1. Sexually Transmitted Diseases
Presenter Norma Sanchez, CDS II

2. STD Overview
STDs affect men and women of all backgrounds and economic levels.
Most prevalent among teens and young adults with nearly 2/3 of all STDs occurring in people under age 25.
Contributing factors in the rise of STDs include: young people have become sexually active earlier, divorce is more common and sexually active people are more likely to have multiple sex partners. Important to note that it is the behavior which puts you at risk not who you are.

3. Types of STDs Bacterial Viral Chlamydia Gonorrhea
Pelvic Inflammatory Disease (PID)
Syphilis
Viral
Genital Warts
Hepatitis B and C
Herpes
HIV

4. Warning! This section contains graphic images of infectious diseases –
You have been warned

5. Chlamydia Caused by Chlamydia Trachomatis.
Can be transmitted during vaginal, oral, and anal sexual contact.
If symptoms appear, they will occur 1-3 weeks after exposure.
Complications: PID, sterility, premature or still births, blindness.

7. Picture of a Normal Cervix

8. Cervical Ectopy

9. Inflammation of the cervix from Chlamydia infection

10. Chlamydia/GC

11. 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)

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

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

14. 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

15. Gonorrhea Caused by Neisseria gonorrhea.
Symptoms may occur 2-21 days after exposure.
Transmitted during vaginal, anal and oral sex.
Can also be transmitted from infected mother to infant during birth.
Complications: PID, sterility, blindness, meningitis, kidney and heart damage, skin rash, ectopic pregnancy.

16. Symptoms of Gonorrhea For Men For Women
Thick yellow or white discharge from vagina
Bleeding from vagina between periods
Burning/pain when urinating/during bowel movement
Cramps and pain in lower abdomen
For Men
Thick yellow or white drip from the penis
Burning or pain when urinating
Need to urinate more often

17. Gonorrhea

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

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

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

21. Gonorrhea Symptoms in Women
Usually asymptomatic
Painful urination
Abnormal vaginal bleeding
Pain during sex
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

22. Cervical GC

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

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

25. Pelvic Inflammatory Disease (PID)
Gonorrhea
Pelvic Inflammatory Disease (PID)
Source: Cincinnati STD/HIV Prevention Training Center

26. Gonorrhea
Gonorrhea in Infants
A mother can pass gonorrhea to her baby during childbirth

27. 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.

28. Pelvic Inflammatory Disease (PID)
Usually caused by Chlamydia trachomatis or Neisseria gonorrhea.
PID occurs when bacteria travel from the vagina through the cervix and into the uterus, fallopian tubes, or ovaries.
Symptoms:
Pain in the lower abdomen or lower back.
Pain in the abdomen during sex.
Fever, chills, or vomiting.
Unusual bleeding or discharge from the vagina.
Complications: infertility, ectopic pregnancy, scar tissue in the pelvic organs, chronic abdominal pain.

29. Syphilis Caused by Treponema pallidum.
Transmitted during vaginal, anal and oral sex.
Symptoms may occur 10 days to 3 months after exposure.
An infected mother can pass the disease to her unborn child.
Three stages: Primary, secondary, tertiary or late.

30. 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

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

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

33. Primary Syphilis
The first symptom is a painless chancre at site of entry of the bacteria i.e. mouth, sex organs, breasts, or fingers which may occur 3-12 weeks after exposure.
Sore can last 1-5 weeks but then disappear.
Swollen glands.

34. Primary chancre

35. Primary syphilis

36. Primary syphilis

37. Secondary Stage
If syphilis is not treated in the first stage the symptom will go away.
About 4 months later (early latent stage) secondary symptoms will show up.
They may show up 0-10 weeks, average is 4 weeks.
Symptoms may last 2-6 weeks, average is 4 weeks.

38. Secondary Syphilis Rash anywhere, but primarily on palms and soles.
Patchy hair loss.
Sore throat.
Swollen glands.
1 week to 6 months after appearance of primary chancre.
This set of symptoms will also eventually disappear.

39. Secondary Syphilis

40. Secondary Syphilis

41. Secondary Syphilis

42. Congenital Syphilis

43. Third Stage of Syphilis
If a person is not treated during these two stages syphilis still remains in the body.
It may take several years but syphilis becomes “latent” which means: to hide.
During this stage syphilis can do damage to the body.

44. Tertiary or Late Syphilis
Approximately 1/3 of untreated cases of secondary syphilis will progress to this stage.
This stage may continue years with no obvious symptoms.
Can cause lesions on body organs such as the brain and heart.

45. Late Syphilis, Gumma

46. Special populations
Women who are pregnant get tested at the beginning of their pregnancy if seen by a doctor.
A woman may become infected during her pregnancy and may transmit syphilis to her child without knowing it.
A baby born from a mother who has syphilis may die from complications of syphilis.

47. End of bacterial slides
There are more bacterial infections but these are the 3 that are reported to the Health Department.
QUESTIONS??????

48. Viruses Viruses are not curable.
The symptoms are treatable and can be manageable.
The viruses we will talk about are:
Herpes
Genital Warts
Hepatitis B and C
HIV

49. Genital Herpes Caused by the Herpes Simplex Virus. Lives in CNS.
Transmitted through skin to skin contact.
Symptoms may occur 1-30 days after exposure.
Transmitted during vaginal, anal, and oral sex.
Transmission can also occur when blisters are not present.
No cure, only treatment available.

50. Symptoms of Genital Herpes
Transmitted through skin to skin contact.
Flu-like symptoms.
Painful blisters/sores at the site of infection, i.e. mouth, penis, vagina, anus, cervix, lips, tongue, gums, and eyes.
Blisters can last 1-3 weeks.
Blisters will heal but may reappear throughout life.
Prodrome effect.
Complications: May cause brain damage or death in infants.

51. HSV I

52. HSV II

53. Human Papillomavirus (HPV)

54. HPV
Human Papillomavirus
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

55. HPV
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.

56. 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

57. 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

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

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

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

61. Testing & Treatment for Genital Warts
HPV
Testing & Treatment for Genital Warts
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

62. Genital Warts Caused by Human Papilloma Virus.
Symptoms may occur 1-8 months after exposure.
Transmitted by direct skin to skin contact.
Can also be passed although no visible warts are present.
No cure, only treatment available for the warts.
Complications: may cause cervical, vulvar, or penile cancer.

63. Symptoms of Genital Warts
Small, bumpy or flat warts on the sex organs and anus.
Itching or burning around the sex organs.
Some people have no visible warts.

64. Symptoms of Genital Herpes
Transmitted through skin to skin contact.
Flu-like symptoms.
Painful blisters/sores at the site of infection, i.e. mouth, penis, vagina, anus, cervix, lips, tongue, gums, and eyes.
Blisters can last 1-3 weeks.
Blisters will heal but may reappear throughout life.
Prodrome effect.
Complications: May cause brain damage or death in infants.

65. Condyloma (Warts)

68. Anal Warts

69. Penile Warts

70. Gardisil
Current vaccine for Gardisil starting for young girls at age 9.
If on Medi-Cal they can be up to age 20 to receive a free physical and vaccine.
If not on Medi-Cal and is enrolled through CHDP it is up to age 18.
3 doses, over a 6 month period

71. Hepatitis B and C Hepatitis - Inflammation of the liver.
Transmitted during vaginal, anal, and oral sex, sharing razors, toothbrushes, needles.
Can also be passed from infected mother to child during birth.
HBV can live on environmental surfaces for up to 7 days.
Complications: Cirrhosis, liver cancer and death. Can also cause premature birth or spontaneous abortion.

72. Symptoms of Hepatitis Nausea, vomiting. Fatigue. Loss of appetite.
Jaundice.
Dark-colored urine/light-colored stools.
Enlarged liver/liver pain.

73. Herpes in a Woman Herpes Source: CDC/NCHSTP/Division of STD,
STD Clinical Slides
Source: Cincinnati STD/HIV Prevention Training Center

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

75. Herpes
Herpes Complications
HSV-2 causes serious problems when it is passed to newborns during birth.

76. 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!

77. Genital Herpes Caused by the Herpes Simplex Virus. Lives in CNS.
Transmitted through skin to skin contact.
Symptoms may occur 1-30 days after exposure.
Transmitted during vaginal, anal, and oral sex.
Transmission can also occur when blisters are not present.
No cure, only treatment available.

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

79. It gets worse!!!

80. Blue Waffle

81. Hepatitis B and C Hepatitis - Inflammation of the liver.
Transmitted during vaginal, anal, and oral sex, sharing razors, toothbrushes, needles.
Can also be passed from infected mother to child during birth.
HBV can live on environmental surfaces for up to 7 days.
Complications: Cirrhosis, liver cancer and death. Can also cause premature birth or spontaneous abortion.

82. HIV
Human
Immunodeficieny
Virus
HIV is the virus that causes AIDS

83. AIDS Acquired Immune Deficiency Syndrome
When your body is no longer able to protect you from disease because your immune system has been compromised.

84. Which bodily fluid is not HIV infectious?
Semen
Blood
Vaginal Secretions
Saliva
Breast Milk

85. Infectious Non-infectious 1) Blood 1) Sweat 2) Semen 2) Saliva
3) Vaginal Secretions
4) Breast milk
1) Sweat
2) Saliva
3) Urine
4) Tears
5) Mucus

86. Behaviors/Activities/Events
1) Unprotected Sexual Intercourse
-Anal, Vaginal, and Oral
2) Sharing Needles
-To inject: IV drug use, steroids, medicine
- What about piercing: ears, nose, body and tattoos??????
3) Vertical Transmission- Mother to baby
4) Blood Transfusions/Blood Products
5) Accidental Blood to Blood Contact

87. Barriers Monogamy - Two people who are lifetime partners
Serial Monogamy - Having multiple monogamous relationships
If practicing serial monogamy, one should use condoms
LATEX 98% Effective
POLYURETHANE 95%Effective
Male Condoms
Dental Dams
Male Condoms
Female Condoms
Water Based Lubricants are recommended for use with condoms

89. Acceptance
Bravery
Self-respect
Trust
Integrity
No Sex
Education
No Risk
Confidence
Esteem
Abstinence means no Sex, Drugs & Alcohol
Abstinence is the only 100% effective way not to get HIV

90. Only way to be 100% sure
Abstinence

91. Reduced Risk Behaviors
Monogamy
Condom Use (latex 98%, polyurethane 95%)
Water based lubricants
Dental Dams

92. Harm Reduction
What is it?

93. Testing The test looks for the presence of HIV antibodies.
Anyone who is sexually active should be tested for HIV.
Especially: Youth/Adolescents, People of Color, and Women.

94. Testing Anonymous Free testing available at the Health Department.
Confidential
Anonymous
Free testing available at the Health Department.
Results are available in 2 weeks.
Test can be done by blood sample.
Mobile Unit available at certain locations offer OraQuick® Rapid Testing, preliminary results are ready in minutes.
12 and over can test without parent permission.

95. Results Non reactive: What does it mean? Reactive: What does it mean?
Is it reportable?

96. Criteria for AIDS Diagnosis
1. Opportunistic Infection (There are 26). The most common are:
PCP - Pneumo Cystis Carinii Pneumonia
KS - Kaposi’s Sarcoma (MSM)
Esophageal Candidiasis
TB - Tuberculosis (Mycobacterium)
MAC
2. T-cells fall below 200 per cm (Healthy people have between T-cells)

97. TESTING Confidential Anonymous
Free testing available at the Health Department.
Rapid Test results in 30 mins
If you have a preliminary positive, then confirmatory results are available in 2 weeks
Test will be done by blood sample/draw
Mobile Unit available at certain locations offer OraQuick® Rapid Testing, preliminary results are ready in minutes.
12 and over can test without parent permission.

98. Relatively few cases were diagnosed among Asian, American Indian/Alaska Native, and Native Hawaiian/other Pacific Islander females, and females reporting multiple races, although the rates for these groups were higher than the rate for white females.

99. Woman are always at higher risk for STD’s and HIV Infection then men
True
False
I don’t know

100. CDC estimates that 1 in five people living with HIV infection in the United States do not know they are infected.
Getting tested for HIV is the first step to protecting yourself and others.
Knowing your own HIV status and that of your male sexual partners is critical because 85% of newly diagnosed HIV infections in US women and girls result from sex with an infected male partner.
Early diagnosis of HIV allows for counseling and prompt treatment. HIV treatment prolongs life and reduces the risk of further HIV transmission.
Encouraging your partner to wear a condom every time you engage in sexual activity is another important way to protect yourself

101. Questions and Answers Hope we didn’t ruin lunch!