1. Sexually Transmitted Infections (STIs) Dr. Nabil Sabri Comunicable Disease Directorate

2. Infections ?—Generally Speaking  What are they? Overgrowths of bacteria, viruses, fungus (yeast), or protozoal pathogens  How are they spread? Inhalation of infected air, contact with infected body fluids, contact with infected skin (rashes, lesions)  How can they be prevented? Avoiding contact with infected air, fluids, and skin

3. Sexually Transmissible Infections (STIs) : Sexually Transmitted Diseases (STDs) Venereal Diseases are illnesses that have a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex. While in the past, these illnesses have mostly been referred to as STDs or VD, in recent years the term sexually transmitted infections (STIs) has been preferred, as it has a broader range of meaning; a person may be infected, and may potentially infect others, without having a disease. Some STIs can also be transmitted via the use of IV drug needles after its use by an infected person, as well as through childbirth or breastfeeding.humanshuman sexual behaviorvaginal intercourseoral sexanal sexIV drugneedleschildbirthbreastfeeding VenereologyVenereology is the branch of medicine that studies these diseases.

4. Sexually Transmissible Infections :  Bacterial Infections Chlamydia (Chlamydia Trachomatis) Gonorrhea (Neisseria Gonorrhea) Syphilis (Treponema Palladium)  Viral Infections Herpes Hepatitis B Molluscum contagiosum HIV Human papillomavirus (HPV)

5. Common STIs :  Human Papillomavirus (HPV) (virus) Warts on genitals and anus (men and women) Warts and pre-cancers on cervix (women) Often asymptomatic, presenting no visible symptoms Communicable or non-communicable when asymptomatic  Chlamydia (bacteria) (Chlamydia Trachomatis) Infected cervix, tubes, epididymis Sometimes no symptoms at all

6. Common STIs :  Herpes (HSV I & II) (virus) Painful ulcers Often no symptoms at all  Molluscum Contagiosum (virus) Pimple-like lesions Often confused with pimples or folliculitis  Chancriod (Haemophilus Ducreyi)  Granuloma Inguinale (Klebsiella Granulomatis)

7. “Risky Contact” for the Spread of STIs ?  You don’t have to have sexual intercourse to contract an STI ? Many STIs are spread by direct skin contact Everyone who has “risky contact” is at risk Teens and young adults are more “at risk” than other populations

8. “Risky Contact” for the Spread of STIs ?  Condoms do NOT completely protect from infections spread by skin contact, because they do not cover all infected areas of the skin Infection with these organisms does not require penetration during intercourse if there is other “risky contact.” HPV Herpes Molluscum

9. “Risky Contact” for the Spread of STIs ?  Avoid “risky contact,” which is any contact with skin or fluids that may contain the viruses and bacteria that cause STIs  Don’t share intimate apparel such as swimwear or underwear

10. Who gets STIs ?  Anyone who has “risky contact” with a person with an STI  One contact might be all it takes to get an STI  The more contacts, the greater the risk

11. The Most Prevalent STIs : Chlamydia :  Women: infects urethra, cervix Often no symptoms Sometimes pain with urination or lower abdominal pain Infection can spread to tubes and ovaries Can cause infertility  Men: infects urethra, epididymis Can cause pain with urination Swelling and pain of the testicles Spread by body fluids Semen Vaginal Anal

12. Epididymitis due to Chlamydia - the swelling of this infection is seen above the right testicle

13. Hydrosalpinx resulting from Chlamydia - closed, swollen and water-filled left tube in a young woman

14. The Most Prevalent STIs : Genital herpes :  Men and women: genital skin Extremely painful lesions Often no symptoms  Women: cervix Abnormal vaginal discharge Often no symptoms May infect newborns during delivery Spread by skin contact Genital-Genital Hand-Genital Oral-Genital

15. Penis with vesicles (blisters) from genital herpes

16. External genital skin of female with herpes ulcers

17. The Most Prevalent STIs :  Molluscum Contagiosum : Can appear anywhere on the skin Bumps that look like pimples Can become infected with bacteria Spread by body skin contact Genital-Genital Hand-Genital Oral-Genital

18. Molluscums of lower abdomen

19. External genital skin of female with huge molluscums

20. Human Papillomavirus (HPV) :  Over 100 types of HPV More than 20 types of HPV can infect genital skin Men and women: genital and anal warts Women: lesions on the cervix and vagina Spread by skin contact Genital-Genital Hand-Genital Oral-Genital

21. Human Papillomavirus (HPV) :  HPV: Genital Warts Men and women: external genital skin, anus, in urethra Women: cervix, vaginal walls Condoms offer some protection, but don’t cover all of the skin that can be infected

22. Papillary genital warts of female

24. Flat genital warts of male

25. Papillary genital warts of male

27. Papillary genital warts of male anus

28. HPV and Pre-Cancers :  Cervix and anus: some HPV types cause lesions that can be pre-cancers If not treated, they can eventually become cancers  The Pap smear detects lesions on cervix Cells scraped from cervix are examined under a microscope If they have ever had sexual contact, women need yearly Paps

29. Genital warts on cervix of female

30. Pre-cancer changes on cervix

31. If you think you have an STI ?  See a health care professional  Be honest about your sexual behavior  Ask for explanations  If you do have an STI, notify your partner

32. American College Health Association Many STIs Have No Symptoms ?  In women: over 50% with gonorrhea and 70% with Chlamydia had no symptoms  In men: 68-92% with gonorrhea and 92% with Chlamydia reported no symptoms

33. Remember: Golden Role ( Abstinence works best )  Avoid genital touching  Many teens and young adults are choosing abstinence for now  Abstinence reflects feelings of self worth and self esteem  Not everyone is “doing it”  Sexual activity is NOT a requirement for friendship or social acceptance

34. American College Health Association STI Prevention ?  Abstinence works best Avoid genital touching Many teens and young adults are now choosing abstinence Abstinence reflects feelings of self worth and self esteem Not everyone is “doing it” Sexual activity is NOT a requirement for friendship or social acceptance

35. STI Prevention :  Alcohol and Drugs contribute to becoming infected with an STI  Combined with sexual activity, the use of alcohol and other drugs is strongly associated with: Sexual activity when you are not really ready The spread of STIs Unwanted/unplanned pregnancy

36. American College Health Association Testing for STIs :  There is no single test that detects all STIs  No test is perfect (every test can fail to detect an infection)  Screening tests (used when no symptoms are present) HPV (visual examination; Pap smear tests the cervix only) Chlamydia, gonorrhea (tests of genital secretions or urine) HIV, syphilis (specific blood tests) There is no reliable test for herpes when symptoms are absent

37. American College Health Association Treatment :  Cefixime  Azithromycine  Metronidazole

38. American College Health Association HPV Protection :  Consistent condom use can cut down, but not eliminate, the transmission of HPV  Many HPV-associated lesions resolve spontaneously, but they may return  Warts can be treated and removed, but the virus may remain in latent form  See your health care provider for an accurate diagnosis and appropriate treatment

39. American College Health Association HPV Treatments : Treatments for External Genital Warts  Patient-applied prescription remedies Aldara™ (imiquimod) Cream, 5% Condylox™ gel 0.5% (podofilox)  Procedures performed in the doctor’s office Freezing–cryoprobe or liquid nitrogen Caustic chemicals–TCA, BCA, podophyllin Laser

40. American College Health Association HPV—Treatments of the Cervix and Anus :  Cervix: destruction of lesion by freezing, laser, loop excision These treatments are about 90% successful  Anus: similar to external genital warts Aldara™, Condylox™, freezing, caustic chemicals, laser

41. The Connection Between STIs and HIV ?

42. Three Main Points :  There is a causal link between infection with STIs and increased transmission of HIV  Preventing and treating STIs will reduce the number of new HIV infections  You can make a difference by helping people prevent, identify and treat STIs

43. What is the STIs-HIV Connection?  Similar behaviors put people at risk of both STIs and HIV  A current STI can increase risk of getting HIV by 2-5 times  People with both HIV infection and another STI have increased HIV viral loads and can more easily infect others with HIV  People with HIV can have more serious complications of other STIs

44. Epidemiologic Evidence ?  Researchers have observed a strong association between having STIs and HIV in a number of studies.  The association is termed “epidemiological synergy”  2-5 fold increased risk for HIV infection among persons who have other STIs.

45. Why the Increased Risk ?  Ulcers and inflamed areas provide an easy portal of entry  STIs attract T-helper cells to the infected area  Even asymptomatic STIs can cause abnormal cellular changes that allow easier passage of infectious agents.  Some STIs increase viral load and shedding of HIV

46. American College Health Association Recommendations :  Use condoms with all new sexual partners  Reduce the number of new sexual partners  Identify and treat new STIs  Know that most STIs do not produce symptoms  People already infected with HIV should be screened routinely for STIs

47. American College Health Association Recommendations (Continued) :  Regular screening for those at risk of STIs Those particularly at risk: sexually active young adults, especially those with multiple partners, those who exchange sex for drugs or money, and young men who have sex with men  Easy access for all to STI care and treatment  Education that douching (vaginal or anal) may increase the risk of acquiring HIV or another STI

48. American College Health Association Conclusions :  There is a direct link between other STIs and HIV transmission  Early identification and treatment of STIs will reduce HIV transmission  You can make a difference by helping people know these facts and working with those at risk to get screened and treated

49. Thank You