Sexually Transmitted Infections Main Points

Pathogens Caused by virus – incurable, but treatable Human papilloma virus Herpes Human immunodeficiency virus Hepatitis Caused by bacterium – curable and treatable Chlamydia Gonorrhea Syphilis

Pathogens Caused by protozoa Caused by multicellular parasites Trichomoniasis Caused by multicellular parasites “Crabs” (pubic lice) Scabies (mites)

Incidence Estimated Differences in states’ reporting requirements HPV most common unreported STI (14 million per CDC) Chlamydia most common reported STI (1.5 million per CDC, 2015 data) One million new cases per day in world (WHO, 2016)

Symptoms Many cases are asymptomatic Symptoms in females may be more difficult to see General (burning during urination, itching) Specific (blisters vs warts)

Herpes Virus (incurable, treatable) Herpes Simplex 1 Associated more frequently with oral infections (“cold sore”) Herpes Simplex 1 can be found in genital region Herpes Simplex 2 Associated more frequently with genital infections Herpes Simplex 2 can be found in oral region

Cold Sore vs Canker Sore Cold sore: Herpes Simplex Usually visible outside of lip Blister-like May include a cluster of blisters Canker sore: not Herpes Simplex Usually visible inside of lip or cheek Caused by trauma, stress, nutrition imbalance, hormone shifts, others

Gonorrhea Bacterial infection (curable) 2016: news of antibiotic resistance Asymptomatic Burning during urination, bowel movement Abdominal, pelvic, anal pain, sore throat Vaginal, penile discharge

Gonorrhea

HPV – Human Papilloma Virus Virus (incurable, treatable) Asymptomatic Main symptom is warts In region of infection – penis, vagina, anus Vary in size Different from plantar warts Symptoms may also affect throat, tonsils Cervical, throat cancer risks

HPV – Human Papilloma Virus

Syphilis Bacterial infection (curable) Four stages, symptoms different for each Primary: chancre Secondary: rash Latent: often asymptomatic Tertiary: organ damage

Syphilis

Syphilis and History Tuskegee Moments in Civil Rights History Documentary – Deadly Deception (PBS, via YouTube) Guatemala Journeyman Pictures, “The Frightening Legacy of US Syphilis Experiments in Guatemala” (16:25) $1B U.S. lawsuit, 2015 (previous lawsuit dismissed) CNN report (3:00)

Complications Vulnerability to HIV transmission (sores) Pelvic inflammatory disease (chlamydia, gonorrhea) Nervous system, cardiovascular system (syphilis) Infertility (PID; urethra stricture in men) Cancer (HPV)

Women & STI Complications Women are more vulnerable to STI complications Internal vs external anatomy Less likely to experience symptoms May confuse STI discharge with normal discharge Women may not see symptoms as easily Pelvic inflammatory disease STIs may be passed to newborn babies

Complications: Gonorrhea If infection spreads to uterus/fallopian tubes, pelvic inflammatory disease can develop Pain (mild to severe) Fever Infertility Epididymitis (swelling of epididymis in the testicle) Drugs.com features an illustration of epididymitis If infection not treated, it may spread to the bloodstream “Disseminated Gonococcal Infection” (DGI) Pain & swelling in tendons, joints Skin rash: red spots may contain pus Resistance to antibiotic treatment (see CNN September 2016 story)

Complications: Syphilis Complications of untreated syphilis are seen in the tertiary stage Bone pain Hearing loss Vision loss Dementia Incontinence Impotence Heart attack Stroke Numbness Sensitive photos available at the CDC Antibiotics can cure syphilis, but cannot undo complication damage Antibiotic resistance has occurred outside the U.S. (Samuel Sarmiento, NBC News, 9/2/16)

Testing Web-based resource via CDC Local: Planned Parenthood of Greater Northwest King County Public Health