Transcript Sexually Transmitted Infections/Diseases

Sexually Transmitted
Infections/Diseases

STD rates are 50-100 times higher in the US than
any other industrialized nation, with an estimated
20 million new cases and 30,000 deaths each year
from unsafe sexual behavior.
 62% of adverse health events effect women. More
than 100,000 women become infertile each year as
a result of PID. Cervical cancer was the leading
cause of sex-related mortality for women,
followed by HIV.
 Men suffer the majority of deaths (60 + %),
primarily from HIV.
Transmission

A. Any oral or genital contact
• B. Contaminated body fluids (blood, semen,
vaginal fluids, saliva, breast milk, mucous
membranes, other)
• C. Skin to skin contact
• D. Contact with contaminated objects
(bedding, towels, toilet seats, clothing, etc.)
Chlamydia

Most common bacterial STD in US
(Chlamydia trachomatis).
 3 million new cases each year.
 Highest rates of infection are in 15 – 19
year olds. It is estimated that 1 in 15
sexually active females aged 14-19 years
has chlamydia.
 Costs about $ 2 billion annually.
Symptoms

75% of women and 50% of men have no
symptoms.
 1 to 3 weeks after exposure there may be
discharge, painful urination, pelvic pain,
bleeding between periods, sore throat or
conjunctivitis.
Diagnosis & Treatment

Several tests available (urine, swab, etc.)
 Treated with antibiotics.
 Both partners should be treated and then
retested 3-4 months later due to the high
rates of reinfection.
Complications

40 + % of untreated women develop PID,
which can lead to chronic pelvic pain,
infertility and ectopic pregnancy. (100,000
women each year become infertile due to
PID)
 Cystitis (bladder infection)
 Prostatitis and epididymitis may cause
painful swelling, scarring or infertility in
men.
Drips
Pelvic Inflammatory Disease
Source: Cincinnati STD/HIV Prevention Training Center
Drips
C. trachomatis Infection (PID)
Normal Human
Fallopian Tube Tissue
PID Infection
Source: Patton, D.L. University of Washington, Seattle, Washington
Complications
 Reiter’s
syndrome – arthritis, redness
of the eyes & urinary tract problems.
 Can cause conjunctivitis, blindness,
pneumonia and death in infants.
 HIV link – 5 times more likely to
become infected, also more contagious.
Drips
Normal Cervix
Source: Claire E. Stevens, Seattle STD/HIV Prevention Training Center
Drips
Chlamydia Cervicitis
Source: St. Louis STD/HIV Prevention Training Center
Herpes

Contagious viral infection
 (HSV-1 & HSV-2)

45 million cases (1 out of 5 ages 12 +)
 776,000 new cases each year
•HSV-2 more common in women - 1 in 4
Symptoms

Many people do NOT have symptoms
 HSV-1 usually causes mouth sores, but can
infect genitals
 HSV-2 usually causes genital sores, but can
infect the mouth
•Sores can appear on other body parts where
broken skin has come into contact with HSV
•Transfer to the eye is particularly dangerous
Symptoms

Typically, blisters appear around genitals,
rectum, buttocks and thighs within 2 weeks
•Blisters break, leaving tender ulcers that
may take 2 – 4 weeks to heal
•May also have flu-like symptoms,
including fever and swollen glands
•Most experience 5 outbreaks the first year
Diagnosis & Treatment

Visual diagnosis or blood test
•No cure, but antiviral medications may
shorten and/or minimize outbreaks
Complications

Proctitis (inflammation of the rectum)
•Herpes keratitis (possible blindness)
•Potentially fatal infection and/or brain
damage in newborns (a C-section may
be necessary)
•HIV link – more susceptible and more
infectious
Sores
Genital Herpes Simplex
Source: Diepgen TL, Yihune G et al. Dermatology Online Atlas
Herpes
Herpes in a Man
Source: Cincinnati STD/HIV Prevention Training Center
Sores
Genital Herpes Simplex
Source: CDC/NCHSTP/Division of STD, STD Clinical Slides
Herpes
Herpes in a Woman
Source: CDC/NCHSTP/Division of STD,
STD Clinical Slides
Source: Cincinnati STD/HIV Prevention Training Ce
Sores
Genital Herpes Simplex in
Females
Source: Centers for Disease Control and Prevention
Sores
Genital Herpes Simplex
Source: Florida STD/HIV Prevention Training Center
Herpes
You can get herpes anywhere
...
Source: Cincinnati STD/HIV Prevention Training Center
Gonorrhea (* NGU *)

A bacterial infection (Neisseria
gonorrhoeae) that thrives in warm moist
environments such as the reproductive tract,
urethra, mouth, throat, eyes and anus
 Sometimes called “clap”
 321,849 cases reported to CDC in 2011
 An estimated 800,000 new cases each year
Symptoms
1 – 14 days after contact men may have a burning
sensation when urinating or a white, yellow or
green discharge and/or swollen testicles.
 Most women are asymptomatic. Some may
experience burning when urinating, increased
vaginal discharge, or bleeding between periods.
 Rectal infections may cause discharge, itching,
soreness, bleeding or painful bowel movements
 If not treated, gonorrhea can also spread to the
blood or joints and can be life-threatening.

Diagnosis & Treatment

Swab/Culture is used to diagnose
 Historically, penicillin has been used to
treat gonorrhea, but antibiotic resistant
strains have emerged
Complications






Epididymitis – A painful swelling of the testicles
that can lead to infertility.
Salpingitis – Inflammation and scarring of the
fallopian tubes which may be resolved in ectopic
pregnancy and/or sterility.
A major cause of PID, which can lead to chronic
pelvic pain, ectopic pregnancy and infertility.
Reiter’s syndrome - Arthritis
Eye infections and pneumonia in newborns
HIV link – Increased susceptibility and
infectiousness
Drips
Gonorrhea
Source: Florida STD/HIV Prevention Training Center
Gonorrhea
Swollen or Tender Testicles
(Epididymitis)
Source: Health Awareness Connection, http://www.healthac.org/images.html
Gonorrhea
Disseminated Gonococcal
(Gonorrhea) Infection
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides
Gonorrhea
Bartholin’s Abscess
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides
Hepatitis

A viral inflammation of the liver
 Of the 200,000 new HBV infections each year,
approximately half are sexually transmitted.
 There are 5 major types of hepatitis:
–
–
–
–
–
Hepatitis A (HAV) - Acute
Hepatitis B (HBV) – Severe complications
Hepatitis C (HCV) - Chronic
Hepatitis D (HDV) – Only present with HBV
Hepatitis E (HEV)’
Symptoms

Liver cells are damaged and scar tissue is
formed.
 Jaundice, chronic fatigue, and flu-like
symptoms.
Diagnosis & Treatment

A blood test is used to diagnose.
 HAV and HBV vaccines exists (prevention)
 There is no cure for hepatitis. Treatment
includes bed rest, a healthy diet, and
avoidance of alcohol. Iterferon alpha
(protein) may also be used with HBV and
HCV.
Complications

Cirrhosis, liver carcinoma, liver failure and
possible death.
Syphilis

Bacterial infection (Treponema pallidum),
known as the “pox” and/or “the great
imitator”
 Around 56,000 new cases annually
•46,042 cases reported in 2011 (rates are
increasing, especially among MSM – 72%)
Symptoms
 1st Stage/Primary – a chancre (sore) appears
after 10 to 90 days (lasts 3 – 6 weeks)
•2nd Stage/Secondary – 2 - 6 months later a
red non itchy rash appears. Other symptoms
include fever, swollen glands, headache,
hair loss, muscle aches and fatigue.
•3rd Stage/Latent – 2 plus years later
internal organs are damaged (brain, nerves,
eyes, heart, liver, bones/joints). Other
symptoms include paralysis, blindness,
dementia, insanity, and death.
Diagnosis & Treatment

Visual diagnosis and/or blood tests
 Easy to cure in the early stages. A single
intramuscular injection of penicillin if
infected less than a year, otherwise
additional doses are needed.
 Cannot treat or cure 3rd/latent stage.
Complications

Birth defects (neurological problems),
stillbirth and/or death soon after birth.
 HIV link– 2 to 5-fold increased risk of
acquiring HIV.
Sores
Primary Syphilis Chancre
Source: Florida STD/HIV Prevention Training Center
Sores
Primary Syphilis
Source: Centers for Disease Control and Prevention
Sores
Secondary Syphilis Rash
Source: Cincinnati STD/HIV Prevention Training Center
Sores
Secondary Syphilis
Source: Diepgen TL, Yihune G et al. Dermatology Online Atlas
Syphilis
Secondary Syphilis Body
Rash
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Sores
Secondary Syphilis Rash
Source: Cincinnati STD/HIV Prevention Training Center
Sores
Secondary Syphilis –
Condylomata Lata
Source: Florida STD/HIV Prevention Training Center
Syphilis
Late Stage Syphilis
Ulcerating Gumma
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
HIV

The virus that causes AIDS. It
compromises the immune system.
 Originated in monkeys in Africa. Hunters
may have become exposed to contaminated
blood.
 First human blood sample in 1959.
 Around 900,000 cases in the US.
Symptoms

Lowered helper T-cell count.
 Thrush, fatigue, night sweats, weight loss,
recurrent fever, skin rashes, diarrhea and
opportunistic infections, such as Kaposi’s
sarcoma and Pneumocystis carinii
pneumonia.
Diagnosis & Treatment

Blood tests can detect the presence of
antibodies. T-cell count and the occurrence
of opportunistic infections are also
considered.
 No cure, antiviral drugs help manage
symptoms.
 Other conditions/infections are treated.
Complications

Reoccurring infections & chronic
conditions such as cancer.
 Death.
Crabs

Pubic lice is an infestation of crab-like
parasites that attach themselves to pubic
hair or other course body hair.
 While they need blood to survive, they can
live for 24 hours off the human body.
 There are an estimated 3 million cases each
year.
Symptoms

Intense itching, about 5 days after
infestation.
 Dark or bluish spots as the result of the
bites, and/or pin head blood spots in
underwear.
Diagnosis & Treatment

Crabs and/or nits are often visible.
 Medicated creams and shampoos are used.
 All clothing and bedding needs to be
laundered (water 130 + degrees, 20 min. in
hot dryer) and/or placed in a plastic bag for
2 weeks.
Complications

Usually just discomfort and inconvenience.
 Occasionally, secondary bacterial infections
occur due to excessive scratching.
HPV

Human papillomavirus is a group of more than
100 strains, 40 + of which are sexually
transmitted.
 At least 80 million people in the US already have
contagious genital HPV. There are about 14
million new cases each year.
 50% of sexually active men and women acquire
genital HPV. By age 50, 80% of women will have
acquired genital HPV.
Symptoms

Most people have no symptoms; around 360,000
people develop warts each year
 Warts appear as soft, moist, pink or flesh-colored
swellings, usually in/around the genital region,
anus or thighs and sometimes in the mouth or
throat. They can be flat or raised, single or
multiple, small or large, and sometimes
cauliflower shaped.
 The warts may appear within weeks, months, or
not at all. The most cancerous strains of HPV
don’t produce warts.
Diagnosis & Treatment

Warts are diagnosed visually. Vinegar may be
applied to improve visibility.
 Most women are diagnosed with HPV on the basis
on abnormal pap smears (pre-cancerous changes).
 No cure exists. Warts may be treated with creams,
acid, freezing, burning, lasers or surgery.
 Sometimes alpha interferon is injected directly
into warts that have returned, but this is very
expensive.
Complications

The major cause of cervical cancer (killing more
than 200,000 women around the world each year).
Around 12,000 cases in the US each year
 HPV also causes cancer of the anus, vulva, vagina,
penis and oropharynx (middle of the throat, soft
palate and base of tonsils).
 Urination may become difficult during pregnancy.
Warts make the vagina less elastic and cause
obstruction during delivery. Some infants develop
warts in their throats. This is a life threatening
condition requiring laser surgery.
 HIV link – increased susceptibility & infectiosness
HPV and Cervical Cancer
HPV Warts on the Thigh
Source: Cincinnati STD/HIV Prevention Training Center
HPV and Cervical Cancer
HPV Penile Warts
Source: Cincinnati STD/HIV Prevention Training Center
HPV
Genital Warts in a Woman
Source: CDC/NCHSTP/Division of STD, STD Clinical Slides
HPV and Cervical Cancer
Perianal Wart
Source: Cincinnati STD/HIV Prevention Training Center
Molluscum Contagiosum

A viral skin disease (MCV) causing small
lesions/bumps.
 Once primarily a childhood disease, it has
evolved into a STD in adults.
Symptoms

The incubation period is from 1 to 6 months after
contact.
 The lesions may begin as small bumps which can
develop over a period of several weeks into larger
sores/bumps. The lesions can be flesh colored,
gray-white, yellow or pink. They can cause itching
or tenderness. Lesions can last from 2 weeks to 4
years.
 In adults, lesions usually appear on the thighs,
buttocks, groin and lower abdomen.
Diagnosis & Treatment

Diagnosis is made visually or by examining
a sample from a lesion using a microscope.
 Most symptoms are self-resolving.
 Lesions can be surgically removed, treated
with chemicals or cryotherapy.
 Autoinoculation is common.
Complications

Often a progressive disease in those with
HIV.
Vaginitis

Trichomoniasis is caused by a single-celled
protozoan parasite (Trichomonas vaginalis).
 7.4 million new cases each year.
 Bacterial Vaginosis is the most common
vaginal infection in women of childbearing
years (commonly called a “yeast”
infection).
Symptoms
Imbalance between “good” and “bad” bacteria in
the vagina. (In BV, this can result from douching,
new/multiple sex partners, IUD, antibiotics,
tight/damp clothing or poor diet).
 Abnormal discharge with a strong, unpleasant
odor.
 Burning or itching during urination or intercourse.
 Symptoms usually occur within 5 to 28 days of
exposure.

Diagnosis & Treatment

Physical exam and lab tests of fluids are used for
diagnosis.
 Both partners should be treated with antibiotics.
 Women should wear cotton underwear, wipe front
to back, avoid douching, tight pants and panty
hose in hot weather.
 Men & women should wash carefully every day,
limit sexual partners and take antibiotics only
when necessary.
Complications

Increased risk for PID.
 Pregnancy complications, such as early
delivery and/or low birth weight (less than 5
pounds).
 Increased susceptibility to other STDs, such
as Chlamydia and Gonorrhea.
 HIV link – increased risks of infection and
transmission.