Ms. Markowski Texas Woman’s University STDs & STIs Ms. Markowski Texas Woman’s University

What do you know? What is a STI? List any STIs you can think of: What symptoms do people with STIs have? How do people get a STI? Who gets a STI? How can people know if they have a STI? How can people avoid or prevent STIs?

http://www.plannedparenthood.org/health-topics/stds-hiv-safer-sex-101.htm

Teen STI Statistics STIs and STDs are used interchangeably (I = infection, D = disease) Teens and young adults (14-25) are more likely than other age groups to have multiple sex partners and to engage in unprotected sex. Therefore, this age group has the HIGHEST rate of STIs (SIECUS, 2005). Most won’t know they have an STI because the most common symptom of STIs is having NO SYMPTOMS at all & most don’t get tested  but it doesn’t mean you aren’t sick; you just can’t see or feel it always Rate of new infections for Herpes & HPV is highest during the late teens and early twenties 50% of young people will become infected with an STI by age 25. 65-75% of ALL sexually active men and women will get either herpes or HPV infections in their lifetime

Fluids & Behaviors that Transmit STIs Contact with of blood, semen, vaginal fluid & with HIV, Breast milk Behaviors: Unprotected oral, anal or vaginal sex Blood to blood contact (fighting, accidents, needles)

How can we PREVENT STIs? Abstinence Get Tested (how often?) Be monogamous (one partner at a time; easier to keep track & most people like it that way  ) Use Condoms (barrier) EVERY TIME & EVERY ORIFICE!

Bacterial v. Viral STIs Bacterial: Virus: Living organism ANTIBIOTICS treat it once infected Examples Chlamydia Gonorrhea Syphilis Bacterial Vaginosis Pelvic Inflammatory Disease (PID) Virus: Non-living, need a host (our bodies are the host) NO CURE, but vaccines for HPV & Hepatitis to prevent Examples: HPV (genital warts) HIV (AIDS) Herpes Hepatitis B & C

Chlamydia Most common Bacterial STI Bacterial, so re-infection is likely if untreated and Person has more unprotected sex Symptoms: few, commonly no symptoms burning sensation with urination (men) Whitish discharge from vagina/penis All these vague symptoms are ignored by some or thought to be temporary issues not related to STIs Long Term Effects: (Women) Pelvic Inflammatory Disease (PID), ectopic (tubal) pregnancy, and infertility (Men): swelling and pain in testes, infertility Transmission: Contact with semen, vaginal fluid, anus or mouth; rarely through vaginal childbirth which would be serious eye or lung infections for newborn Treatment: Antibiotics as soon as possible

Chlamydia discharge (looks very similar to pre ejaculate fluid, but comes out when not erect)

Gonorrhea (aka “the clap”) Common Bacterial STI Re-infection is likely if untreated and infected person has more unprotected sex Symptoms: few, commonly no symptoms Frequent, persistent sore throat Burning sensation with urination (men) Green discharge from vagina/penis Long Term Effects: (Women) Pelvic Inflammatory Disease (PID), ectopic preg., and infertility (Men): swelling and pain in testes, infertility Transmission: Contact with semen, vaginal fluid, anus or mouth; rarely through vaginal childbirth which would be serious eye or lung infections for newborn Treatment: Antibiotics as soon as possible

Gonorrhea (greenish discharge coming out of urethra of penis) Drips Gonorrhea (greenish discharge coming out of urethra of penis) Source: Florida STD/HIV Prevention Training Center

Syphilis Bacterial Infection that has 3 distinct stages Symptoms: Primary Stage: Chancre at entry site Secondary Stage: Skin rash up to 180 days after chancre disappears Latent Stage: “Hidden Stage” when there are symptoms but the bacteria is doing internal damage 4. Late stage: Rash/chancre disappear then it can cause severe brain/joint disease Long Term Effects: Blindness, brain & heart damage, psychosis or death Transmission: Contact with semen, vaginal fluid, anus or mouth; rarely through vaginal childbirth & to cause blindness, meningitis or death in infant Treatment: Antibiotics as soon as possible

Syphilis (1st stage chancre)

Bacterial Vaginosis (aka BV) Bacterial STI involving an imbalance of the natural bacteria in the vagina by not using condoms during sex or new or multiple partners Symptoms: (obviously only in women) few, commonly no symptoms Thin, off-white discharge from vagina which may have a foul odor (less thick discharge than a yeast infection) Long Term Effects: Increases risk of getting other STIs Transmission: Contact with semen, vaginal fluid, anus or mouth; rarely through vaginal childbirth which would be serious eye or lung infections for newborn Treatment: Antibiotics as soon as possible

Yeast infections Treatment: Symptoms: (obviously only in women) Fungal infection involving the overgrowth of yeast normally living in mouth, vagina, scrotum & feet. Symptoms: (obviously only in women) Redness, burning, Itching, thick whitish or yellowish discharge, sore/itchy around area of infection Also known as jock itch, athletes foot, thrush and yeast infection Transmission & Causes: Contact with infected genitals or fluids Caused usually by STRESS, antibiotics without taking acidophillis. sweaty workout wear, damp bathing suit, scented pads, or rarely, sex with certain partners Treatment: Antifungal medications (see next slide for examples)

Yeast infection treatments (active ingredient same for all 3 but price differs)

Pubic Lice (aka “crabs”) Parasitic infection Found on any pubic hair, including legs, armpit, moustache, beard, or eyebrows Symptoms: itching, redness, visible lice Transmission: Any Contact with other’s pubic hair or Contact with infected bedding/ towels, or clothes Treatment: Lice-killing shampoo, shave hair if possible wash all clothes, bedding, towels

Human Papilloma Virus (HPV) (genital warts) Most common Viral STI in America, even in teens Symptoms: Generally no early symptoms 1-8 months later, warts appear in contact area of infection usually on mouth, throat, genitals or anus Long Term Effects: Warts, most common cause of Cancer of throat, anus, cervix, penis Usually burning or itching near the warts Transmission: Contact with penis, vagina, anus, or mouth (either the fluid or the wart itself) Treatment: Try to lazer or freeze (cryotherapy) visible warts (they usually reappear) **Guardasil is a vaccine to prevent but not treat HPV

HPV VACCINE (Gardasil) The vaccine Gardasil®, protects against 4 HPV types, which together cause 70% of cervical cancers & 90% of genital warts. The FDA licensed this vaccine for use in girls/women, ages 9-26. It is also recommended by for boys at age 11-26 years old. The vaccination of boys is also likely to benefit girls by reducing the spread of HPV viruses. The vaccine is given in a series of three shots over a six month period.

HPV Penile Warts HPV and Cervical Cancer Source: Cincinnati STD/HIV Prevention Training Center

HPV Cervical Warts & Thigh Source: Cincinnati STD/HIV Prevention Training Center

Genital Herpes Viral infection caused by herpes simplex I or II infections Symptoms: sores or blisters on or around genitals/rectum, mouth or eye (wherever the virus entered the body) Flu-like symptoms, fever, swollen glands Sores come and go for the rest of your life, especially with stress and last from 2 days to 4 weeks Long Term Consequences: Reoccurring infections (painful), infants born to infected moms can lead to encephalitis, jaundice, or other infections Transmission: Contact with semen, vaginal fluid, anus or active viruses in mouth/saliva Can spread without visible sore and transmits oral to genital and vice versa Treatment: (no cure) Anti-viral Rx meds, or over the counter (OTC) medicines lik eLysine, Abreva, Novitra, Herpacin, all help symptoms

Herpes

Genital Herpes Simplex in Females Sores Source: Centers for Disease Control and Prevention

Pelvic Inflammatory Disease (PID) Infection of a woman's pelvic organs including uterus, fallopian tubes and cervix Symptoms: none, mild to severe pain in abdomen, pain with sex, fever, irregular periods Transmission: Caused from Bacteria found in two common (STIs) gonorrhea and chlamydia Long term issues: Commonly causes sterility if left untreated! Risk factors: Have had an STI (especially if left untreated for 3+ months) Being under 25 and having sex Having more than one sex partner Using douches can push bacteria into the uterus, ovaries, and tubes, causing infection.

PID Healthy

HIV & AIDS How it works: Transmitted through 4 fluids & methods  Human Immunodeficiency Virus Acquired Immuno-Deficiency Syndrome Transmitted through 4 fluids & methods  vaginal secretions, semen blood breast milk Does NOT transmit through air or surfaces How it works: HIV targets T helper cells of the Immune System T-helpers Recognize diseases (virus, bacteria, fungus, parasite, etc) and initiate an immune attack Destruction of T-cells will make an immune response less and less effective and increase vulnerability to sickness over time

Get tested for HIV!!! Symptoms: Most people have none right away, some people get flu- like symptoms that eventually go away for years until HIV becomes AIDS If you have ever come into contact with someone else’s blood, semen, vaginal fluid or breast milk, GET TESTED for HIV You must ask specifically for an HIV test Most accurate tests are about 3 months after suspected exposure for accuracy it takes time to HIV to target, reproduce and kill enough T helper cells to show up in blood work 3 out of 4 people who are HIV positive DO NOT TELL their partners because they have no idea they have the virus!

When does HIV become AIDS? 1. When T Helper Cell count lowers to below 200, a person is considered to have AIDS. (normal: 1,000)‏ OR 2. Having 1 or more opportunistic infections - such as pneumonia, flu, cold, cancer Time for transition to AIDS diagnosis varies by person and access to Rx drugs: 5%: die after 3 yrs 20%: 5 years 40%: 10 or more years 35%: 20 years or more (this is as much as we know since mid-80s) GET TESTED with each new exposure to these fluids!!

Treatment for HIV Rx Anti-retroviral drugs Recommend 3 or more meds from at least 2 different classes to interrupt virus replication That’s at least 6 medication a day, multiple times a day for the rest of your life! If don’t stick to the meds, it will cause HIV resistance, which makes it more lethal Identification: oral swab, takes 20 minutes 4 classes of drugs to treat the disease If don’t stick to them, will cause resistance Post Exposure Prophylaxis (PEP_: highly effective anti retroviral drugs Up to 72 hours post exposure, really toxic to body, but can prevent infection

Historical Perspective 1926-46: HIV spreads from monkeys to humans through eating monkey meat (similar to how we eat deer) In 1981, cases of a rare cancer began affecting young healthy gay men in NY and San Francisco (700 deaths in first year)‏ 1982: GRID immerges as name; then later changed to “4H label” 1987: 150,000 cases of HIV worldwide (40,000 deaths) 1990: 1 million living with HIV/AIDS worldwide 2000: 21 million have died, 30 million currently living with virus To Date: At least 30 million people have died of AIDS 40 million living with the virus 16,000 new infections every day 110 new infections in US every day 8,000 deaths a day worldwide

Specific ways to prevent ANY STD/STI Abstinence from oral, vaginal and anal sex Using a condom EVERY TIME during any sex type any exchange of bodily fluids (semen, vaginal secretions, blood) transmits infections Get Yourself Tested (GYT) and your partner too How often: every new partner or new fluid exchange! As always, avoid Alcohol and other Drugs Making sexual decisions is hard enough without the influence of mind-altering drugs

Adolescent Condom Use According to the Youth Risk Behavior Surveillance (2014): Among currently sexually active students, 57.9% reported using condoms during last intercourse 73% reported having had intercourse at least once without a condom Very few use a condom with oral sex, which explains the increase in mouth cancer

Protect yourself! Remember: you only have ONE body and ONE life Use condoms EVERY time and get TESTED Every time you switch partners! Be safe, be smart, be healthy!

Resources: C.D.C., (2005). Human Papillomavirus (HPV) and Cervical Cancer: An Update on Prevention Strategies Script. Retrieved October 6, 2005 from http://www.cdc.gov/std/HPV/HPVscript.pdf Grunbaum, J., Kann, L., Kinchen, S., Williams, B., Gross, J., Lowry, R., & Kolbe, L. (2002). Youth Risk Behavior Surveillance (YRBS)-United States, 2001, Morbidity and Mortality Weekly Report, 51, 1-64. SIECUS., (2005). The truth about STDs. Retrieved October 5, 2005 from http://www.siecus.org/pubs/fact/fact0019.html SIECUS., (2005). The truth about adolescent sexuality. Retrieved October 5, 2005 from http://www.siecus.org/pubs/fact/fact0020.html