1. Chapter 18 Sexually Transmitted Infections © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

2. 18-2 Chlamydia Chlamydia trachomatis is a bacterium spread by sexual contact and infects the genital organs of males and females – approximately 1,100,000 new cases are reported each year – adolescent girls have a particularly high rate of infection © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

3. 18-3 Symptoms of Chlamydia Thin, usually clear discharge and mild discomfort on urination, appearing 7 to 14 days after infection –in men, 50% of cases are asymptomatic –in women, 75% of cases are asymptomatic Diagnosis: –men – urine sample –women – cell sample from cervix or urine sample © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

4. 18-4 Treatment of Chlamydia Curable with azithromycin or one of the tetracyclines –does not respond to penicillin Poorly treated or undiagnosed cases may lead to: –urethral damage –epididymitis (infection of the epididymis) –Reiter’s syndrome –proctitis in men who had anal intercourse –Pelvic Inflammatory Disease (PID) –problems with pregnancy and risks for newborn infants of infected mothers © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

5. 18-5 Prevention of Chlamydia Scientists have a goal of developing a vaccine Many infected people are asymptomatic and spread the disease unknowingly Screening programs can identify, treat, and cure asymptomatic carriers Free testing kits available online at www.iwantthekit.org www.iwantthekit.org The best method of prevention is the consistent use of a condom © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

6. 18-6 HPV Human papillomavirus Genital warts — cauliflower—like warts appearing 3 to 8 months after sex with infected perso n –around the urethral opening of the penis –on the shaft of the penis –on the scrotum –on the vulva –on the walls of the vagina –in the cervix –on the anus © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

7. 18-7 HPV The majority of people infected with HPV are asymptomatic HPV is the single most important risk factor for cervical cancer Also associated with cancer of the penis and the anus Individuals infected by oral sex have an increased risk of cancers of the mouth and throat © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

8. 18-8 HPV Diagnosis –Sometimes inspecting the warts –Some strains are less obvious –Some warts grow inside the vagina –High—risk types do not produce warts © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

9. 18-9 HPV Treatment –Several treatments are available: podophyllin acid or bichloroacetic acid — applied directly to the warts cryotherapy — warts are frozen off Aldara cream can be applied by the patient –Vaccine Gardacil, approved in 2006 administered in 3 shots over a 6 month period © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

10. 18-10 Genital Herpes A disease of the genital organs caused by a herpes simplex virus (HSV—1or HSV—2) Symptoms — small, painful bumps or blisters –typically appear within 2—3 weeks of infection –usually found on the vaginal lips, penis, or anus © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

11. 18-11 Genital Herpes Treatment –Drugs such as acyclovir prevents or reduces recurring symptoms there is no cure –Valacyclovir and famciclovir are new drugs that are even more effective at shortening outbreaks and suppressing recurrences –Scientists are actively working to create an immunization against herpes © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

12. 18-12 Genital Herpes Long—Term Consequences –Meningitis –Narrowing of the urethra due to scarring –Increased risk of becoming infected with HIV –Transfer of virus from mother to infant during childbirth © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

13. 18-13 Genital Herpes Psychological Aspects of Coping with Herpes –Psychological consequences need to be taken as seriously as the medical consequences one highly effective treatment program combines information on herpes, relaxation training, stress management training, and imagery technique © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

14. 18-14 HIV Infection and AIDS AIDS — acquired immune deficiency syndrome HIV — human immune deficiency virus; the virus that causes AIDS –opportunistic diseases make take over once HIV has damaged an individual’s immune system © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

15. 18-15 HIV Infection and AIDS An Epidemic? –By the end of 2006, more than 1 million persons in the United States had been diagnosed with AIDS 550,000 deaths –Estimated that 60 million are infected with HIV worldwide –2009 research trials provide hope for creating an improved vaccine for HIV © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

16. HIV Infection and AIDS Men Men who have sex with men Heterosexual contact Injection drug use Other sources including contaminated blood transfusions Women Heterosexual contact Injection drug use 18-16 © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part. Transmission

17. 18-17 HIV Infection and AIDS Transmission (cont’d) –Anal intercourse is the sexual behavior most likely to spread AIDS –Heterosexual, penis—in—vagina intercourse spreads HIV as well –The greater number of sexual partners, the greater risk of getting infected with HIV –Condoms are 80—90% effective in protecting against HIV transmission during heterosexual intercourse © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

18. 18-18 HIV Infection and AIDS The Virus HIV is one of the retroviruses –reproduce only in living cells of the host species HIV invades a group of white blood cells (lymphocytes) called T—helper or T4 cells –cells critical to the body’s immune response in fighting off infections –when HIV reproduces, it destroys the infected T— cells © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

19. 18-19 HIV Infection and AIDS The Disease –The Centers for Disease Control has established the following categorization of HIV infection: Early Stage — initial infection Middle Stage — may have no symptoms AIDS © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

20. 18-20 HIV Infection and AIDS Diagnosis –Two major tests for HIV infection: ELISA (enzyme—linked immunosorbent assay) — blood test that detects the presence of antibodies for HIV produces a substantial number of false positives –Western blot or immunoblot method highly accurate though more expensive and difficult to perform –The Home Access HIV — 1 Test System A finger prick, then the dried blood spots are mailed to lab for anonymous testing © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

21. 18-21 HIV Infection and AIDS Treatment –No cure for AIDS –AZT (azidothymidine zidovudine, ZDV) stops virus from multiplying –DDI (dideoxyinosine or didanosine) slows the progression of the disease –DDC (dideoxycytidine) stops the virus from replicating © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

22. 18-22 HIV Infection and AIDS Treatment (cont’d) –Protease inhibitors attack the viral enzyme protease which is necessary for HIV to make copies of itself and multiply –HAART (highly active anti—retroviral therapy) patients take a “drug cocktail” of protease inhibitor combined with AZT and another anti-HIV drug helping people survive much longer concern about the emergence of resistant strains © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

23. 18-23 HIV Infection and AIDS Women, Children, Ethnic Minorities, and AIDS –HIV/AIDS is now the fifth leading cause of death for U.S. women between the ages of 25 and 44 leading cause of death for African American women between the ages of 25 and 34 –Intervention programs should include sexual assertiveness training © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

24. 18-24 HIV Infection and AIDS Women, Children, Ethnic Minorities, and AIDS (cont’d) –Children become infected: from an infected mother at birth (87%) from hemophilia or transfusions of contaminated blood (13%) –Culturally sensitive education and prevention programs that focus on the elimination of needle sharing and unsafe sexual practices, should be developed for the Black and Latino communities © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

25. 18-25 HIV Infection and AIDS Women, Children, Ethnic Minorities, and AIDS (cont’d) –African Americans 12% of population 49% of AIDS cases –Hispanics 13% of the population 18% of AIDS cases –Asian Americans and Native Americans less than 1% of cases © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

26. 18-26 HIV Infection and AIDS Psychological Considerations –Many patients experience a reaction that is a typical response to receiving a diagnosis of an incurable disease denial of the reality anger depression –AIDS is a socially stigmatized disease © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

27. 18-27 HIV Infection and AIDS Psychological Considerations –Cognitive—behavioral therapy combined with stress—management therapy has been shown to be effective improving quality of life decreasing anxiety and infection in HIV—infected people –Social and psychological support is essential © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

28. 18-28 HIV Infection and AIDS Recent Progress in AIDS Research –Vaccine researchers are working to develop a vaccine, but this is more difficult than was expected –Treatment as Prevention anti—retroviral treatment in infected person prevent transmission to the sexual partner (2011) –Research on Nonprogressors HIV—infected people who go for 10 years or more without symptoms are being studied possibly they have unusually strong immune systems that contain the virus high levels of defensins –Known to contribute to the killing of microbes © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

29. 18-29 HIV Infection and AIDS Recent Progress in AIDS Research (cont’d) –Killer T Cells known as CTL’s lymphocytes that battle against HIV in the body –Chemokines RANTES, MIP—1a, MIP—1b molecules that bind to other molecules blocking HIV from entering cells © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

30. 18-30 HIV Infection and AIDS Recent Progress in AIDS Research (cont’d) –Genetic Resistance called CCR5 a mutation selected during plagues people with 2 copies of the mutation are resistant to infection people with 1 copy of the mutation may get infected, but infection progresses more slowly © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

31. 18-31 HIV Infection and AIDS Recent Progress in AIDS Research (cont’d) –Microbicides An ointment that could be applied to battle HIV transmission –Tenofovir Used vaginally, reduced infection rates by 39% (2010) –Behavioral prevention Prevention is better than a cure © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

32. 18-32 Gonorrhea Also called “the clap” or “the drip” Caused by a bacterium Oldest of the sexual diseases Symptoms –appear 2—5 days after infection –men: pus—like discharge and painful, burning urination –women: asymptomatic © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

33. 18-33 Gonorrhea Diagnosis –Men: sample of discharge is examined a urine test is also available –Women: cervical discharge is taken and cultured a urine test is available a pelvic exam should also be performed –Both: a swab from the throat or rectum should be taken and cultured if necessary © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

34. 18-34 Gonorrhea Treatment –The traditional treatment was a large dose of penicillin or tetracycline –Ceftriaxone is highly effective antibiotic even against resistant strains concern that there will be no remaining antibiotics for treatment if resistance develops © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

35. 18-35 Syphilis Caused by the Treponema pallidum bacterium Incidence is much lesser than that of gonorrhea or chlamydia Can damage the nervous system and even cause death Makes one, more vulnerable to HIV and vice versa © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

36. 18-36 Syphilis Symptoms and Progress –Major early symptom — chancre a round, ulcer—like lesion with a hard, raised edge, resembling a crater –Syphilis proceeds in stages: primary—stage syphilis secondary—stage syphilis latent syphilis late syphilis –Congenital syphilis passed from mother to infant © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

37. 18-37 Syphilis Diagnosis: –physical exam –examination of fluid from chancre –VDRL — fairly accurate blood test Treatment: –antibiotics penicillin, tetracycline, or doxycycline © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

38. 18-38 Viral Hepatitis There are 5 types of viral hepatitis, but hepatitis B is of most interest in a discussion of STDs People with long—term hepatitis B may develop serious liver disease involving cirrhosis or cancer Treatment — rest, symptom relief, antiviral treatments Prevention — vaccine for hepatitis B © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

39. 18-39 Trichomoniasis Caused by Trichomonas vaginalis protozoan –transmitted mainly through sexual intercourse –occasionally transmitted nonsexually — organism can survive on toilet seats and other objects Can lead to pelvic inflammatory disease and problems with birth Treatment is metronidazole taken orally © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

40. 18-40 Pubic Lice (Crabs) Tiny lice that attach to the base of pubic hairs and feed on blood from their human host Symptom –itching Treatment –Nix and Rid both are available without prescription © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

41. 18-41 Preventing STIs Abstain from sexual activity Limit to monogamous relationship with an uninfected person Condom use Careful washing and inspecting of genitals Urinating before and after intercourse helps keep bacteria out of the urethra © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.

42. 18-42 Other Genital Infections Vaginitis –vaginal inflammation or irritation Monilia (candida) –yeast infection –Bacterial vaginosis Prostatitis –inflammation of the prostate gland © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or in part.