1. Sexually Transmitted Infections
(STIs)
Dr. Assad Rahhal
National AIDS Program

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)
Also known as
Sexually Transmitted Diseases (STDs)
Venereal Diseases
What are your risks?

4. Sexually Transmissible Infections
Bacterial Infections
Chlamydia
Gonorrhea
Syphilis
Viral Infections
Herpes
Hepatitis B
Molluscum contagiosum
HIV
Human papillomavirus

5. Common STIs Human Papillomavirus (HPV) (virus) Chlamydia (bacteria)
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)
Infected cervix, tubes, epididymis
Sometimes no symptoms at all

6. Common STIs Herpes (HSV I & II) (virus) Molluscum Contagiosum (virus)
Painful ulcers
Often no symptoms at all
Molluscum Contagiosum (virus)
Pimple-like lesions
Often confused with pimples or folliculitis

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. 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

12. 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

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

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

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

16. Penis with vesicles (blisters) from genital herpes

17. External genital skin of female with herpes ulcers

18. The Most Prevalent STIs
Molluscum
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

19. Molluscums of lower abdomen

20. External genital skin of female with huge molluscums

21. 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

22. 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

23. Papillary genital warts of female

24. Papillary genital warts of female

25. Flat genital warts of male

26. Papillary genital warts of male

27. Papillary genital warts of male

28. Papillary genital warts of male anus

29. 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

30. Genital warts on cervix of female

31. Pre-cancer changes on cervix

32. 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

33. Remember: 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. 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

35. The Connection Between STDs and HIV

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

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

38. Many STDs 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

39. Epidemiologic Evidence
Researchers have observed a strong association between having STDs 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 STDs.

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

41. Recommendations Use condoms with all new sexual partners
Reduce the number of new sexual partners
Identify and treat new STDs
Know that most STDs do not produce symptoms
People already infected with HIV should be screened routinely for STDs

42. Recommendations (Continued)
Regular screening for those at risk of STDs
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 STD care and treatment
Education that douching (vaginal or anal) may increase the risk of acquiring HIV or another STD

43. Conclusions
There is a direct link between other STDs and HIV transmission
Early identification and treatment of STDs 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

44. Thank You

45. 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

46. 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

47. 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

48. 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