most (depending on disease
and gender) are ASYMPTOMATIC
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So: can transmit unknowingly
Chapter 8: STIs
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Most Common:
 HPV human papilloma virus (warts), not
reportable
 HPV:
 over 150 different strains
 transmitted not only sexually but by skin to
skin in genital, oral and anal contact
 cauliflower-like warts in vulva, vagina, penis,
pubic area and anus but can be asymptomatic
 leads to cervical cancer; recently vulvar
precancerous growths, especially women
over 40 (e.g. labia, clitoris)
Chapter 8: STIs
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HPV: (Cont’d)
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oral cancer : increase of oral sex
oropharyngeal cancer (mouth and throat) associated with HPV
in the oral cavity. Far fewer oral sex partners result in increased
cancer risk than with genital partners, rivaling oral cancers due
to tobacco and alcohol
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can cause penile and anal cancer
100 MUN female students a year have
precancerous changes due to HPV
birth control pill interaction
• hormones in contraceptive promotes changes in
cervical cells that make it more vulnerable
(squamous cells)
Chapter 8: STIs
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HPV (Cont’d):
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smoking interaction:
• nicotine metabolites increase cervical cancer risk
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early sex (13-15) is a risk factor (more likely to have more
partners)
multiple partners, also a risk factor, including multiple
partners of partner
effect of alcohol and drugs:
• weaken immune system, impair judgment of risk
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condoms not very effective in protecting against HPV:
• warts can be in areas other than penis or vagina, e.g. pubic
area, anus
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no cure
it’s estimated that 85% of sexually active people have it,
but strong immune system can fight it off
Chapter 8: STIs
HPV (Cont’d):
 A new vaccine for HPV prevention is
available since July ’06
Gardasil (contraindication: yeast allergy)
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the vaccine prevents four strains of HPV, which
happen to be the ones that most commonly
(70%) cause cervical cancer. The
recommendation is to vaccinate girls between
ges 9 and 14, before they become sexually
active. Girls chosen due to cervical cancer risk.
Health Canada approved it for boys and men
ages 9-26, in February 2010.
HPV causes oral cancer in men via oral sex,
rivaling oral cancers due to tobacco and alcohol.
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About 40% of college students have HPV at any
given time
Worldwide distribution
Incubation period 6 weeks to 12 months
Lifelong infection
Asymptomatic shedding
Most infections cause no symptoms
Lesions clear in 2 years w/o treatment
 Cervical
cancer is
(partially) infectious
disease!
 new vaccination
prevention strategy
Chapter 8: STIs
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Chlamydia:
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± 400 per 100,000 depending on location
• 600 female
• 200 male
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most common reportable STI in Canada
very high incidence
more in women, but less reporting from men
age 15-24 women highest rate
75% women asymptomatic until it spreads to uterus
damage to:
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cervix
uterus
fallopian tubes
peritoneum
liver
Chapter 8: STIs
 Chlamydia
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(Cont’d):
can cause:
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PID
tubal blockage
ectopic pregnancies
infertility
prematurity and low birth weight in infants of
affected mothers
 Females:
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Cervicitis
Salpingitis
Bartholinitis
Urethritis
Hepatitis
Proctitis
Chapter 8: STIs
 Chlamydia
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males:
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(Cont’d):
50% asymptomatic
50% have urethral discharge
burning urination
epididymitis
infertility
Reiter’s syndrome (conjunctivitis and arthritis)
if having anal sex:
• proctitis and proctocolitis
• 50% of chlamydia patients also have gonorrhea
Chlamydia
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C.trachomatis, intracellular
pathogen, not a virus, not a
regular bacterium
Affects only humans
Tropic to specific epithelial
cells
Most common STD
 3-5% of college students
 Highest incidence in
urban women 15-24
years old
 All time high incidence in
Canada 179 per 100 000
in 2002
 522 cases in NL (2002)
C. trachomatis also
causes other
illnesses:
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Conjunctivits
 There
are other
species of chlamydia
that cause trachoma
and pneumonia
 Pelvic
inflammatory
disease is a
devastating
complication of
chlamydial infection
 Can lead to
infertility, sepsis
LYMPHOGRANULOMA (LGV)
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So far mostly men/men
Same type as chlamydia
Much more invasive
Through oral, vaginal, anal sex
Treatable with antibiotics
Symptoms (3-30 days): vaginal painless sore in
initial phase
 Low grade fever
 Fatigue
 Muscle and joint aches
Chapter 8: STIs
 Genital
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Herpes:
± 25% incidence (not reportable)
 Caused
by herpes simplex virus, Type I
(cold sores) and Type II – both cause the
STI
 2010 study: HSV I more common in
genital infections in university students
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Can be transmitted through kissing, oral,
genital or anal sex
Chapter 8: STIs
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Most are asymptomatic:
 if symptomatic: small, painful blisters on
genitals
 also, fever, painful urination, headaches,
vaginal and urethral discharge, enlarged
lymph nodes
 oral HSV also includes malaise, muscle
aches, lesions in the soft palate, tongue,
gums, lips and face
(rash)
(blisters on fingers,
itchy/painful)
Chapter 8: STIs
Genital Herpes (Cont’d):
 These symptoms last 3 weeks, then virus goes
dormant, but still contagious. Genital herpes
lodges at base of spinal cord, while oral herpes
infects top of spinal cord and base of brain.
Symptoms may recur randomly.
 Children of mothers with GH Type II have higher
rates of schizophrenia or other psychoses.
Correlational data. N = 3,000
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Chapter 8: STIs
Genital Herpes (Cont’d):
 Pregnant women can transfer to fetus, can lead
to fatal brain infection even if no genital blisters
present at the delivery  C-section
recommended.
 Correlation between HSV I and cognitive deficits
in offspring.
 No cure, some antiviral drugs lessen severity of
symptoms and shorten the outbreak but always
contagious.
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Chapter 8: STIs
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Long term: can lead to meningitis, narrowed urethra
UTIs, increased HIV infection, genital scarring,
encephalitis (fatal), ocular herpes (from rubbing
eyes after touching blisters elsewhere)
No cure and always contagious
Recently, a gel developed to protect women from
HIV proved effective in protecting against herpes
(51%)
The virus can survive several hours on toilet seats
Vaccine being tested
Gonorrhea
 Gonococcus
 Only
affects humans
 Worldwide distribution
 Most affected groups:
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Females 15-24
Males 20-29
cases in NL (2002)
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Incubation period: 2-7 days
Period of communicability: months
for untreated patients, treatment
ends infectiousness within hours
Complications include:
 Disseminated gonococcemia
 Arthritis
 Endocarditis
 Meningitis
Treatment
Antibiotics
Chapter 8: STIs
 Hepatitis:
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± 3 per 100,000
Viral disease of the liver.
 Types
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A, B, C, D, E.
Type B most common STI.
Next is Type C.
Hepatitis B
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Worldwide
Incubation:
1-6 months
 Infectious
through
body fluids
 Symptoms
due to liver
dysfunction,
hepatitis,
cirrhosis
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Hepatoma
(liver
tumour) is a
result of
HCV
infection
 First cancer
to have
“vaccine”
Chapter 8: STIs
Hepatitis (Cont’d):
 Hep B:
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Symptoms:
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Through blood, saliva, semen, vaginal secretion,
other body fluids, IV drugs, piercing, tatoos.
Enlarged liver, fever, fatigue, jaundice, vomiting. But
some asymptomatic. No cure, can lead to liver
degeneration and death.
Liver cirrhosis, cancer:
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Second leading cause of cancer world-wide (after
smoking).
But – there is a vaccine: prevention.
 200 times more common than HIV.
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Chapter 8: STIs
 Hepatitis
 Hep
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(Cont’d):
C:
Can also lead to liver cirrhosis and cancer of
the liver. Found in users of IV drugs, nasal
coke, tattoos and piercings. Also
contaminated water.
Recent increase in incidence (2011 data)
Chapter 8: STIs
 HIV:
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Human Immunodeficiency Virus
 HIV/AIDS:
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By 2007 almost 80,000 in Canada reported
cases.
67% had died. But now a chronic illness
thanks to medications.
 AIDS:
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Acquired Immune Deficiency Syndrome
• Estimate (2009): 65,000 Canadians live with HIV.
One third not aware.
• Worldwide: 40 million have HIV (estimate)
Chapter 8: STIs
 AIDS
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(Cont’d):
Transmission:
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body fluids (not saliva)
sex (penis/vagina or penis/anus)
contaminated blood
hypodermic needles
during pregnancy and childbirth
 Condoms
87% effective for HIV
 No cure but effective treatments make it a
chronic illness
 Recent studies: health problems of
HIV/AIDS patients in middle/old age
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HIV damages the immune
system, particularly CD4 cells
 Results in decreased
immunological defences
 AIDS patients get sick from
pathogens that are ubiquitous
in environment and cause no
problem in people with healthy
immune systems
 Candida
 Pneumocystis
 Cytomegalovirus
 Increased “opportunistic”
infections and increased
development of cancers
 Kaposi sarcoma
Chapter 8: STIs
 TRICHOMONIASIS:
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caused by neither bacterium nor virus, but by:
Trichomonas vaginalis:
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single cell protozoan, a parasite that attaches
to vaginal cells.
transmitted mostly through sex, but the
organism can survive for some time on toilet
seats and other surfaces.
more common in women, very widespread
(8,000,000 in North America, 170 million
worldwide).
Chapter 8: STIs
TRICHOMONIASIS (Cont’d):
 Men are asymptomatic, 50% women have
symptoms:
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Can cause:
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vaginal itch
smelly (fishy), frothy vaginal discharge
PID
increased female vulnerability to HIV
people with HIV transmit it more easily if they have
trichomoniasis
in pregnancy, premature birth and/or low birth weight
in fertility
Treatment: Yes
Chapter 8: STIs
SYPHILLIS
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Bacterial infection: curable
Making a comeback in several parts of the world, including
Canada. Men/men sex higher.
Early symptom: chancre, a round lesion in the genitals,
painless. Harder to see in women: This is the primary
stage.
If through oral sex it appears in oral areas. It disappears but
the disease continues.
Secondary stage: body rash, not itchy or painful. Also “goes
away”  latent stage, could last years or the rest of the
person’s life.
Tertiary stage: about 50% get there
CNS: insanity, paralysis
CVS: death
Pregnant woman can infect fetus
How do I prevent STD’s?
Education about STD’s
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Open discussion
 Increase knowledge
about STD risks and
transmission
 Start young
Selective
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Promiscuity is a
risk factor
More sexual
partners = more
risk
Communication
Get tested
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Rule out asymptomatic
disease
Condoms
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No glove, no love
Doesn’t protect against all
STD’s (eg. Herpes and Wart
virus are not prevented by
condoms)
Intoxicants
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Drug and alcohol abuse is a risk factor
Intoxication = mistakes of judgment, unintended
intercourse, assault, mistakes in contraceptive use
Chapter 8: STIs
Safe Sex vs. safER sex
 Two monogamous people who have
tested negative for STIs or have
never had any sexual contact before.
 Issue of trust.
Safe Sex
(Safer sex)