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Epi 723 Sexually Transmitted Infections and Womens Reproductive Health

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Chlamydia Positivity among 15-24 year old women tested in. prenatal clinics by state, 2000 ... among 16-24 year-old women entering the National Job Training ... – PowerPoint PPT presentation

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Title: Epi 723 Sexually Transmitted Infections and Womens Reproductive Health


1
Epi 723 Sexually Transmitted Infections and
Womens Reproductive Health
  • Patty Kissinger, Ph.D.
  • Kat Theall, MPH

2
Sexually Acquired Infections and Womens
Reproductive HealthCore Competencies
  • Describe the epidemiology and natural history of
    the most common sexually acquired pathogens
    among women
  • Describe the components of womens reproductive
    health
  • To identify contraceptive methods and how they
    influence acquisition of STIs
  • Describe the reproductive rate of an infectious
    disease epidemic
  • Describe methodological issues of studying
    treatable versus non-treatable STDs
  • Describe measurement issues in the STD research

3
Core Competencies (cont)
  • Describe epidemiologic methods to study
    interventions at the individual level and at the
    community level
  • Discuss issues in STI behavioral epidemiology
  • Critically evaluate the literature and identify
    appropriate study designs
  • Design a study examining an issue of womens
    reproductive health and sexually acquired
    infections

4
Day 1
5
Biological and Social issues of Women and STDs
  • Objectives are to
  • Define reproductive health
  • Discuss the role of epidemiology in STD control
  • Describe why women are more at risk for STDs then
    men
  • Identify the 25 sexually transmitted pathogens
  • Interpret STD surveillance data

6
Magnitude of the STI Problem
  • Annual incidence of curable STDs (which excludes
    AIDS) is 333 million cases
  • The top four most common are gonorrhea (62
    million), chlamydia (89 million), syphilis (12
    million) and trichomonas (170 million)
  • An estimated 250 million new infections of STIs
    occur each year.
  • 12 million new cases in the United states
  • 3 million of these cases in US are teenagers
  • Cost of PID is more than 3.5 million dollars

7
Problems specific to women?
  • Women are more vulnerable
  • Biologically
  • Culturally
  • Socio-economically
  • Majority of STDs are asymptomatic in women
  • 60-70 for gonococcal and chlamydial infections)
  • Consequences of STDs are very serious in women,
    sometimes fatal
  • Cervical cancer, ectopic pregnancy
  • For offspring - stillbirth and blindness

8
Women and STDs
  • Worldwide women may be less likely to seek
    healthcare for STDs because it is stigmatizing or
    they lack the financial resources to do so.
  • In developing countries where syndromic treatment
    is common, women will be under-treated.

9
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10
Human Sexuality
Reproduction
Sexuality
11
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12
Sexuality and Reproduction
  • When one wants sex but no reproduction barrier
    methods are okay
  • There is no good method for a women who wants to
    avoid STDs but also wants to become pregnant

13
Reproductive Health
Biological (age, Hormones, Gentics, parity and
gravida
Economics
Politics and Access to Health Care
nutrition
Fertility choices
STD
Gender roles
Norms
Others?
14
Reproductive Health
Biological (age, Hormones, Gentics, parity and
gravida
Economics
Politics and Access to Health Care
nutrition
Fertility choices
STD
Gender roles
Norms
Others?
15
Key Points in a womans reproductive life
16
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17
Basic Reproductive Rate of Infection
18
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19
Comparison of syphilis to HIV
HIV .003 400 2 2.4
syphilis .30 26 2 15.6
chlamydia .20 16 2 6.4
20
Biological reasons that place women at risk for
STDs
21
Vagina is more equipped to support pathogens
  • Larger surface area
  • More vascular and has more nutrients
  • Receptive sex
  • Most of the reproductive anatomy is inside

22
Male Anatomy
  • Yellow papules
  • sweat glands
  • redundant prepuce (foreskin)
  • glands of Tyson secrete keratinous material
    (smegma)
  • pearly penile papules (mistaken for HPV)

23
Female Anatomy
  • Pebbly papules on labia major
  • gland under clitoral hood secretes sebacious
    material (smega)

24
Adolescent women
  • More at risk because
  • More ectopy
  • Less acquired immunity
  • More high risk sex

25
Stratified squamous epithelium
  • Covers ectocervix
  • cells rich in glycogen in sexually mature women

26
Endocervical canal
  • Tall columnar cells line endocervical canal
  • deep invaginations of mucous secreting epithelium
    exist in cervical stroma and facilitate secretion
    of mucous

27
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28
Normal Cervix
  • Squamous junction is seen
  • part of the endocervical canals is also seen

29
Sexually transmitted infections
30
Modes of STD acquisition
  • Penile-vaginal
  • Oral-vaginal
  • Anal-vaginal
  • Sex toys, digits

31
TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND
ASSOCIATED DISEASES OR SYNDROMES - BACTERIA
32
TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND
ASSOCIATED DISEASES OR SYNDROMES - BACTERIA
33
TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND
ASSOCIATED DISEASES OR SYNDROMES- BACTERIA
34
TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND
ASSOCIATED DISEASES OR SYNDROMES - VIRUSES
35
TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND
ASSOCIATED DISEASES OR SYNDROMES - VIRUSES
36
TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND
ASSOCIATED DISEASES OR SYNDROMES - OTHER
37
Gender inequities and sexually transmitted
diseases
38
Interpreting Surveillance Data
  • Who is getting tested?
  • Are they representative of the target population?
  • Is the test good?
  • Is the reporting good?
  • Are the graphics numbers or percents?

39
WHO Report 2003
40
Surveillance issues
  • Women more likely to get tested
  • Women more likely to be index case
  • Women more likely to be reported

41
In class exercise
  • What do you know about the disease?
  • What does the slide tell us?
  • What hypotheses can you generate from the
    information?

42
Gonorrhea Reported rates United States,
19702001 and the Healthy People year 2010
objective
Note The Healthy People 2010 (HP2010) objective
for gonorrhea is 19.0 cases per 100,000
population.
43
Gonorrhea Rates by sex United States,
19812001 and the Healthy People year 2010
objective
44
Gonorrhea Rates by region United States,
19812001 and the Healthy People year 2010
objective
45
Gonorrhea Rates by state United States and
outlying areas, 2001
Note The total rate of gonorrhea for the United
States and outlying areas (including Guam, Puerto
Rico and Virgin Islands) was 126.9 per 100,000
population. The Healthy People year 2010
objective is 19.0 per 100,000 population.
46
Gonorrhea Positivity among 15-24 year old women
tested in family planning clinics by state
United States and outlying areas, 2001
States reported gonorrhea positivity data on
less than 500 women aged 15-24 years during
2001.SOURCE Regional Infertility Prevention
Program Office of Population Affairs Local and
State STD Control Programs Centers for Disease
Control and Prevention
47
Gonorrhea Rates by race and ethnicity United
States, 19812001 and the Healthy People year
2010 objective
48
Gonorrhea Age- and sex-specific rates United
States, 2001
49
Syphilis Reported cases by stage of illness
United States, 19412001
50
Primary and secondary syphilis Reported rates
United States, 19702001 and the Healthy People
year 2010 objective
Note The Healthy People 2010 (HP2010) objective
for primary and secondary syphilis is 0.2 case
per 100,000 population.
51
Primary and secondary syphilis Rates by region
United States, 19812001 and the Healthy People
year 2010 objective
52
Primary and secondary syphilis Rates by sex
United States, 19812001 and the Healthy People
year 2010 objective
53
Primary and secondary syphilis Male to female
rate ratios United States, 19812001
54
Primary and secondary syphilis Rates by race
and ethnicity United States, 19812001 and the
Healthy People year 2010 objective
55
Primary and secondary syphilis Rates by state
United States and outlying areas, 2001
Note The total rate of primary and secondary
syphilis for the United States and outlying areas
(including Guam, Puerto Rico and Virgin Islands)
was 2.2 per 100,000 population. The Healthy
People year 2010 objective is 0.2 per 100,000
population.
56
Primary and secondary syphilis Age- and
sex-specific rates United States, 2001
57
Congenital syphilis Reported cases for infants
syphilis among women United States, 19702001
Note The surveillance case definition for
congenital syphilis changed in 1988.
58
South Chlamydia case rates by county, 2001
SOURCE National Electronic Telecommunications
System for Surveillance (NETSS) data
59
South Primary and secondary syphilis case rates
by county, 2001
60
Syphilis serologic tests Percent
seroreactivity in women entering juvenile and
adult corrections facilities, 2000
From facilities reporting 100 test
results.SOURCE Local and State STD Control
Programs Regional Infertility Prevention
Programs Centers for Disease Control and
Prevention
61
Chlamydia Positivity in women entering
juvenile and adult corrections facilities, 2000
From facilities reporting 100 test
results.SOURCE Local and State STD Control
Programs Regional Infertility Prevention
Programs Centers for Disease Control and
Prevention
62
Chlamydia Positivity in men entering
juvenile and adult corrections facilities, 2000
From facilities reporting 100 test
results.SOURCE Local and State STD Control
Programs Regional Infertility Prevention
Programs Centers for Disease Control and
Prevention
63
Gonorrhea Positivity in women entering
juvenile and adult corrections facilities, 2000
From facilities reporting 100 test
results.SOURCE Local and State STD Control
Programs Regional Infertility Prevention
Programs Centers for Disease Control and
Prevention
64
Gonorrhea Positivity in men entering
juvenile and adult corrections facilities, 2000
From facilities reporting 100 test
results.SOURCE Local and State STD Control
Programs Regional Infertility Prevention
Programs Centers for Disease Control and
Prevention
65
Chlamydia Rates for women by state United
States and outlying areas, 2000
Note The total rate of chlamydia for women in
the United States and outlying areas (including
Guam, Puerto Rico and Virgin Islands) was 399.8
per 100,000 population.
66
Gonorrhea Rates for women by state United
States and outlying areas, 2000
Note The total rate of gonorrhea for women in
the United States and outlying areas (including
Guam, Puerto Rico and Virgin Islands) was 126.5
per 100,000 population. The Healthy People year
2010 objective is 19.0 per 100,000 population for
women.
67
Primary and secondary syphilis Rates for
women by stateUnited States and outlying areas,
2000
Note The total rate of primary and secondary
syphilis for women in the United States and
outlying areas (including Guam, Puerto Rico and
Virgin Islands) was 1.8 per 100,000 population.
The Healthy People year 2010 objective is 0.2 per
100,000 population.
68
Congenital syphilis Rates for infants year of age by stateUnited States and outlying
areas, 2000
Note The total rate of congenital syphilis for
infants outlying areas (including Guam, Puerto Rico and
Virgin Islands) was 13.6 per 100,000 live births.
The Healthy People year 2010 objective is 1.0 per
100,000 live births.
69
Congenital syphilis Cases by prenatal care
utilization United States, 1995-2000
70
Chlamydia Positivity among 15-24 year old
women tested inprenatal clinics by state, 2000
States not reporting chlamydia positivity data
in prenatal clinics. Note States reported
chlamydia positivity data on at least 100 women
aged 15-24 years during 2000. SOURCE Regional
Infertility Prevention Programs Office of
Population Affairs Local and State STD Control
Programs Centers for Disease Control and
Prevention
71
Gonorrhea Positivity among 15-24 year old
women tested inprenatal clinics by state, 2000
States not reporting gonorrhea positivity data
in prenatal clinics.Note States reported
gonorrhea positivity data on at least 100 women
aged 15-24 years during 2000. SOURCE Regional
Infertility Prevention Programs Office of
Population Affairs Local and State STD Control
Programs Centers for Disease Control and
Prevention
72
Ectopic pregnancy Hospitalizations of women
15-44 years of age United States, 1980-1999
Note Some variations in 1981 and 1988 numbers
may be due to changes in sampling procedures. The
relative standard error for these estimates
ranges from 8 to 11. SOURCE National Hospital
Discharge Survey (National Center for Health
Statistics, CDC)
73
Pelvic inflammatory disease
Hospitalizations of women 15-44 years of age
United States, 19801999
Note The relative standard error for the
estimates of the overall total number of PID
cases range from 6 to 9. SOURCE National
Hospital Discharge Survey (National Center for
Health Statistics, CDC)
74
Pelvic inflammatory disease Initial visits
to physicians offices by women 15-44 years of
age United States, 19802000
SOURCE National Disease and Therapeutic Index
(IMS America, Ltd.)
75
Chlamydia Positivity among women tested in
family planning clinics by age group Region X,
19882000
Note Women who met screening criteria were
tested. Trends not adjusted for changes in
laboratory test method in 1994, 1999, and 2000
and associated increases in test sensitivity.
SOURCE Regional Infertility Prevention
Programs Region X Chlamydia Project (Alaska,
Idaho, Oregon and Washington)
76
Chlamydia Prevalence among 16-24 year-old
women entering the National Job Training Program
by state of residence, 2000
Fewer than 100 women residing in these states
and entering the National Job Training Program
were screened for chlamydia in 2000.Note The
overall chlamydia prevalence among female
students entering the National Job Training
Program in 2000 was 11.2.SOURCE U.S.
Department of Labor
77
Chlamydia Positivity among 17-37 year-old
women entering the U.S. Army by state of
residence, 1999
Fewer than 100 women residing in these states
and entering the U.S. Army were screened for
chlamydia in 1999.Note Screening female
recruits from January July 1999. Overall
chlamydia positivity was 9.9.SOURCE Johns
Hopkins University Chlamydia Research Laboratory
(funding initiative Office of Defense Womens
Health Research)
78
Chlamydia Positivity among 17-37 year-old
men entering theU.S. Army by state of residence,
1999-2000
Fewer than 100 men residing in these states and
entering the U.S. Army were screened.Note
Screening male recruits from January - February
1999 and August 1999 - June 2000. Overall
chlamydia positivity was 4.7.SOURCE Johns
Hopkins University Chlamydia Research Laboratory
(funding initiative Aberdeen Proving Ground)
79
Gonorrhea Prevalence among 16-24 year-old
women entering the National Job Training Program
by state of residence, 2000
Fewer than 100 women residing in these states
and entering the National Job Training Program
were screened for gonorrhea by the national
contract laboratory in 2000.Note Many training
centers test female students for gonorrhea using
local laboratories these results are not
available to CDC. For this map, gonorrhea test
results for students at centers submitting
specimens to the national contract laboratory
were included if the number of gonorrhea tests
submitted was greater than 90 of the number of
chlamydia tests submitted. The overall gonorrhea
prevalence among female students entering the
National Job Training Program in 2000 was 3.3.
SOURCE U.S. Department of Labor
80
Gonorrhea Positivity among 17-37 year-old
men entering theU.S. Army by state of residence,
1999-2000
Fewer than 100 men residing in these states and
entering the U.S. Army were screened.Note
Screening male recruits from January - February
1999 and August 1999 - June 2000. Overall
gonorrhea positivity was 0.4.SOURCE Johns
Hopkins University Chlamydia Research Laboratory
(funding initiative Aberdeen Proving Ground)
81
Gonorrhea Age-specific rates among women
10-44 years of age United States, 19812000
82
Gonorrhea Age-specific rates among men
10-44 years of ageUnited States, 19812000
83
Primary and secondary syphilis Age-specific
rates among women 10-44 years of age United
States, 19812000
84
Primary and secondary syphilis Age-specific
rates among men10-44 years of age United
States, 19812000
85
Chlamydia Positivity among women tested in
family planning clinics by race and ethnicity
Region X, 19882000
Note Women who met screening criteria were
tested. Trends not adjusted for changes in
laboratory test method and associated increases
in test sensitivity in 1994, 1999, and
2000.SOURCE Regional Infertility Prevention
Programs Region X Chlamydia Project (Alaska,
Idaho, Oregon and Washington)
86
Gonorrhea Reported rates for 15-19 year old
females by raceand ethnicity United States,
19812000
87
Gonorrhea Reported rates for 15-19 year old
males by race andethnicity United States,
19812000
88
Primary and secondary syphilis Reported
rates for 15-19 year old females by race and
ethnicity United States, 19812000
89
Primary and secondary syphilis Reported
rates for 15-19 year old males by race and
ethnicity United States, 19812000
90
Congenital syphilis Rates for infants year of age by mothersrace and ethnicity
United States, 19912000 and the Healthy
Peopleyear 2010 objective
Note Less than 5 of cases had missing
race/ethnicity information and were excluded.
91
Chlamydia Trends in positivity among 15-44 year
old women tested in family planning clinics by
HHS regions, 19882001
Note Trends adjusted for changes in laboratory
test method and associated increases in test
sensitivity. No data on laboratory test method
available for Region VII in 1995 and Regions IV
and V in 1996.SOURCE Regional Infertility
Prevention Program Office of Population Affairs
Local and State STD Control Programs Centers for
Disease Control and Prevention
92
Chlamydia Number of states that require
reporting of Chlamydia trachomatis infections
United States, 19872001
93
Chlamydia Reported rates United States,
19842001
94
Chlamydia Rates by state United States and
outlying areas, 2001
Note The total rate of chlamydia for the United
States and outlying areas (including Guam, Puerto
Rico and Virgin Islands) was 275.5 per 100,000
population.
95
Chlamydia Rates by region United States,
19842001
96
Chlamydia Rates by sex United States,
19842001
97
Chlamydia Age- and sex-specific rates United
States, 2001
98
Chlamydia Positivity among 15-24 year old women
tested in family planning clinics by state
United States and outlying areas, 2001
Note States reported chlamydia positivity data
on at least 500 women aged 15-24 years screened
during 2001. SOURCE Regional Infertility
Prevention Program Office of Population Affairs
Local and State STD Control Programs Centers for
Disease Control and Prevention
99
Chancroid Reported cases United States,
19812001
100
Genital herpes Initial visits to physicians
offices United States, 19662001
SOURCE National Disease and Therapeutic Index
(IMS America, Ltd.)
101
Genital herpes simplex virus type 2 infections
Percent seroprevalence according to age in
NHANES II (1976-1980) and NHANES III (1988-1994)
Note Bars indicate 95 confidence
intervals. National Health and Nutrition
Examination Survey
102
Genital warts Initial visits to physicians
offices United States, 19662001
SOURCE National Disease and Therapeutic Index
(IMS America, Ltd.)
103
Nonspecific urethritis Initial visits to
physicians offices by menUnited States,
19662001
SOURCE National Disease and Therapeutic Index
(IMS America, Ltd.)
104
Trichomonal and other vaginal infections
Initial visits to physicians offices United
States, 19662001
SOURCE National Disease and Therapeutic Index
(IMS America, Ltd.)
105
Pelvic inflammatory disease Initial visits
to physicians offices by women 15-44 years of
age United States, 19802000
SOURCE National Disease and Therapeutic Index
(IMS America, Ltd.)
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