Sexually Transmitted Diseases Presenter Norma Sanchez, CDS II

STD Overview STDs affect men and women of all backgrounds and economic levels. Most prevalent among teens and young adults with nearly 2/3 of all STDs occurring in people under age 25. Contributing factors in the rise of STDs include: young people have become sexually active earlier, divorce is more common and sexually active people are more likely to have multiple sex partners. Important to note that it is the behavior which puts you at risk not who you are.

Types of STDs Bacterial Viral Chlamydia Gonorrhea Pelvic Inflammatory Disease (PID) Syphilis Viral Genital Warts Hepatitis B and C Herpes HIV

Warning! This section contains graphic images of infectious diseases – You have been warned

Chlamydia Caused by Chlamydia Trachomatis. Can be transmitted during vaginal, oral, and anal sexual contact. If symptoms appear, they will occur 1-3 weeks after exposure. Complications: PID, sterility, premature or still births, blindness.

Picture of a Normal Cervix

Cervical Ectopy

Inflammation of the cervix from Chlamydia infection

Chlamydia/GC

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 Caused by Neisseria gonorrhea. Symptoms may occur 2-21 days after exposure. Transmitted during vaginal, anal and oral sex. Can also be transmitted from infected mother to infant during birth. Complications: PID, sterility, blindness, meningitis, kidney and heart damage, skin rash, ectopic pregnancy.

Symptoms of Gonorrhea For Men For Women Thick yellow or white discharge from vagina Bleeding from vagina between periods Burning/pain when urinating/during bowel movement Cramps and pain in lower abdomen For Men Thick yellow or white drip from the penis Burning or pain when urinating Need to urinate more often

Gonorrhea

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

Swollen or Tender Testicles (Epididymitis) Gonorrhea 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

Gonorrhea Symptoms in Women Usually asymptomatic Painful urination Abnormal vaginal bleeding Pain during sex Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

Cervical GC

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

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

Pelvic Inflammatory Disease (PID) Gonorrhea Pelvic Inflammatory Disease (PID) Source: Cincinnati STD/HIV Prevention Training Center

Gonorrhea Gonorrhea in Infants A mother can pass gonorrhea to her baby during childbirth

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.

Pelvic Inflammatory Disease (PID) Usually caused by Chlamydia trachomatis or Neisseria gonorrhea. PID occurs when bacteria travel from the vagina through the cervix and into the uterus, fallopian tubes, or ovaries. Symptoms: Pain in the lower abdomen or lower back. Pain in the abdomen during sex. Fever, chills, or vomiting. Unusual bleeding or discharge from the vagina. Complications: infertility, ectopic pregnancy, scar tissue in the pelvic organs, chronic abdominal pain.

Syphilis Caused by Treponema pallidum. Transmitted during vaginal, anal and oral sex. Symptoms may occur 10 days to 3 months after exposure. An infected mother can pass the disease to her unborn child. Three stages: Primary, secondary, tertiary or late.

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

Primary Syphilis The first symptom is a painless chancre at site of entry of the bacteria i.e. mouth, sex organs, breasts, or fingers which may occur 3-12 weeks after exposure. Sore can last 1-5 weeks but then disappear. Swollen glands.

Primary chancre

Primary syphilis

Primary syphilis

Secondary Stage If syphilis is not treated in the first stage the symptom will go away. About 4 months later (early latent stage) secondary symptoms will show up. They may show up 0-10 weeks, average is 4 weeks. Symptoms may last 2-6 weeks, average is 4 weeks.

Secondary Syphilis Rash anywhere, but primarily on palms and soles. Patchy hair loss. Sore throat. Swollen glands. 1 week to 6 months after appearance of primary chancre. This set of symptoms will also eventually disappear.

Secondary Syphilis

Secondary Syphilis

Secondary Syphilis

Congenital Syphilis

Third Stage of Syphilis If a person is not treated during these two stages syphilis still remains in the body. It may take several years but syphilis becomes “latent” which means: to hide. During this stage syphilis can do damage to the body.

Tertiary or Late Syphilis Approximately 1/3 of untreated cases of secondary syphilis will progress to this stage. This stage may continue 5-20+ years with no obvious symptoms. Can cause lesions on body organs such as the brain and heart.

Late Syphilis, Gumma

Special populations Women who are pregnant get tested at the beginning of their pregnancy if seen by a doctor. A woman may become infected during her pregnancy and may transmit syphilis to her child without knowing it. A baby born from a mother who has syphilis may die from complications of syphilis.

End of bacterial slides There are more bacterial infections but these are the 3 that are reported to the Health Department. QUESTIONS??????

Viruses Viruses are not curable. The symptoms are treatable and can be manageable. The viruses we will talk about are: Herpes Genital Warts Hepatitis B and C HIV

Genital Herpes Caused by the Herpes Simplex Virus. Lives in CNS. Transmitted through skin to skin contact. Symptoms may occur 1-30 days after exposure. Transmitted during vaginal, anal, and oral sex. Transmission can also occur when blisters are not present. No cure, only treatment available.

Symptoms of Genital Herpes Transmitted through skin to skin contact. Flu-like symptoms. Painful blisters/sores at the site of infection, i.e. mouth, penis, vagina, anus, cervix, lips, tongue, gums, and eyes. Blisters can last 1-3 weeks. Blisters will heal but may reappear throughout life. Prodrome effect. Complications: May cause brain damage or death in infants.

HSV I

HSV II

Human Papillomavirus (HPV)

HPV Human Papillomavirus 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

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

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

HPV Perianal Wart Source: Cincinnati STD/HIV Prevention Training Center

Testing & Treatment for Genital Warts HPV Testing & Treatment for Genital Warts 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

Genital Warts Caused by Human Papilloma Virus. Symptoms may occur 1-8 months after exposure. Transmitted by direct skin to skin contact. Can also be passed although no visible warts are present. No cure, only treatment available for the warts. Complications: may cause cervical, vulvar, or penile cancer.

Symptoms of Genital Warts Small, bumpy or flat warts on the sex organs and anus. Itching or burning around the sex organs. Some people have no visible warts.

Symptoms of Genital Herpes Transmitted through skin to skin contact. Flu-like symptoms. Painful blisters/sores at the site of infection, i.e. mouth, penis, vagina, anus, cervix, lips, tongue, gums, and eyes. Blisters can last 1-3 weeks. Blisters will heal but may reappear throughout life. Prodrome effect. Complications: May cause brain damage or death in infants.

Condyloma (Warts)

Anal Warts

Penile Warts

Gardisil Current vaccine for Gardisil starting for young girls at age 9. If on Medi-Cal they can be up to age 20 to receive a free physical and vaccine. If not on Medi-Cal and is enrolled through CHDP it is up to age 18. 3 doses, over a 6 month period

Hepatitis B and C Hepatitis - Inflammation of the liver. Transmitted during vaginal, anal, and oral sex, sharing razors, toothbrushes, needles. Can also be passed from infected mother to child during birth. HBV can live on environmental surfaces for up to 7 days. Complications: Cirrhosis, liver cancer and death. Can also cause premature birth or spontaneous abortion.

Symptoms of Hepatitis Nausea, vomiting. Fatigue. Loss of appetite. Jaundice. Dark-colored urine/light-colored stools. Enlarged liver/liver pain.

Herpes in a Woman Herpes Source: CDC/NCHSTP/Division of STD, STD Clinical Slides Source: Cincinnati STD/HIV Prevention Training Center

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

Herpes Herpes Complications HSV-2 causes serious problems when it is passed to newborns during birth.

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 Caused by the Herpes Simplex Virus. Lives in CNS. Transmitted through skin to skin contact. Symptoms may occur 1-30 days after exposure. Transmitted during vaginal, anal, and oral sex. Transmission can also occur when blisters are not present. No cure, only treatment available.

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

It gets worse!!!

Blue Waffle

Hepatitis B and C Hepatitis - Inflammation of the liver. Transmitted during vaginal, anal, and oral sex, sharing razors, toothbrushes, needles. Can also be passed from infected mother to child during birth. HBV can live on environmental surfaces for up to 7 days. Complications: Cirrhosis, liver cancer and death. Can also cause premature birth or spontaneous abortion.

HIV Human Immunodeficieny Virus HIV is the virus that causes AIDS

AIDS Acquired Immune Deficiency Syndrome When your body is no longer able to protect you from disease because your immune system has been compromised.

Which bodily fluid is not HIV infectious? Semen Blood Vaginal Secretions Saliva Breast Milk

Infectious Non-infectious 1) Blood 1) Sweat 2) Semen 2) Saliva 3) Vaginal Secretions 4) Breast milk 1) Sweat 2) Saliva 3) Urine 4) Tears 5) Mucus

Behaviors/Activities/Events 1) Unprotected Sexual Intercourse -Anal, Vaginal, and Oral 2) Sharing Needles -To inject: IV drug use, steroids, medicine - What about piercing: ears, nose, body and tattoos?????? 3) Vertical Transmission- Mother to baby 4) Blood Transfusions/Blood Products 5) Accidental Blood to Blood Contact

Barriers Monogamy - Two people who are lifetime partners Serial Monogamy - Having multiple monogamous relationships If practicing serial monogamy, one should use condoms LATEX 98% Effective POLYURETHANE 95%Effective Male Condoms Dental Dams Male Condoms Female Condoms Water Based Lubricants are recommended for use with condoms

Acceptance Bravery Self-respect Trust Integrity No Sex Education No Risk Confidence Esteem Abstinence means no Sex, Drugs & Alcohol Abstinence is the only 100% effective way not to get HIV

Only way to be 100% sure Abstinence

Reduced Risk Behaviors Monogamy Condom Use (latex 98%, polyurethane 95%) Water based lubricants Dental Dams

Harm Reduction What is it?

Testing The test looks for the presence of HIV antibodies. Anyone who is sexually active should be tested for HIV. Especially: Youth/Adolescents, People of Color, and Women.

Testing Anonymous Free testing available at the Health Department. Confidential Anonymous Free testing available at the Health Department. Results are available in 2 weeks. Test can be done by blood sample. Mobile Unit available at certain locations offer OraQuick® Rapid Testing, preliminary results are ready in 20-30 minutes. 12 and over can test without parent permission.

Results Non reactive: What does it mean? Reactive: What does it mean? Is it reportable?

Criteria for AIDS Diagnosis 1. Opportunistic Infection (There are 26). The most common are: PCP - Pneumo Cystis Carinii Pneumonia KS - Kaposi’s Sarcoma (MSM) Esophageal Candidiasis TB - Tuberculosis (Mycobacterium) MAC 2. T-cells fall below 200 per cm (Healthy people have between 800-1600 T-cells)

TESTING Confidential Anonymous Free testing available at the Health Department. Rapid Test results in 30 mins If you have a preliminary positive, then confirmatory results are available in 2 weeks Test will be done by blood sample/draw Mobile Unit available at certain locations offer OraQuick® Rapid Testing, preliminary results are ready in 20-30 minutes. 12 and over can test without parent permission.

Relatively few cases were diagnosed among Asian, American Indian/Alaska Native, and Native Hawaiian/other Pacific Islander females, and females reporting multiple races, although the rates for these groups were higher than the rate for white females.

Woman are always at higher risk for STD’s and HIV Infection then men True False I don’t know

CDC estimates that 1 in five people living with HIV infection in the United States do not know they are infected. Getting tested for HIV is the first step to protecting yourself and others. Knowing your own HIV status and that of your male sexual partners is critical because 85% of newly diagnosed HIV infections in US women and girls result from sex with an infected male partner. Early diagnosis of HIV allows for counseling and prompt treatment. HIV treatment prolongs life and reduces the risk of further HIV transmission. Encouraging your partner to wear a condom every time you engage in sexual activity is another important way to protect yourself

Questions and Answers Hope we didn’t ruin lunch!