Sexually Transmitted Infections: What You Need To Know Presented By Jessica Papocchia, B.S., M.S. Suffolk County Health Services

Why Can’t We Talk About It? “STDs are hidden epidemics of enormous health and economic consequence in the United States. They are hidden because many Americans are reluctant to address sexual health issues in an open way and because of the biologic and social characteristics of these diseases.” STD Surveillance 2007, CDC, Division of STD Prevention November 2009, pg. vi Sexually Transmitted Disease Surveillance, 2008 presents statistics and trends for sexually transmitted diseases (STDs) in the United States through 2008. This annual publication is intended as a reference document for policy makers, program managers, health planners, researchers, and others who are concerned with the public health implications of these diseases. The process of preventing STDs must be a collaborative one. No one agency, organization, or sector can effectively do it alone; all members of the community must do their part. A successful national initiative to confront and prevent STDs requires widespread public awareness and participation and bold national leadership from the highest levels.” Concluding statement from the Institute of Medicine’s Summary Report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, National Academy Press, Washington, DC, 1997, p.43, as cited in STD Surveillance 2008, CDC, pg. vi

Objectives You will understand some of the common issues associated with STDs which further complicate the problem You will learn some basic, yet highly functional, information about some common STDs, including transmission, symptoms, complications, testing, treatment, and prevention You will become aware of the process of partner notification and understand the role it plays in interrupting in the spread of infection

Statistics The Centers for Disease Control and Prevention (CDC) estimates there are approximately 20 million new STD infections nationwide each year. Half of all new infections occur in young people (ages 15-24) 1,412,791 Chlamydial infections were reported to CDC from 50 states and the District of Columbia in 2011 Suffolk County reported 3,442 for 2012 (2,887 of those occurred in ages 15-29). Many STDs go undiagnosed, and some highly prevalent viral STDs, such as human papilloma virus and genital herpes, are not reported at all. Statewide, 2009 figures represent an increase of four percent over 2008 with a three percent increase in NYC (2009: 58,353 cases; 2008: 56,448 cases) and a five percent increase in Upstate New York Estimates suggest that 15- to 24-year-olds acquire nearly half of all new STDs. Young People (15-24) have FIVE TIMES the reported Chlamydia rate of the entire population (10-65+). Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States. What is a REPORTABLE infection?? Why do you think there is a higher prevalence among adolescents? The higher prevalence of STDs among adolescents may also reflect multiple barriers to accessing quality STD prevention services, including lack of insurance or other ability to pay, lack of transportation, discomfort with facilities and services designed for adults, and concerns about confidentiality. In 2008, there were more than 1.5 million total cases of chlamydia and gonorrhea reported to CDC — making them the two most commonly reported infectious diseases in the United States. Adolescent girls and young women are especially hard hit by these two diseases. The largest number of reported cases of both chlamydia and gonorrhea in 2008 was among girls between 15 and 19 years of age, followed closely by young women 20 to 24 years of age. This likely reflects a combination of factors, including biological differences that place females at greater risk for STDs than males, as well as higher STD screening rates among young women.

Chlamydia Chlamydia is the most commonly reported STD in the United States. Can cause infection in men, women, and newborn babies Chlamydia is caused by a bacteria Incubation Period: 2-3 weeks The person can pass it on to sex partners and to babies during childbirth

Symptoms of Chlamydia Symptoms in Women: Usually asymptomatic Abnormal vaginal discharge Pain during sex Complications, if not treated: Pelvic inflammatory disease (PID) Symptoms in Men: Usually asymptomatic Discharge from the penis (may be runny, whitish) Burning on urination Complications, if not treated Swollen and tender testicles (epididymitis)

Chlamydia Symptoms in Men Source: Seattle STD/HIV PTC

Chlamydia Symptoms in Women Mucopurulent Cervicitis Source: St. Louis STD/HIV PTC

Testing & Treatment for Chlamydia Easily detected by a urine test or a swab; and Easily cured with antibiotics; but Any damage to the body cannot be repaired

Gonorrhea Gonorrhea is sometimes called clap, drip, dose, strain, gleet or the whites Incubation period: 1 – 14 days A bacteria causes gonorrhea Can cause infections in men, women, and new babies The person can easily pass it on to sex partners and babies during childbirth

Gonorrhea Symptoms in Men Discharge from the penis (may be thick, milky white, yellowish, or greenish) Burning on urination Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

Gonorrhea Symptoms in Women Usually asymptomatic Painful urination Abnormal vaginal bleeding Pain during sex Source: Health Awareness Connection http://www.healthac.org/images.html

Complications in Men Swollen or tender testicles (epididymitis) Disseminated gonococcal infection (DGI)

Swollen or Tender Testicles (Epididymitis) Source: Health Awareness Connection, http://www.healthac.org/images.html

Disseminated Gonococcal (Gonorrhea) Infection Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

Complications in Women Bartholin’s Abscess Pelvic inflammatory disease (PID) Disseminated gonococcal infection (DGI)

Pelvic Inflammatory Disease (PID) A: Uterus B: Fallopian tube C: Cervix D: Ovary

Severe Pelvic Inflammatory Disease Normal Female Reproductive System Severe Pelvic Inflammatory Disease Source: The Embryologists Newsletter

Bartholin’s Abscess Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

Testing & Treatment for Gonorrhea Easily detected by a urine test or swab; and Easily cured with antibiotics; but Any damage to the body cannot be repaired.

Syphilis Syphilis is caused by a bacteria Occurs in stages Incubation Period: 10-90 days (average 21 days) Can cause infections in men, women, and unborn babies during pregnancy

Symptoms of Syphilis Primary Stage A painless sore called a chancre may be located on the genitals, lips, anus, or other area of direct contact The chancre will last 1-5 weeks and heal without treatment The person can easily pass it on to sex partners

Primary Syphilis Chancre in a Man Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Primary Syphilis Chancre in a Woman Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Symptoms of Syphilis Secondary Stage Skin rashes lasting 2 – 6 weeks (average of 4 weeks) on the palms of the hands, bottoms of the feet, or any part of the body Other symptoms include fever, swollen lymph glands, headache, hair loss, and muscle ache Symptoms will go away without treatment The person may be able to pass it on to sex partners

Secondary Syphilis Palm Rash Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Symptoms of Syphilis Late Stage Paralysis Insanity Blindness Damage to knee joints Personality changes Impotency Aneurysm (ballooning of a blood vessel) Tumor on the skin or internal organs

Congenital Syphilis A mother can pass syphilis on to her unborn child

Testing & Treatment for Syphilis Easily detected by a blood test; and Easily cured with antibiotics; Any damage done to the body cannot be repaired.

Herpes (HSV) There are 2 types of HSV: HSV-1 and HSV-2. HSV-2 causes most genital infections. HSV-1 causes oral infections (cold sores, fever blisters) and some genital infections.

Genital Herpes Causes infection in men, women, and newborns Herpes simplex viruses (HSV) cause genital herpes infections. Incubation period: 2 – 12 days The person can easily pass it on to sex partners and babies during childbirth

Symptoms of Genital Herpes Numerous painful lesions (sores) On the penis, vagina, anus, buttocks, thighs, mouth, or finger Last up to 4 – 21 days Other symptoms include headache, fever, muscle aches, swollen lymph nodes, and difficult urination. Symptoms may or may not come back.

Herpes in a Man Source: Cincinnati STD/HIV Prevention Training Center

Herpes in a Woman Source: CDC/NCHSTP/Division of STD, STD Clinical Slides Source: CDC/NCHSTP/Division of STD, STD Clinical Slides

Herpes Simplex (HSV) HSV-1 HSV-2 Cold Sores Oral-genital frequent Genital Lesions Genital-oral infrequent

You can get herpes anywhere . . . Source: Cincinnati STD/HIV Prevention Training Center

Testing & Treatment for Genital Herpes Can be detected by: culturing the lesion blood test Herpes cannot be cured, but symptoms can be treated with medicines called antivirals. You can still spread herpes even if you are taking antiviral medicine!

Genital Herpes Without Symptoms Many people with herpes do not have any symptoms or do not recognize that they have symptoms. Most people with herpes can pass the virus to sex partners even when they do not have symptoms.

Human Papillomavirus (HPV) HPV is so common that at least 50% of sexually active men and women get it at some point in their lives. Approximately 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year. Many types of Human Papillomavirus (HPV), some of which infect the genital area Incubation period unclear Can infect men, women, and newborns The person can easily pass it on to sex partners

Genital HPV: Two Types The types of HPV that infect the genital area are labeled “low-risk” or “high-risk” depending on whether they can cause cancer or not. Low-risk HPV types can cause genital warts. High-risk HPV types can cause serious cervical lesions, cervical cancer, and other genital cancers.

Symptoms of Genital HPV Infection Usually asymptomatic and brief (6 – 12 months) Genital warts (usually infection with low-risk type of HPV) Warts on the penis, vagina, anus or urethra Rarely may have itching, bleeding, burning, or pain along with the warts May go away on their own, stay about the same, or get worse

Symptoms of Genital HPV Infection Cervical lesions (usually infection with high-risk type of HPV) Usually no symptoms Detected by Pap smear Most will go away on their own Some will persist and need to be followed by health care provider Most women with high-risk HPV types do not get cervical cancer

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

Genital Warts in a Woman Source: CDC/NCHSTP/Division of STD, STD Clinical Slides

Perianal Wart Source: Cincinnati STD/HIV Prevention Training Center

Testing & Treatment for Genital Warts No tests for genital warts Several types of treatment are available Warts may come back Cervical lesions and cervical cancer Regular Pap smears are best way to detect serious lesions and prevent cervical cancer Pap smear screening is recommended for all sexually active women

HIV/AIDS CDC estimates that more than one million people are living with HIV in the United States (US). One in five (21%) of those people living with HIV is unaware of their infection. In 2008, 249 newly diagnosed in Nassau & Suffolk Counties (41 of those ages 13-19) NO CURE FOR HIV There IS treatment Sometimes symptoms do not appear until 10 or more years later You can NOT tell by looking at someone if they are infected The CDC is one of the major operating components of the Department of Health and Human Services. CDC′s Mission is to collaborate to create the expertise, information, and tools that people and communities need to protect their health – through health promotion, prevention of disease, injury and disability, and preparedness for new health threats. CDC estimates 56,300 Americans becoming infected with HIV each year. Human Immunodeficiency VIRUS Symptoms MAY include fever, headache, tiredness, enlarged lymph nodes (glands in neck and groin) These symptoms include lack of energy, weight loss, frequent fevers and nights sweats, yeast infections, skin rashes, short term memory loss. HIV progresses to AIDS (coughing, shortness of breath, persistent diarrhea) Prenatal testing is done, should have another done at time of delivery

How Do You Get It? HIV is spread through blood, semen, vaginal secretions & breast milk Enters the body through the lining of the vagina, vulva, penis, rectum or mouth during sex Can also be spread by sharing needles/syringes Women CAN pass HIV onto their baby during pregnancy, delivery or from breastfeeding

How Do You NOT Get It? Abstain from sexual activity Be monogamous/limit sexual partners and KNOW your partner Use condoms CORRECTLY and EVERY time you have sex Abstain from and/or limit drug and alcohol use Harm reduction if choosing to engage in risk behaviors Universal precautions We have some of the power to NOT get these diseases

What’s the Big Deal?? Medical Complications Physical Discomfort Lifetime Therapy Regimens Re-infection Social Issues Monetary Costs Untreated STDs can lead to serious long-term health consequences, especially for adolescent girls and young women. Some are curable, some are not

Who Should You Tell? (Partner Notification) Several options for notifying all past & present sex and/or needle-sharing partners Free, Voluntary, Confidential “Need to Know” Basis Domestic Violence Screening Explain Reportable Infections Provider Report & Provider Responsibilities

What Can You Do? TALK TO YOUR PARTNER(S) Modify Risk Behavior/Harm Reduction Testing/Treatment Partner Notification Educate Others WE HAVE THE POWER TO PREVENT THESE INFECTIONS Limit sexual partners, use condoms, get tested, RESPECT your sexual health and that of your partners Don’t take for granted that your friends & family know much about STDs

Info & Partner Services Local STD Unit (631) 854-0364 Info & Partner Services Free Condoms at S.C. Health Centers!!! Suffolk County Health Centers Free STI Testing & Treatment Local EZ Call: 631-439-1551 “Public Health Visit” GET TESTED!!!

QUICK! ANONYMOUS! FREE HIV Testing!!! 1-800-462-6786

Where Can You Get More Information? Hotline 1-800-541-AIDS www.health.state.ny.us www.cdc.gov

Questions?

References Common Sexually Transmitted Diseases: STD 101 for Non-Clinicians, Developed by The Training and Health Communications Branch, in partnership with the Program Development and Support Branch, Division of STD Prevention NCHSTP, CDC http://www.nyhealth.gov/diseases/aids/facts/questions/basicinformation.htm http://www.health.state.ny.us/diseases/aids/statistics/annual/2008/2008-12_annual_surveillance_report.pdf http://www.health.state.ny.us/statistics/diseases/communicable/std/abstracts/docs/2007.pdf http://www.cdc.gov/std/HPV/STDFact-HPV.htm http://www.cdc.gov/hiv/resources/factsheets/PDF/us.pdf