Sexually Transmitted Diseases

Incidence of STDs Startling statistics – Most STD’s contracted by year-olds – 1 in 4 treated for STD by age 21 – 25% of U.S. population > 1 STD by age 35 – Largest proportion of AIDS cases infected in teens or 20s

Incidence of STDs (cont.) Why so high? – more sexual partners – use of oral contraceptive – limited access to health care – practitioners do not ask questions about STDs – some diseases have no obvious symptoms – difficulty talking to partner

Bacterial Infections Chlamydia – most prevalent and damaging of STDs – females: urethritis, cervicitis symptoms: few or none; mild irritation or itching; burning; slight discharge – pelvic inflammatory disease (PID) symptoms: pain; fever; headache; n/v

Bacterial Infections (cont.) Chlamydia (cont.) – males: epididymitis; nongonococcal urethritis – symptoms: heaviness in testis; small, hard, painful swelling in testis; inflamed scrotum

Bacterial Infections (cont.) Chlamydia (cont.) – minimal or no symptoms in majority of men and women – consequences: infertility & sterility; preterm birth; infant conjunctivitis or pneumonia – treatment: doxycycline or azithromycin Most recurrent infections result of re-exposure

Bacterial Infections (cont.) Gonorrhea – females: gonococcal cervicitis symptoms: 80% no early symptoms; yellow-green discharge, vulval irritation – males: gonococcal urethritis symptoms: discharge, burning; swelling

Bacterial Infections (cont.) Gonorrhea (consequences) – female: PID, ectopic pregnancy, severe pelvic pain, infant conjunctivitis – male: prostate abcesses, painful BMs, difficult urination, possible sterility – both: fever, loss of appetite, arthritic pain, can invade heart, liver, CNS – can cause blindness in infants

Bacterial Infections (cont.) Gonorrhea (consequences) (cont.) – treatment: dual treatment for chlamydia & gonorrhea – resistant bacteria require special treatment – dual therapy now needed

Bacterial Infections (cont.) Nongonococcal urethritis – female: few symptoms; may be itching, burning, vaginal discharge of pus – male: penile discharge, urinary burning – consequences: inflamed cervix or PID – treatment: doxycycline or azithromycin

Bacterial Infections (cont.) Syphilis – rates have risen dramatically – all pregnant women should be tested – primary: red, painless chancre – secondary: painless, non-itching skin rash, flu-like symptoms – latent: no observable symptoms – tertiary: severe disorder, death

Bacterial Infections (cont.) Syphilis (cont.) – other consequences: infected fetus can die – treatment: early cases treated with benzathine penicillin G or other antibiotic – 3 weekly injections for later case – all partners need testing at three month intervals

Viral Infections Herpes: herpes simplex; types 1 & 2 transmitted even when no blisters – 20-25% of Americans have HSV-2 – symptoms: painful, red bumps develop into blisters that rupture & form sores – can spread even when no lesions present – may or may not be recurrent – prodromal symptoms can warn of recurrence

Viral Infections (cont.) Herpes (cont.) – consequences: 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 (cont.) Herpes (cont.) – treatment: no cure; working on vaccine – acyclovir may reduce length & severity of outbreak & may reduce recurring attacks – suppressive vs episodic treatment – hygiene & stress reduction may provide relief – vaccine in development

Viral Infections (cont.) Genital warts (human papilloma virus) – epidemic levels – transmitted even when no warts are evident; > 100 types – symptoms: moist, soft, cauliflower-like warts, or dry, yellow-gray, hard warts majority of people have no symptoms

Viral Infections (cont.) Genital warts (cont.) – consequences: urinary obstruction & bleeding; greater risk of genital cancers – respiratory infection in newborn – treatment: no cure; removal of warts – recurrence likely – Gardisicile vaccine

Viral Infections (cont.) Viral hepatitis (3 types) – needle-sharing & sexual transmission – Hepatitis C most health threatening – symptoms: few or none; initially flu like; incapacitating fever, vomiting, abdominal pain; yellowed sclera & skin

Viral Infections (cont.) Viral hepatitis (cont.) – consequences: liver cancer; death – treatment: bed rest & fluids; vaccines are available for Hepatitis A and B; antiviral combination may help Hepatitis C

Common Vaginal Infections Bacterial vaginosis (Gardnerella) – symptoms: foul-smelling, thin flour-paste discharge (white, yellow or green) – may be genital irritation or urinary burning; most men have no symptoms

Common Vaginal Infections (cont.) Bacterial vaginosis (Gardnerella) (cont.) – consequences: greater risk of PID; premature rupture of amniotic sac & preterm labor – treatment: oral, cream or gel Flagyl – Some recommend that male should be treated too

Common Vaginal Infections (cont.) Candidiasis (moniliasis, yeast infection): – symptoms: white, (cottage cheese-like) discharge with intense itching, sore tissue – consequences: confused with other infections – treatment: vaginal suppositories or creams

Common Vaginal Infections (cont.) Trichomoniasis – symptoms: copious, odorous, frothy, white or yellow-green vaginal discharge; inflamed, irritated, itchy and sore – male partners must be treated

Common Vaginal Infections (cont.) Trichomoniasis (cont.) – consequences: may increase risk of cervical cancer – treatment: both partners; oral Flagyl; topical cream

Ectoparasitic Infections Pubic lice – symptoms: little to severe itchiness – treatment: Lindane shampoo; 1% permethrin rinse – launder linens & clothing

Ectoparasitic Infections (cont.) Scabies – symptoms: small, pimple-like bumps; red rash around primary lesion – intense itching, especially at night – treatment: topical scabicide; launder or dry-clean linens & clothing

Acquired Immunodeficiency Syndrome (AIDS) HIV & AIDS – HIV = a retrovirus that targets & destroys helper T- 4 cells – HIV becomes AIDS when HIV is present, and CD-4 count is < 200

Acquired Immunodeficiency Syndrome (cont.) Incidence – rates among teenagers, women and minorities rising – MSM transmission increasing – decreasing IDU transmission – increasing heterosexual transmission, especially among women & minorities

Acquired Immunodeficiency Syndrome (cont.) Transmission – occurs in any bodily fluid depends on viral load – likelihood greatest when HIV transmitted directly to blood – low risk: casual contact – high risk: sexual contact, sharing needles

Acquired Immunodeficiency Syndrome (cont.) Symptoms: brief flulike symptoms that progress depending on immunosuppression HIV antibody tests – most develop antibodies in a few months but can take three years to seroconvert – usual progression (8 to 11 years) – full-blown AIDS

Acquired Immunodeficiency Syndrome (cont.) Treatment – no cure or vaccine at this time – combination drug therapy (HAART) shows best results for slowing progress success dependent on compliance but side effects severe – zidovudine may significantly decrease maternal transmission

Acquired Immunodeficiency Syndrome (cont.) Treatment (cont.) – the search for a vaccine A number of vaccines are in clinical trials problems due to disease mutations none available for general use now

Acquired Immunodeficiency Syndrome (cont.) Prevention is the best solution – use condoms and avoid multiple partners – do not share needles – avoid contact with bodily fluids – avoid sexual behaviors involving anus

Acquired Immunodeficiency Syndrome (cont.) Prevention is the best solution (cont.) – avoid implements that could be contaminated with blood (e.g., razors) – avoid sexual contact with sex workers

Preventing STDs Guidelines for lowering risk – abstinence – get to know partners before sex – obtain prior medical examinations – always use condoms properly & spermicide – avoid multiple sexual partners – inspect and wash genitals – disclose your STD status