1. Sexually Transmitted Infections: What You Need To Know
Presented By
Jessica Papocchia, B.S., M.S.
Suffolk County Health Services

3. Why Can’t We Talk About It?
“STDs are hidden epidemics of enormous health and economic consequence in the United States. They are hidden because many Americans are reluctant to address sexual health issues in an open way and because of the biologic and social characteristics of these diseases.”
STD Surveillance 2007, CDC, Division of STD Prevention November 2009, pg. vi
Sexually Transmitted Disease Surveillance, 2008 presents statistics and trends for sexually transmitted diseases (STDs) in the United States through This annual publication is intended as a reference document for policy makers, program managers, health planners, researchers, and others who are concerned with the public health implications of these diseases.
The process of preventing STDs must be a collaborative one. No one agency, organization, or sector can effectively do it alone; all members of the community must do their part. A successful national initiative to confront and prevent STDs requires widespread public awareness and participation and bold national leadership from the highest levels.”
Concluding statement from the Institute of Medicine’s Summary Report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, National Academy Press, Washington, DC, 1997, p.43, as cited in STD Surveillance 2008, CDC, pg. vi

4. Objectives
You will understand some of the common issues associated with STDs which further complicate the problem
You will learn some basic, yet highly functional, information about some common STDs, including transmission, symptoms, complications, testing, treatment, and prevention
You will become aware of the process of partner notification and understand the role it plays in interrupting in the spread of infection

5. Statistics
The Centers for Disease Control and Prevention (CDC) estimates there are approximately 20 million new STD infections nationwide each year.
Half of all new infections occur in young people (ages 15-24)
1,412,791 Chlamydial infections were reported to CDC from 50 states and the District of Columbia in 2011
Suffolk County reported 3,442 for 2012
(2,887 of those occurred in ages 15-29).
Many STDs go undiagnosed, and some highly prevalent viral STDs, such as human papilloma virus and genital herpes, are not reported at all.
Statewide, 2009 figures represent an increase of four percent over 2008 with a three percent increase in NYC (2009: 58,353 cases; 2008: 56,448 cases) and a five percent increase in Upstate New York
Estimates suggest that 15- to 24-year-olds acquire nearly half of all new STDs.
Young People (15-24) have FIVE TIMES the reported Chlamydia rate of the entire population (10-65+).
Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States. What is a REPORTABLE infection??
Why do you think there is a higher prevalence among adolescents? The higher prevalence of STDs among adolescents may also reflect multiple barriers to accessing quality STD prevention services, including lack of insurance or other ability to pay, lack of transportation, discomfort with facilities and services designed for adults, and concerns about confidentiality.
In 2008, there were more than 1.5 million total cases of chlamydia and gonorrhea reported to CDC — making them the two most commonly reported infectious diseases in the United States. Adolescent girls and young women are especially hard hit by these two diseases. The largest number of reported cases of both chlamydia and gonorrhea in 2008 was among girls between 15 and 19 years of age, followed closely by young women 20 to 24 years of age. This likely reflects a combination of factors, including biological differences that place females at greater risk for STDs than males, as well as higher STD screening rates among young women.

6. Chlamydia
Chlamydia is the most commonly reported STD in the United States.
Can cause infection in men, women, and newborn babies
Chlamydia is caused by a bacteria
Incubation Period: 2-3 weeks
The person can pass it on to sex partners and to babies during childbirth

7. Symptoms of Chlamydia Symptoms in Women: Usually asymptomatic
Abnormal vaginal discharge
Pain during sex
Complications, if not treated:
Pelvic inflammatory disease (PID)
Symptoms in Men:
Usually asymptomatic
Discharge from the penis (may be runny, whitish)
Burning on urination
Complications, if not treated
Swollen and tender testicles (epididymitis)

8. Chlamydia Symptoms in Men
Source: Seattle STD/HIV PTC

9. Chlamydia Symptoms in Women Mucopurulent Cervicitis
Source: St. Louis STD/HIV PTC

10. Testing & Treatment for Chlamydia
Easily detected by a urine test or a swab; and
Easily cured with antibiotics; but
Any damage to the body cannot be repaired

11. Gonorrhea
Gonorrhea is sometimes called clap, drip, dose, strain, gleet or the whites
Incubation period: 1 – 14 days
A bacteria causes gonorrhea
Can cause infections in men, women, and new babies
The person can easily pass it on to sex partners and babies during childbirth

12. Gonorrhea Symptoms in Men
Discharge from the penis (may be thick, milky white, yellowish, or greenish)
Burning on urination
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

13. Gonorrhea Symptoms in Women
Usually asymptomatic
Painful urination
Abnormal vaginal bleeding
Pain during sex
Source: Health Awareness Connection

14. Complications in Men Swollen or tender testicles (epididymitis)
Disseminated gonococcal infection (DGI)

15. Swollen or Tender Testicles (Epididymitis)
Source: Health Awareness Connection,

16. Disseminated Gonococcal (Gonorrhea) Infection
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

17. Complications in Women
Bartholin’s Abscess
Pelvic inflammatory disease (PID)
Disseminated gonococcal infection (DGI)

18. Pelvic Inflammatory Disease (PID)
A: Uterus
B: Fallopian tube
C: Cervix
D: Ovary

19. Severe Pelvic Inflammatory Disease
Normal Female Reproductive System
Severe Pelvic Inflammatory Disease
Source: The Embryologists Newsletter

20. Bartholin’s Abscess
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

21. Testing & Treatment for Gonorrhea
Easily detected by a urine test or swab; and
Easily cured with antibiotics; but
Any damage to the body cannot be repaired.

22. Syphilis Syphilis is caused by a bacteria Occurs in stages
Incubation Period: days (average 21 days)
Can cause infections in men, women, and unborn babies during pregnancy

23. Symptoms of Syphilis Primary Stage
A painless sore called a chancre may be located on the genitals, lips, anus, or other area of direct contact
The chancre will last 1-5 weeks and heal without treatment
The person can easily pass it on to sex partners

24. Primary Syphilis Chancre in a Man
Source: CDC/ NCHSTP/ Division of STD Prevention,
STD Clinical Slides

25. Primary Syphilis Chancre in a Woman
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

26. Symptoms of Syphilis Secondary Stage
Skin rashes lasting 2 – 6 weeks (average of 4 weeks) on the palms of the hands, bottoms of the feet, or any part of the body
Other symptoms include fever, swollen lymph glands, headache, hair loss, and muscle ache
Symptoms will go away without treatment
The person may be able to pass it on to sex partners

27. Secondary Syphilis Palm Rash
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

28. Symptoms of Syphilis Late Stage
Paralysis
Insanity
Blindness
Damage to knee joints
Personality changes
Impotency
Aneurysm (ballooning of a blood vessel)
Tumor on the skin or internal organs

29. Congenital Syphilis
A mother can pass syphilis on to her unborn child

30. Testing & Treatment for Syphilis
Easily detected by a blood test; and
Easily cured with antibiotics;
Any damage done to the body cannot be repaired.

31. Herpes (HSV) There are 2 types of HSV: HSV-1 and HSV-2.
HSV-2 causes most genital infections.
HSV-1 causes oral infections (cold sores, fever blisters) and some genital infections.

32. Genital Herpes Causes infection in men, women, and newborns
Herpes simplex viruses (HSV) cause genital herpes infections.
Incubation period: 2 – 12 days
The person can easily pass it on to sex partners and babies during childbirth

33. Symptoms of Genital Herpes
Numerous painful lesions (sores)
On the penis, vagina, anus, buttocks, thighs, mouth, or finger
Last up to 4 – 21 days
Other symptoms include headache, fever, muscle aches, swollen lymph nodes, and difficult urination.
Symptoms may or may not come back.

34. Herpes in a Man
Source: Cincinnati STD/HIV Prevention Training Center

35. Herpes in a Woman Source: CDC/NCHSTP/Division of STD,
STD Clinical Slides
Source: CDC/NCHSTP/Division of STD, STD Clinical Slides

36. Herpes Simplex (HSV) HSV-1 HSV-2 Cold Sores Oral-genital frequent
Genital Lesions
Genital-oral infrequent

37. You can get herpes anywhere . . .
Source: Cincinnati STD/HIV Prevention Training Center

38. Testing & Treatment for Genital Herpes
Can be detected by:
culturing the lesion
blood test
Herpes cannot be cured, but symptoms can be treated with medicines called antivirals.
You can still spread herpes even if you are taking antiviral medicine!

39. Genital Herpes Without Symptoms
Many people with herpes do not have any symptoms or do not recognize that they have symptoms.
Most people with herpes can pass the virus to sex partners even when they do not have symptoms.

40. Human Papillomavirus (HPV)
HPV is so common that at least 50% of sexually active men and women get it at some point in their lives.
Approximately 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year.
Many types of Human Papillomavirus (HPV), some of which infect the genital area
Incubation period unclear
Can infect men, women, and newborns
The person can easily pass it on to sex partners

41. Genital HPV: Two Types
The types of HPV that infect the genital area are labeled “low-risk” or “high-risk” depending on whether they can cause cancer or not.
Low-risk HPV types can cause genital warts.
High-risk HPV types can cause serious cervical lesions, cervical cancer, and other genital cancers.

42. Symptoms of Genital HPV Infection
Usually asymptomatic and brief (6 – 12 months)
Genital warts (usually infection with low-risk type of HPV)
Warts on the penis, vagina, anus or urethra
Rarely may have itching, bleeding, burning, or pain along with the warts
May go away on their own, stay about the same, or get worse

43. Symptoms of Genital HPV Infection
Cervical lesions (usually infection with high-risk type of HPV)
Usually no symptoms
Detected by Pap smear
Most will go away on their own
Some will persist and need to be followed by health care provider
Most women with high-risk HPV types do not get cervical cancer

44. HPV Penile Warts
Source: Cincinnati STD/HIV Prevention Training Center

45. Genital Warts in a Woman
Source: CDC/NCHSTP/Division of STD, STD Clinical Slides

46. Perianal Wart
Source: Cincinnati STD/HIV Prevention Training Center

47. Testing & Treatment for Genital Warts
No tests for genital warts
Several types of treatment are available
Warts may come back
Cervical lesions and cervical cancer
Regular Pap smears are best way to detect serious lesions and prevent cervical cancer
Pap smear screening is recommended for all sexually active women

48. HIV/AIDS
CDC estimates that more than one million people are living with HIV in the United States (US). One in five (21%) of those people living with HIV is unaware of their infection.
In 2008, 249 newly diagnosed in Nassau & Suffolk Counties (41 of those ages 13-19)
NO CURE FOR HIV
There IS treatment
Sometimes symptoms do not appear until 10 or more years later
You can NOT tell by looking at someone if they are infected
The CDC is one of the major operating components of the Department of Health and Human Services. CDC′s Mission is to collaborate to create the expertise, information, and tools that people and communities need to protect their health – through health promotion, prevention of disease, injury and disability, and preparedness for new health threats.
CDC estimates 56,300 Americans becoming infected with HIV each year.
Human Immunodeficiency VIRUS
Symptoms MAY include fever, headache, tiredness, enlarged lymph nodes (glands in neck and groin)
These symptoms include lack of energy, weight loss, frequent fevers and nights sweats, yeast infections, skin rashes, short term memory loss.
HIV progresses to AIDS (coughing, shortness of breath, persistent diarrhea)
Prenatal testing is done, should have another done at time of delivery

49. How Do You Get It?
HIV is spread through blood, semen, vaginal secretions & breast milk
Enters the body through the lining of the vagina, vulva, penis, rectum or mouth during sex
Can also be spread by sharing needles/syringes
Women CAN pass HIV onto their baby during pregnancy, delivery or from breastfeeding

50. How Do You NOT Get It? Abstain from sexual activity
Be monogamous/limit sexual partners and KNOW your partner
Use condoms CORRECTLY and EVERY time you have sex
Abstain from and/or limit drug and alcohol use
Harm reduction if choosing to engage in risk behaviors
Universal precautions
We have some of the power to NOT get these diseases

51. What’s the Big Deal?? Medical Complications Physical Discomfort
Lifetime Therapy Regimens
Re-infection
Social Issues
Monetary Costs
Untreated STDs can lead to serious long-term health consequences, especially for adolescent girls and young women.
Some are curable, some are not

52. Who Should You Tell? (Partner Notification)
Several options for notifying all past & present sex and/or needle-sharing partners
Free, Voluntary, Confidential
“Need to Know” Basis
Domestic Violence Screening
Explain Reportable Infections
Provider Report & Provider Responsibilities

53. What Can You Do? TALK TO YOUR PARTNER(S)
Modify Risk Behavior/Harm Reduction
Testing/Treatment
Partner Notification
Educate Others
WE HAVE THE POWER TO PREVENT THESE INFECTIONS
Limit sexual partners, use condoms, get tested, RESPECT your sexual health and that of your partners
Don’t take for granted that your friends & family know much about STDs

54. Info & Partner Services
Local STD Unit
(631)
Info & Partner Services
Free Condoms
at S.C. Health Centers!!!
Suffolk County Health Centers
Free STI Testing & Treatment
Local EZ Call:
“Public Health Visit”
GET TESTED!!!

55. QUICK!
ANONYMOUS!
FREE HIV Testing!!!

56. Where Can You Get More Information?
Hotline AIDS

58. Questions?

59. References
Common Sexually Transmitted Diseases: STD 101 for Non-Clinicians, Developed by The Training and Health Communications Branch, in partnership with the Program Development and Support Branch, Division of STD Prevention
NCHSTP, CDC