Chapter 15 Sexually Transmitted Infections

Sexually Transmitted Infections Engaging in risky behavior Multiple partners Unprotected (without condom) sex Highest in adolescence and early adulthood, when incidence of STIs is highest Oral contraceptives Lack of public health measures and limited access STI prevention and treatment

Bacterial Infections Chlamydia Gonorrhea Nongonococcal Urethritis (NGU) Syphilis

Bacterial Infections Chlamydia Most prevalent STI Few or no presenting symptoms Consequences: chronic, contagious trachoma; infertility and sterility; preterm birth; infant conjunctivitis or pneumonia Trachoma (form of conjunctivitis); Leading cause of preventable blindness Treatment: doxycycline or azithromycin All sexual partners should be tested for STIs

Bacterial Infections Symptoms of Chlamydia Women: 2 types of genital chlamydia infections Infection of mucosa of lower reproductive tract Few or no symptoms; mild irritation or itching, burning; slight discharge Infection of upper reproductive tract (PID) Pain, fever, headache, and nausea Men: Epididymitis; nongonococcal urethritis (NGU) Heaviness in testis; small, hard, painful swelling in testis; inflamed scrotum

Bacterial Infections Gonorrhea “The Clap” Consequences Women: PID; ectopic pregnancy; severe pelvic pain; infant conjunctivitis Men: Prostate abscesses, painful BMs, difficult urination; possible sterility Both: Fever, loss of appetite, arthritic pain; can invade heart, liver, CNS, can cause blindness in infants Treatment Cephalosporin

Bacterial Infections Symptoms of Gonorrhea Women: Gonococcal Cervicitis 80% no early symptoms Yellow-green discharge Vulval irritation Men: Gonococcal Urethritis Discharge Burning Swelling

Bacterial Infections Nongonococcal Urethritis Symptoms Women: few symptoms; itching, burning, vaginal discharge of pus Men: penile discharge, urinary burning Consequences: Women: inflamed cervix or PID Men: can spread to prostate, epididymis, or both Treatment: Doxycycline or Azithromycin

Bacterial Infections Syphilis Recent increase in rates, primarily among MSM Pregnant women should be tested Phases of Development, Symptoms, Consequences Primary: Red, painless chancre Secondary: Painless, non-itching skin rash, flu-like symptoms Latent: No observable symptoms Tertiary: Severe disorder, death

Bacterial Infections Treatment of Syphilis Early cases (primary, secondary, or latent syphilis of less than 1 year) with benzathine penicillin G or other antibiotic Later cases (more than 1 year): 1 weekly injection for 3 weeks (benzathine penicillin G or other antibiotic) All partners tested at 3 month intervals

Viral Infections Herpes Genital Warts Viral Hepatitis

Viral Infections Herpes Herpes Symplex Virus (HSV) Types 1 & 2 Transmitted even when no blisters present 20-25% of Americans have HSV-2 May or may not be recurrent Symptoms painful, red bumps develop into blisters that rupture and form sores swollen lymph nodes headache fever muscle aches

Viral Infections Consequences of Herpes Risk for cervical cancer Newborn infected during delivery may die or suffer severe damage C-section for women with active disease Can cause eye infection Psychological distress

Viral Infections Treatment of Herpes Acyclovir may reduce length and severity of outbreak; Valtrex and Famvir may reduce recurring attacks Suppressive therapy vs. Episodic treatment Hygiene and stress reduction No cure; vaccine in development

Viral Infections Genital Warts Human Papillomavirus (HPV) Epidemic levels Transmitted even when no warts are evident Symptoms: moist, soft cauliflower-like warts; or dry, yellow-gray, hard warts majority of people have no symptoms

Viral Infections Genital Warts Consequences Urinary obstruction and bleeding Greater risk of genital cancers Respiratory infection in newborn Treatment No cure; removal of warts Recurrence likely Vaccine against 4 types - Gardasil

Viral Infections Viral Hepatitis Three types Hepatitis A (commonly transmitted sexually) Hepatitis B (more commonly transmitted sexually) Hepatitis C (commonly transmitted through blood-contaminated needles) Hepatitis C most health threatening Symptoms Few or none Flu-like initially Can become incapacitating: fever, vomiting, abdominal pain Yellowed whites of eyes and skin

Viral Infections Viral Hepatitis Consequences Liver cancer 20-25% Hepatitis C infected develop severe complications (liver failure) Death Treatment Bed rest and fluids Vaccines for Hepatitis A and B Antiviral combination may help Hepatitis C

Common Vaginal Infections Bacterial Vaginosis Candidiasis Trichomoniasis

Common Vaginal Infections Bacterial Vaginosis (BV) Symptoms Foul smelling, thin flour-paste discharge Genital irritation or urinary burning Most men have no symptoms Consequences Women: Greater risk of PID; premature rupture of amniotic sac, and preterm labor Men: Mostly asymptomatic; may develop urethritis or cystitis Treatment Oral metronidazole Recent research: intravaginal application of topical gel or cream are as effective as oral

Common Vaginal Infections Candidiasis Second most common vaginal infection in North America Symptoms White, cottage-cheese like, discharge Intense itching, sore tissue Consequences Confused with other infections Treatment Vaginal suppositories or creams

Common Vaginal Infections Trichomoniasis Symptoms Copious, odorous, frothy, white or yellow-green vaginal discharge Inflamed, irritated, itchy, and sore Consequences May increase risk of cervical cancer Treatment Both partners; oral Flagyl; topical cream

Ectoparasitic Infections Pubic lice Scabies

Ectoparasitic Infections Pubic Lice Commonly known as “crabs” Quite common, especially prevalent among young 15- to 25-year old) single people Associated with presence of other STIs Symptoms Little to severe itchiness Treatment 1% permethrin or pyrethrin lotion or cream Launder clothes and sheets

Ectoparasitic Infections Scabies Too tiny to be seen by naked eye Highly contagious condition Symptoms Small, pimple-like bumps; red rash around primary lesion Intense itchiness, especially at night Treatment Topical scabicide Launder clothes and sheets

Acquired Immunodeficiency Syndrome (AIDS) HIV (human immunodeficiency virus) Retrovirus that targets and destroys helper T-4 cells HIV becomes AIDS when HIV is present and CD-4 count is < 200

Incidence of AIDS Rates rising among teenagers, women, and minorities MSM transmission had leveled off in 1990s, but is now increasing U.S. cases increasing among “heterosexual” transmission Heterosexual contact has always been primary form of HIV transmission worldwide Women are the fastest growing population with HIV

AIDS and Adolescence Many young people with AIDS were infected as teenagers Risk factors for teenagers include Multiple partners Engaging in sexual activities without condoms Lack of access to condoms during teenage years Substance abuse increases risky behavior Feelings of invulnerability

HIV Transmission Transmission occurs in any bodily fluid Mother-to-child transmission (MTCT) Depends on viral load Likelihood greatest when HIV transmitted directly to blood Low risk: casual contact High risk: sexual contact, sharing needles

HIV Symptoms and Complications Brief flu-like symptoms that progress depending on immunosuppression HIV Antibody Tests Most develop antibodies in a few months, but it can take 3 years to seroconvert Usual progression (8 to 11 years) Full-blown AIDS

HIV Treatment No cure or vaccine at this time Combination drug therapy, Highly Active Antiretroviral Therapy (HAART), shows best results for slowing progress Zidovudine may significantly decrease maternal transmission

HIV Treatment Search for a Vaccine Vaccine remains best long-term hope for controlling HIV/AIDS pandemic Two categories of vaccines Prophylactic Therapeutic Several vaccines under clinical trials

HIV Prevention Prevention is the best solution Use condoms and avoid multiple partners Do not share needles Avoid oral, vaginal, or anal contact with semen Avoid sexual behaviors involving anus Avoid oral contact with vaginal fluids Do not share items that could be contaminated with blood (e.g., razors, toothbrushes) Avoid sexual contact with sex workers

Preventing STIs Prevention Guidelines Abstinence Get to know partner(s) before sex Obtain prior medical examinations Always use condoms and spermicide Avoid multiple sexual partners Inspect and wash genitals Obtain routine medical evaluations Disclose your STI status to partner