Sexually Transmitted Diseases & Pregnancy Jennifer Musante

Lesson Overview Make a chart/presentation: Std, signs, symptoms Fetal risk and newborn outcome Use the quiz as a discussion topics and go over answers as a group

Material Handouts Quiz Visual presentation

Lesson Objectives Students will be able to identify the risks involved with getting an STD Classify a number of STDs, the symptoms and prenatal effects How to prevent getting an STD How to obtain effective treatment should an infection arise

Sexually Transmitted Diseases (STDs) Sexually transmitted diseases are specific infections or syndromes transmitted primarily during sexual contact The consequences of an STD can be significantly more serious, even life threatening, for a woman and her baby if the woman becomes infected with an STD while pregnant More than 20 different diseases are recognized as being sexually transmitted Can anyone tell me what an STD is? What do you know about STDs? Spend no more than five minutes on this – can use a wipe board or poster board paper to write down answers

STD Facts Nineteen million new sexually transmitted infections (STIs) occur each year, almost half of them among young people ages 15 to 24 10,000 teens are infected by STIs per day, one every eight seconds One out of every four sexually active teens has an STD, and one in two sexually active youth will contract an STD by age 25 Read the facts out loud to group

Condoms can protect you from STDs? True and False Condoms can protect you from most STDs, but only if they’re used consistently and correctly. There are also some STDs that can be spread by contact with skin not covered by a condom.

I would know if my partner or I have a STD FALSE Many STDs have no symptoms and the only way to confirm infection is with testing

Only people with many sexual partners get STDs? FALSE While having many partners increases your risk for a STD, having sex one time with just one person can put you at risk for a STD Almost half of all new STD infections occur among young people between the ages of 15 and 24 Anyone who is sexually active is at risk for an STD, regardless of gender, race, social class, or sexual orientation. That said, teenagers and young adults acquire STDs more easily than older people. By age 25, half of sexually active adults get an STD. Having multiple sex partners also raises your risk.

Oral and anal sex are abstinent behaviors and do not transmit STDs? FALSE Some young people, including those who have had abstinence education, consider oral and anal sex to be abstinent behaviors and do not realize these behaviors present risks of STI transmission. Read the questions out loud and have students give there answers. Then give correct answer with the facts.

Can you get more than one sexual transmitted disease at a time? TRUE It is possible to have many STDs at one time. In fact, having one STD may make it more likely that a person will acquire more STDs. For example, the open sores from herpes creates a place for HIV to be transmitted.

STDs can be passed on from a pregnant women to her baby TRUE STDs can be passed from a pregnant women to her fetus, newborn, or infant before, during, or after birth Certain STDs such as syphilis are able to cross the placenta and infect the fetus-- potentially affecting fetal development Other sexually transmitted diseases including gonorrhea, chlamydia, hepatitis B, and genital herpes can be transmitted to the infant during vaginal delivery Women who are HIV positive can transmit the virus that causes AIDS to the fetus through the placenta during pregnancy or infection can occur during the process of birth. HIV can also be passed to an infants through breastfeeding by an infected mother

All types of sexually transmitted disease can be cured? FALSE Some STDs are viruses and therefore cannot be cured. There is no cure presently for Herpes, HIV/AIDS, or Genital Warts. Some STDs are treatable (to lesson pain and irritation with symptoms), but not curable.

Virgins can’t get STDs? FALSE Yes, they can. Many STDs spread through any type of sexual activity, including skin-to-skin contact and oral sex. This is especially true of STDs that produce genital lesions or sores.

Can STDs Come Back? FALSE Most STD treatments do not protect you from getting the same infection again. A course of drugs may cure gonorrhea, syphilis, chlamydia or trichomoniasis, but a new exposure can start a new infection. If you're partner is not treated, you can continue to pass infections back and forth. And if you're not taking the right precautions to protect yourself, you can be re-infected quickly or even pick up a second STD

Genital Warts (HPV)

Genital Warts (HPV – Human Papilloma virus) How is it spread? Signs & Symptoms: You don't have to have sex to get an STD. Skin-to-skin contact is enough to spread HPV, the virus family that causes genital warts. Some types cause warts and are usually harmless, but others may lead to cervical or anal cancer. Vaccines can protect against some of the most dangerous types Pink or flesh-colored warts that are raised, flat, or shaped like cauliflower. Often there are no symptoms Genital warts may be so tiny, you might not see them. The warts may look like: Flesh-colored spots that are raised or flat Growths that look like the top of a cauliflower In females, genital warts may be found: Inside the vagina or anus Outside the vagina or anus, or on nearby skin On the cervix inside the body In males, genital warts may be found on the: Penis Scrotum Groin area Thighs Inside or around the anus Genital warts may also occur on the Lips Mouth Tongue Throat Other symptoms are rare, but may include: Increased dampness in the genital area near the warts Increased vaginal discharge Genital itching Vaginal bleeding during or after sex

Genital Warts (HPV) Treatment Perinatal Genital warts is curable and must be treated by a doctor Genital warts may cause a number of problems during pregnancy. Sometimes they get larger during pregnancy, making it difficult to urinate. If the warts are in the vagina, they can make the vagina less elastic and cause obstruction during delivery Rarely, infants born to women with genital warts develop warts in their throats. The baby may need surgery to prevent airway obstruction Treatment may include: A skin treatment done in the doctor's office Prescription medicine that you apply at home several times per week Prescription medicines include: Imiquimod (Aldara) Podophyllin and podofilox (Condylox) Trichloroacetic acid (TCA) The warts may be removed with surgery, including: Cryosurgery Electrocauterization Laser therapy Surgical excision (cutting them out)

Crabs (Pubic Lice)

Crabs (Pubic Lice) How it is spread Signs & Symptoms "Crabs" is the common term for lice that set up shop in pubic hair. The term comes from the shape of the tiny parasites, which look very different from head or body lice. The creatures crawl from one person to another during close contact Intense itching, tiny eggs attached to pubic hair, or crawling lice Another sign of lice can be the blue-grayish marks left from crab bites on the thighs and pubic area

Crabs (Pubic Lice) Treatment Perinatal Pubic lice can be killed with over-the-counter lice-killing lotions No serious effects or complications, to the baby or mother If you're pregnant or breast-feeding you should notify your doctor or health care provider before using treatments. Since some medicated creams and shampoos used to eliminate crabs can potentially harm the fetus, and should be avoided. Some medicated crab treatments should be avoided during breastfeeding

Scabies

Scabies How it is spread Signs & Symptoms Scabies is an itchy infestation caused by a tiny mite that burrows into human skin to lay eggs. It is not always an STD, as it can spread through any skin-to-skin contact. But among young adults, the mites are often acquired during sex. Intense itching especially at night and a pimple-like rash. It may take 2-6 weeks for symptoms to appear.

Scabies Treatment Perinatal Scabies is treated with prescription mite-killing creams Before taking any medicines, it's always better to consult a health care provider Scabies is extremely contagious, and anyone at any age can get it — even if they're scrupulously clean. It often shows up in more than one family member or in groups of children in daycare

The Clap (Gonorrhea)

The Clap (Gonorrhea) Who it is spread Signs and Symptoms The most commonly reported disease along with chlamydia Gonorrhea spreads easily and can lead to infertility in both men and women, if untreated. Symptoms: Common symptoms are burning during urination and discharge, but often there are no early symptoms. Later, the infection may cause skin rashes or spread to the joints and blood. In Men: Discharge from the penis, swollen testicles In Women: Vaginal discharge, pelvic pain, spotting. Symptoms may be mild and are easily confused with a urinary tract or vaginal infection

The Clap (Gonorrhea) Treatment Perinatal Antibiotics stop the infection Untreated during pregnancy is associated with increased risk of PROM, Preterm birth, miscarriages, infection of the amniotic sac and fluid Newborns acquire the infection during passage through the infected cervix Gonorrhea in newborns most commonly affects the eyes, and babies may eventually go blind if left untreated. PROM -Premature rupture of membranes, also known as PROM, refers to when a pregnant women’s amniotic membrane, which surrounds the fetus, either bursts or suffers a hole to it. The amniotic membrane is an enclosed sac consisting of amniotic fluid, the fetus and the placenta. Amniotic fluid is important because it surrounds the fetus, protecting it from viruses and bacteria; it also allows the umbilical cord to float, providing the fetus with oxygen and nutrients. The membrane is also central to the development of the fetus’s lungs.

Syphilis

Syphilis How is it spread Signs & Symptoms Chronic infection – also known as “the great Pox” Transmitted by direct contact with skin lesions or blood, primarily through sexual intimacy, including kissing Can be passed to baby through pregnancy or by contact with a sore during birth The first sign is usually a firm, round, painless sore on the genitals or anus. The disease spreads through direct contact with this sore. Later there may be a rash on the soles, palms, or other parts of the body (seen here), as well as swollen glands, fever, hair loss, or fatigue. In the late stage, symptoms come from damage to organs such as the heart, brain, liver, nerves, and eyes

Syphilis Treatment Perinatal Most people don't notice the early symptoms of syphilis. Without treatment, it can lead to paralysis, blindness, and death. Syphilis can be cured with antibiotics. About 40 % of pregnant women with untreated early syphilis end up having a miscarriage, a stillbirth, or a baby who dies soon after birth. Syphilis also increases the risk of preterm birth and low birth weight Having syphilis makes you more susceptible to HIV if you're exposed to it, so if you test positive for syphilis, you should also be tested (or retested) for HIV and other STDs

Chlamydia

Chlamydia How it is spread Signs & Symptoms Chlamydia and gonorrheal infections are the two most prevalent sexually transmitted bacterial infections in the US today Can lead to infertility if left untreated It often goes unnoticed because symptoms are vague or absent. Chlamydia can also infect the rectum and throat Symptoms in Men: Burning and itching at the tip of the penis, discharge, painful urination Symptoms in Women: Vaginal itching, discharge that may have an odor, pain during sex, painful urination

Chlamydia Treatment Perinatal It clears up quickly with antibiotics. Women with Chlamydia infections have two to three times the risk of ectopic pregnancy During pregnancy , cervical chlamydial infection has been associated with premature labor, premature rupture of membranes, and preterm birth Ectopic pregnancy: a pregnancy that occurs outside the womb (uterus). It is a life-threatening condition to the mother. The baby (fetus) cannot survive. 

Herpes Simplex Virus Type 1 painful cold sore you get on your lip every now and then. Caused by a type of herpes virus called HSV-1. This virus is usually not an STD; it spreads easily among household members or through kissing. But it can be spread to the genitals through oral or genital contact with an infected person. Though there is no cure, drugs can shorten or prevent outbreaks.

Herpes Simplex Virus Type 2

Herpes Simplex Virus Type 2 How it is Spread Signs & Symptoms Most cases of genital herpes are caused by a virus called HSV-2. It's highly contagious and can spread through intercourse or direct contact with a herpes sore Fluid-filled blisters that form painful, crusted sores on the genitals, anus, thighs, or buttocks. Can spread to the lips through oral contact

Herpes Simplex Virus Type 2 Treatment Perinatal As with HSV-1, there is no cure. But antiviral drugs can make outbreaks less frequent and help clear up symptoms more quickly Can be passed to the infant during delivery Without treatment babies infected with herpes either die or suffer from damage to their nerves. A baby born with herpes can develop serious problems that may affect the brain, the skin, or the eyes

Hepatitis B

Hepatitis B How is it Spread Signs & Symptoms Hepatitis B is a stealthy virus that can cause severe liver damage It spreads through contact with blood and other body fluids People can be infected through sex, needle sharing, and at birth, as well as by sharing razors and toothbrushes. Symptoms: People may develop nausea, belly pain, dark urine, fatigue, and a yellowing of the skin or eyes with acute infection. Chronic infection can lead to liver cirrhosis and liver cancer. Many people have no symptoms for years.

Hepatitis B Treatment: Perinatal There is no cure, but drugs can keep the virus in check There's an effective vaccine to prevent hepatitis B hepatitis B infection should not cause any problems for you or your unborn baby during your pregnancy If left untreated your baby has a 95% chance of developing chronic hepatitis B

Trichomoniasis

Trichomoniasis How it is Spread Signs & Symptoms Trichomoniasis is caused by a parasite that spreads during sexual contact The Centers for Disease Control and Prevention (CDC) estimates that over 7 million people – including 124,000 pregnant women – become infected in the United States each year Men: Most men have no obvious symptoms. Some develop a mild discharge or slight burning during urination Women: Women may develop a yellow-green discharge with a strong odor, vaginal itching, or pain during sex or urination. Symptoms usually begin 5 to 28 days after acquiring the parasite

Trichomoniasis Treatment Perinatal It can be cured with prescription drugs associated with a higher risk of preterm birth, preterm premature rupture of the membranes (PPROM), and having a low-birth-weight baby (a baby weighing less than 5.5 pounds at birth) Trichomoniasis can also make you more susceptible to HIV if you're exposed to it PPROM: a condition in which the membrane rupture occurs before 37 weeks of pregnancy

Pelvic Inflammatory Disease Not an STD itself, pelvic inflammatory disease (PID) is a serious complication of untreated STDs, especially chlamydia and gonorrhea. It happens when bacteria spread to infect the uterus and other female reproductive organs. Prompt treatment is essential to prevent damage to a woman's fertility Signs and Symptoms: Lower abdominal pain, fever, unusual discharge, painful intercourse, painful urination, and spotting. There are often no warning signs

Preventing STDs The best ways to avoid getting an STD are to abstain from any sexual contact and be in a monogamous, long-term relationship with an uninfected partner. To reduce your odds of getting STDs: Ask your partner if he or she has an STD Ask partners to be tested before sexual activity Use condoms Avoid sexual activity if your partner has signs of an STD Be aware of symptoms and get regular checkups with your health care provider Discussion: How can you prevent getting an STD?

Limits of Condoms While condoms are effective in preventing the spread of some STDs, they are not perfect. Condoms are better at protecting against gonorrhea, chlamydia, HIV, and trichomoniasis. But they offer less protection against herpes, syphilis, and genital warts. These infections can spread through contact with skin lesions that are not covered by a condom. Finally, condoms offer virtually no protection against crabs and scabies

STDs and Pregnancy It is important for pregnant women to be checked for STDs. They can cause women to go into labor too early and may complicate delivery. Many STDs can be passed from mother to baby during pregnancy, childbirth, or after the baby is born. STDs effects on babies can include stillbirth, low birth weight, neurologic problems, blindness, liver disease, and serious infection. But there are treatments to minimize these risks. Treatment during pregnancy can cure some STDs and lower the risk of passing the infection to your baby

References "11 Facts About Teens and STIs." DoSomething.org. N.p., n.d. Web. 19 Oct. 2012.<http://www.dosomething.org/tipsandtools/11-facts-about-teens-and-stds>. Dickason, Elizabeth Jean, Bonnie Lang Silverman, and Judith A. Kaplan. Maternal-Infant Nursing Care. 3rd ed. Missouri: Mosby, 1998. Print. Center for disease control and Prevention. N.p., n.d. Web. 19 Oct. 2012. <http://www.cdc.gov/std/ pregnancy/stdfact-pregnancy.htm>. Medicinenet.com. N.p., n.d. Web. 19 Oct. 2012. <http://www.medicinenet.com/ stds_pictures_slideshow/article.htm>. http://www.dosomething.org/tipsandtools/11-facts-about-teens-and-stds http://www.cdc.gov/std/pregnancy/stdfact-pregnancy.htm http://www.medicinenet.com/stds_pictures_slideshow/article.htm