1. Epidemiology of STD

2. Change in incidence (simple access to antibiotic, change to sexual behavior, multiple partner, low age of sexual contact, addiction, hemoseuality ) Epidemiology in developed and undeveloped area

3. Trichomoniasis There are >170 million cases of trichomoniasis annually worldwide, including >7.4 million new cases annually in North America. Trichomoniasis vaginalis is the protozoan that causes trichomoniasis. Men who are infected may be asymptomatic or may have nongonococcal urethritis. Women who are infected may have no or minimal symptoms.

4. Epidemiology of STD The Centers for Disease Control and Prevention (CDC) estimated that 20 million new sexually transmitted diseases (STDs) occur each year in USA. Of the new cases, half occur in patients aged 15 to 24 years. Although there have been significant advances in prevention, diagnosis, treatment, and education, the occurrence of STDs continues to increase. Diagnosis and treatment continue to be major public health challenges because of the asymptomatic nature of many of these infections

5. Epidemiology of STD The most common STDs include: Chlamydia Herpes simplex virus types 1 and 2 Human papillomavirus (HPV) Syphilis Gonorrhea Bacterial vaginosis Trichomoniasis and pelvic inflammatory disease (PID)

6. Epidemiology of STD STDs have not only physical but also emotional and psychological consequences for infected patients. STDs also have a direct and indirect economic effect; costs associated with STDs were estimated to be approximately $14.7 billion in 2006. Many attempts have therefore been made to increase prevention, proper diagnosis, and early treatment of STDs.

7. Epidemiology of STD In the general population, patients are considered to be at high risk for contracting an STD: Multiple sex partners Used intravenous (IV) drugs, have been Men who have sex with men (MSM) Contact withprostitutes Unprotected intercourse and are not in a monogamous relationship.

8. Epidemiology of STD Special populations to consider when assessing a patient's risk for STDs include: Pregnant women Adolescents MSM Women who have sex with women (WSW) and older patients.

9. Chlamydia Chlamydia trachomatis infection is the most frequently reported sexually transmitted infectious disease in the United States and continues to be an important risk factor for pelvic inflammatory disease (PID), ectopic pregnancies, urethritis, cervicitis, chronic pelvic pain, and infertility. In 2007, there were 1,108,374 cases of chlamydia reported to the CDC. In women, the highest age-specific rates were among patients aged 15 to 19 years (3,004.7 cases per 100,000) and those aged 20 to 24 years (2,948.8 cases per 100,000). Typically, patients are asymptomatic and are unaware of an infection with C trachomatis. 7

10. Genital herpes Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infections are both chronic, lifelong viral infections. Approximately 50 million people in the United States are infected with HSV. Historically, HSV-2 has been the causative agent in the majority of genital herpes cases, but HSV-1 has become more prevalent, causing approximately half of first episode outbreaks. Epidemiology of STD

11. Genital herpes 15-fold increase during 1966 to 1984. 724000 new cases annually in USA.

12. Genital warts Human papillomavirus (HPV), which is responsible for cervical cancer and genital warts. In most studies HPV is the most common STD. Although there are >100 genotypes of HPV, the 4 genotypes targeted by the vaccine cause the majority of cervical cancers and genital warts. HPV types 6 and 11 cause 90% of genital warts, and types 16 and 18 cause 70% of cervical cancers. Vaccination ???

13. Genital warts Similar to HSV. Magnitude 3-4 greater to HSV. Eradication ???

14. Gonorrhea Neisseria gonorrhoeae infection has been increasing over the past few years, causing a growing public health concern in the United States.

15. Gonorrhea After outbreak during second world war, decrease incidence were seen. Between 1964 to 1975 increase were seen. There is resistant species of NG to antibiotics.

16. Syphilis Syphilis is caused by the bacterium Treponema pallidum. Although syphilis incidence had decreased by 2000, the incidence of the disease has since increased; in 2007, a total of 11,466 cases were reported, an increase of 15% from 2006. The population most affected is MSM.

17. Syphilis After large outbreak of syphilis during second world war, dropped low level of syphilis. Between 1985-89 high incidence were seen.

18. Bacterial vaginosis Bacterial vaginosis (BV) is a polymicrobial syndrome that causes 10% to 30% of infectious vaginitis cases in women of childbearing age. Bacterial vaginosis is the result of an overgrowth of Gardnerella vaginalis, Mycoplasma hominis, Mobiluncusspecies, Bacteroides species (excluding Bacteroides fragilis), and Peptostreptococcusspecies. 50% of women with BV are asymptomatic.

19. گزارش موارد چند بیماری آمیزشی در ايران در سال 1385 سوزاك 6373 تريكومونيازيس 127567 زگيل هاي تناسلي 6806 تبخال ژنيتال 3863 سيفيليس 952 پي آي دي 41988 اورتريت غير سوزاكي 2556 سرويسيت غير سوزاكي 47922