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STDs

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Title: STDs


1
STDs in the 1990s
By Dianne M. Eddy, M.T., ASCP
2
Is it really that bad?
Hasnt this stuff always been around?
Never before in these amounts 33,000 NEW cases
EVERY DAY, Over 12 million per year!
Only the common cold is more common today than
STD infection.
3
1 in 5 Americans has an incurable viral STD RIGHT
NOW
1 in 6 teens gets an STD EVERY YEAR
4
63 of all STDs occur in people less than 25
years old
5
Two Basic Types of STDs
  • BACTERIA
  • Gonorrhea
  • Syphilis
  • Chlamydia
  • Chancroid
  • Treated with antibiotics
  • Damage can occur before treatment
  • VIRUSES
  • Herpes Simplex Virus (HSV-1, HSV-2)
  • Human Papilloma Virus (HPV)
  • Hepatitis B Virus (HBV)
  • Human Immunodeficiency Virus (HIV)
  • Treat symptoms only
  • Remains in body and re-occurs for life

6
COMPARE the SIZES

. HIV 4 millionths of an inch
. HEP B
Herpes
Chlamydia
Gonorrhea
Syphilis
Head of a Sperm
7
How can STDs harm the body?
By causing
  • Discharges
  • Abscesses
  • Rashes
  • Blindness
  • Arthritis
  • Brain damage
  • Liver damage
  • Pelvic Inflammatory Disease
  • Sterility (both male and female)
  • Tubal Pregnancy (can be fatal)
  • Deformity (of adults and newborns)
  • Cancer (can be fatal)
  • Death (HIV, Hepatitis B and Syphilis can be
    fatal)
  • Miscarriages, stillbirth and premature birth

8
How are STDs spread?
STDs are spread in several ways, besides sexual
intercourse.
Eye Infections (gonorrhea, Chlamydia,
herpes) Oral region (herpes, syphilis, gonorrhea,
hepatitis B) Finger spread (to self or
others) Genital Region (entire region can be
infected especially for herpes, HPV, syphilis,
chancroid others
  • Skin to Skin contact with infected areas,
    including thighs, scrotum, vulva, penis, anus
  • Touching below the waist (infected areas)
  • Oral sex infected genitals to mouth or infected
    mouth to genitals
  • Kissing infected mouth area
  • Anal sex

9
Tongue with Syphilis
10
Throat with Herpes
11
Tongue with Chancroid
12
Finger with Gonorrhea
13
Finger with Herpes
14
Finger with Syphilis
15
Abdomen with Herpes
16
Abdomen with Syphilis
17
Eye with Chlamydia
18
Eye with Gonorrhea
19
Eye with Herpes
20
Pelvic Inflammatory Disease (P.I.D.)
Usually caused by gonorrhea or Chlamydia, can be
other bacteria
Bacteria travel up through the cervix, through
the uterus, through the fallopian tubes and into
the abdomen. The bacteria causes pus, swelling,
scaring and adhesions. Infection can be so
severe that hospitalization can be needed.
21
Normal Uterus
22
PID Uterus
Add illustration here
23
PID Ovary
Add illustration here
24
Adhesions
Add illustration here
25
PID . . . The Silent Epidemic
70 may have NO SYMPTOMS
26
Symptoms of P.I.D.
  • Longer and or heavier periods
  • More cramping during periods
  • Abnormal mucus discharge
  • Pain in lower abdomen
  • Tiredness, weakness
  • Fever, chills
  • Nausea vomiting
  • Pain during intercourse

27
Teens at Higher Risk for P.I.D.
Add illustration here
Teenage girls are more at risk for P.I.D. than
adult women because the teenagers cervix is
still maturing. It is soft with thin mucus, and
is a good environment for STD germs.
1 in 8 chance of PID for 15 year olds
The adult womens cervix is tougher, with thicker
mucus, and is less nourishing to STD germs. STD
can still occur.
1 in 80 chances of PID for 24 year olds
Add illustration here
28
P.I.D. CAUSES STERILITY
There are more than 1 MILLION cases of P.I.D. per
year
As many as 150,000 women per year become sterile
as a result of PID damage to their organs
Add illustration here
Tiny cilia lining the fallopian tubes are
destroyed, so that they cant move the egg
through the tube to the uterus.
Add illustration here
Scar tissue or adhesions inside of the tubes may
block the path of the egg
Add illustration here
Pits (craters, holes) may trap the egg, possibly
causing tubal pregnancy --- a life-threatening
condition
29
TUBAL PREGNANCY
After P.I.D., a woman is 10 times more likely to
have a tubal pregnancy.
Add illustration here
If fallopian tubes are partially blocked by scar
tissue, the tiny sperm may swim through, but the
larger egg gets stuck. Then the pregnancy may
begin inside the tube instead of the uterus.
Add illustration here
The tube cant stretch very much, and in 4 6
weeks it will rupture. This causes severe
internal bleeding, shock, and death unless the
woman receives emergency surgery.
30
TUBAL PREGNANCIES
Outpatient treatment has increased, so the TOTAL
number of Tubal Pregnancies continues to rise.
TOTAL INpatient and OUTpatient Estimates
108,000 Does NOT include Private Physician Office
Treatment
INPATIENT Estimates Hospitalizations 1970 - 1992
31
GONORRHEA
Caused by Neisseria gonorrhea, a pus producing
bacteria
Up to 1 MILLION people affected each
year Teenagers (15-19) have the highest rate if
infection
32
GONORRHEA
60 of Females DONT KNOW they have it.
NO SYMPTOMS
20 - 40 of Males DONT KNOW they have it.
NO SYMPTOMS
BUT Does spread to partners Does damage
the body
33
SYMTOMS OF GONORRHEA
  • Occur 3-30 days after contact with infected
    partner
  • May include
  • Thick, whitish discharge (pus) from penis or
    vagina
  • Burning or pain during urination
  • Frequent urge to urinate
  • Cramps in lower abdomen in females
  • Pain or selling in penis or testicles in males
  • Sore throat after oral sex

34
HARMFUL EFFECTS OF GONORRHEA
Add illustration here
Newborn eye infections, may lead to blindness
Abscess of penis, may rupture and require
surgical repair
Add illustration here
Adult eye infections, spread on fingers, can lead
to blindness
Abscess of vulva and Bartholin gland, also may
rupture
Add illustration here
Abscess of finger, can spread germs to other
places and to other people
Epididymitis infection in the sperm-carrying
tubes, can lead to sterility (unable to have
children)
35
GONORRHEA - Swollen Finger
Add illustration here
36
GONORRHEA - Sores of Forearm
37
DRUG RESISTANT GONORRHEA
Gonorrhea has become more and more resistant to
treatment with penicillin and other antibiotics.
38
CHLAMYDIA
THE MOST COMMON BACTERIAL STD IN THE USA, WITH 3
TO 5 MILLION CASES PER YEAR
One of the most common causes of P.I.D. and
sterility
Caused by a bacteria that acts like a virus, it
is TWICE as damaging as gonorrhea, with even
FEWER symptoms
39
CHLAMYDIA IS THE 1 BACTERIAL STD
Chlamydia can infect 20-40 of some sexually
active groups
Teenage Infection Rtes Highest of all age groups
40
CHLAMYDIA
70 of Females DONT KNOW they have it.
NO SYMPTOMS
30 of Males DONT KNOW they have it.
NO SYMPTOMS
BUT Does spread to partners Does damage
the body
41
SYMTOMS OF CHLAMYDIA
Many have NO SYMPTOMS causing a SILENT
EPIDEMIC May occur within 103 weeks after contact
with infected partner
  • MALES
  • Thin, watery, or milky DISCHARGE from penis
  • Pain or BURNING during urination
  • Frequent URGE to urinate
  • May Only occur in the morning, could be ignored
  • FEMALES
  • Heavier vaginal DISCHARGE, may be yellowish
  • Pain or BURNING during urination
  • Frequent URGE to urinate
  • Pain or CRAMPS in abdomen, abnormal bleeding

42
HARMFUL EFFECTS OF CHLAMYDIA
Pelvic Inflammatory Disease, Epididymitis, and
Sterility Male and Female Newborn and Adult
Pneumonia slow recovery, often have chronic
bronchitis long afterwards Newborn Eye Infections
Can cause blindness Adult Eye infections
spread from genitals to eyes by ands or fingers,
can cause blindness Throat Infections spread by
oral sex Rectal Infections spread by anal
sex Reiters Syndrome symptoms of
arthritis-like joint pain, eyelid swelling, skin
rash, skin sores
43
SYPHILIS
Caused by spiral-shaped bacteria, called
spirochetes
Can enter any mucous membrane or break in the
skin, can be spread by kissing and close contact
without going all the way
44
SYPHILIS
Up to 50 of people dont know they have it.
NO SYMPTOMS
Symptoms may be mild or painless or nearly
invisible. People may not notice, or may
think they are nothing serious.
The symptoms (sores,rashes) go away by
themselves, without any treatment, between the 3
stages of the disease. So people may think they
are OK, but the syphilis is still inside their
body, and they are still contagious and it is
still causing damage.
45
1st Stage SYPHILIS
10 to 90 days after contact, painless sores or
ulcers may appear, called CHANCRES. They DO NOT
HURT, and may not be noticed, especially if
unseen. (i.e., inside of vagina/cervix, mouth,
throat)
They can appear ANYWHERE that the spirochetes
entered a mucous membrane or break in the skin.
Add illustration here
penis
tongue
Add illustration here
abdomen
cervix
finger
46
2nd Stage SYPHILIS
Symptoms appear 2 weeks to 6 months after
chancres, these signs will also disappear without
treatment
  • Rash on hands and feet
  • Lesions of vulva
  • (can be on penis/scrotum)
  • Rash over entire body
  • Lesions of tongue

47
(No Transcript)
48
3rd Stage SYPHILIS
May be many years later, no longer curable at
this stage. Syphilis can affect and damage all
the organs of the body.
Damages heart and aorta, causes hardening,
distortion, ulceration.can lead to rupture,
hemorrhaging and death
Add illustration here
Brain damage and infection, causes headaches,
dizziness, blurred vision, paralysis, and can
lead to insanity.
Skin Damage, causes gummata, large open sores
which are slow to heal. Syphilis can also damage
the bones.
49
Syphilis Rates in the USA
50
CONGENITSAL SYPHILIS
Syphilis is transmitted from the mother to the
baby trough the placenta.
The more recent the infection, especially during
the pregnancy, the more damaging to the baby.
COMPLICATIONS Miscarriage Enlarged liver and
spleen Stillbirth Hydrocephalus Meningitis Mental
Retardation Convulsions Sever Skin
Rashes Blindness Deafness Deformities of face,
nose, teeth, jaw, leg bones
51
CHANCROID
Caused by Haemophilis ducreyi bacteria.
The number is cases in the USA has quadrupled in
the last 10 years. Chancroid is probably brought
into the USA by people who had sex while on
vacation in the tropics, where it is a common STD.
Can enter any mucous membrane or break in the
skin, can be spread by contact with pus from
sores, even without going all the way
52
Treatment of BACTERIAL STDs
  • SEE A DOCTOR or CLINIC, both partners need to be
    seen
  • FOLLOW INSTRUCTIONS EXACTLY for taking
    medications
  • CONTINUE TAKING ALL MEDICATIONS, even if symptoms
    disappear
  • DONT SHARE MEDICATION WITH OTHERS!! The amount
    you are given is ONLY enough to cure YOUR
    infection.
  • HAVE A FOLLOW-UP EXAM to be sure you are
    completely free of infections
  • DONT HAVE SEX (ABSTAIN) until completely cured
  • HAVE YOUR PARTNER TESTED TREATED at the SAME
    TIME, or they will RE- INFECT YOU or pass it on
    to others

53
GENITAL HERPES
Caused by Herpes simplex virus (HSV), type I or
type II
HSV type I is usually around the mouth, and type
II is usually around genitals, but BOTH types can
infect either site due to oral sex or finger
spread. HSV can be spread to others WITHOUT ANY
visible blisters or sores. It is present in the
skin days before and for a week after an
outbreak. The herpes virus remains in the body
FOR LIFE. There is not cure, only treatment to
ease symptoms.
Eye Infections Oral region Finger spread (to
self or others) Genital Region (entire region
can be infectious)
54
30 Million Americans Have Herpes
Thats about 1/5 of all sexually active people,
with about 1 million NEW cases per year.
Up to 50 DONT KNOW they have it.
NO SYMPTOMS
BUT Does spread to partners Does damage
the body
55
SYMPTOMS of HERPES
Occur 2-20 days after contact with infected
partner
Blisters or rash small, painful, fluid-filled
blisters can appear anywhere penis, vulva,
thighs, buttocks,inside vagina, throat, mouth,
eyes, fingers, etc. Flu-like symptoms fever,
headache, nausea, swollen glands, aching
muscles Painful urination pain and swelling may
be severe, may be unable to urinate
56
HERPES OUTBREAKS
PRIMARY EXPOSURE
First-time outbreaks are the most severe and most
painful, and it takes form 1 to 3 weeks for the
sores to heal over. Blisters rupture, causing
open sores that can sometimes run together to
make large sores. Scarring can occur.
SECONDARY (RECURRENT) EPISODES
Secondary or recurrent\ outbreaks are less
painful than the first episode, but they are
still painful and troublesome. The average
number is about 4 to 7 flare-ups per year, but
some women have them monthly along with their
periods. Other factors that seem, to cause
flare-ups are tight clothes, sun exposure,
stress, fatigue, illness. Diet, sexual activity.
57
HARMFUL EFFECTS of HERPES
Autoinoculation self-spread to eyes or other
parts of body, can lead to scarring or
blindness. Higher risk of cervical cancer, need
more frequent Pap smears and doctors visits to
detect it Newborn Infections sever skin
rash, brain damage, blindness, or possibly death
(up to 50)
58
HERPES AND PREGNANCY
Babies can be infected at birth, especially
during a primary outbreak in the mother.
Mother has primary outbreak at delivery/birth
50 of babies become infected
60 die of the infection
50 of survivors have severe brain damage
A Cesarean delivery can be performed to avoid
infection of the baby.
59
HUMAN PAPILLOMA VIRUS (HPV)
(60 different strains)
Causes Genital Warts Causes CANCER of the Cervix
and Penis
FASTEST GROWING STD IN USA
Estimated 24 to 40 million cases today, with 1
million NEW cases per year, mostly in people
under 25 years old.
Several studies have shown that about use third
(33) of sexually active females carry this virus
60
HPV Infection and Spread
HPV infects the ENTIRE GENITAL REGION
--- Including the vulva, penis, cervix, thighs,
scrotum, anus, mouth, and throat. As many as 90
have NO SYMPTOMS HPV is spread by SKIN- TO-
SKIN CONTACT, as well as vaginal sex, oral sex,
anal sex. Can infect NEWBORNs genitals or
throat. CAN BE SPREAD WITHOUT ANY VISIBLE WARTS
Oral region Genital Region
61
HPV SYMPTOMS
  • May appear 1 to 3 months after contact with
    infected person
  • GENITAL WARTS
  • May be flat or raised, invisible, tiny, or large
    and cauliflower-like
  • RARELY may have
  • Itching
  • Burning
  • Bleeding
  • pain

MALES
MILD
SEVERE
FEMALES
MILD
SEVERE
TONGUE (From oral sex)
CERVIX (Unseen)
62
(No Transcript)
63
Office Visits for HPV and HSV
64
HARMFUL EFFECTS OF HPV
CANCER 90 of cervical cancers are associated
with HPV also causes genital cancer in men
10 times more women die from cervical cancer
(4,600 per year) than from AIDS (lt500)
NEWBORN INFECTION Can cause genital or anal
infections, can also infect throat and vocal
cords, requiring many surgeries to remove
re-growing warts
BLOCKAGE OF URETHRA, VAGINA, OR ANUS
PAINFUL INTERCOURSE
65
Recurring respiratory papillomatosis
Nastiest picture in the world! Slide 29
66
HIV / AIDS
HIV Human Immunodeficiency Virus
AIDS Acquired Immunodeficiency Syndrome a
result of HIV infection
67
HOW IS HIV SPREAD?
HIV is spread by contact with infectious body
fluids
Blood Semen Vaginal Fluid Breast Milk
HIV is usually transmitted by CERTAIN ACTIVIITIES
  • Having sex with an infected person
  • Sharing needles, syringes, ear piercing, or
    tattooing equipment with an infected person
  • From infected mother to baby during pregnancy,
    forth, or breast feeding (few cases)
  • From transfusion with infected blood or blood
    products (clotting factors, plasma, platelets,
    etc)

HIV is NOT spread through casual contact or just
being around someone with HIV/AIDS.
68
RISKY ACTIVITIES FOR HIV / AIDS
Risky activities include any contact with your
partners blood, semen, or vaginal fluid during
Vaginal, oral, and anal sex Mutual masturbation
(foreplay, petting) ?? Open-mouth kissing
(undocumented) Sharing sex toys
69
HIV INFECTION
HIV infection may have NO SYMPTOMS, sometimes for
5 to 10 years.
May have flu-like symptoms, which may be
ignored fever loss of appetite night
sweats diarrhea swollen glands skin rashes
WINDOW PERIOD 6 to 12 weeks (or longer) before
HIV antibodies are produced. Person may be HIV
infected but their blood test is negative. (false
negative)
70
HIV / AIDS SYMPTOMS
Later symptoms of HIV infection, and then AIDS
  • Significant weight loss
  • Lack of resistance to infection
  • Dry couch or shortness of breath
  • Furry white spots in the mouth
  • Red or purplish spots on the body
  • Memory or movement difficulties

Add illustration here Nasty mouth
Add illustration here Nasty mouth??
71
Sad picture of man with AIDS and lack soars
72
HARMFUL EFFECTS of HIV / AIDS
HIV destroys cells in the immune system, leaving
them unable to fight off diseases which most
healthy people can resist.
These opportunistic infections that take
advantage of the bodys weakened defenses
include Fungi (yeast / thrush, cryptococcus /
brain) Parasites (pnuemocystis /
pnuemonia) Viruses (systemic herpes, shingles,
CMV) Bacteria (tuberculosis)
HIV can infect and disrupt many cells in the
body brain, heart, lungs, kidneys, liver,
intestines.
73
AIDS CASES AND DEATH
Total Cases to 1-1-95 361,164
Total Deaths to 1-1-95 220,736 (81)
First 100,000 cases
Second 100,000
Third 100,000
74
Heterosexual AIDS Cases
75
HEPATITIS B VIRUS
Estimated 300,000 cases in the USA each year
(CDC MMWR 39 (NO.RR-1), 1990) 5,000 to 6,000
DEATHS per year due to HBV
300 million people infected worldwide, making it
one of the most common STDs in the world.
76
HEPATITIS B SPREAD
SPREAD THE SAME WAY as the HIV / AIDS virus,
(blood body fluid contact, sexual activity,
sharing needles)
But it is MANY TIMES MORE CONTAGIOUS
Sexual transmission, both heterosexual and
homosexual, is now the most common risk factor,
and accounts for at least 30 of reported cases
of acute Hepatitis B infection
ALSO spread by mouth-to-mouth contact (kissing)
77
HEPATITIS B SYMPTOMS
Symptoms occur within a month after
contact. Some may have mild or unnoticeable
symptoms. Usually people will have signs of
illness such as
Fever dizziness light or gray-colored
stools Achiness nausea yellow skin and eyes
(jaundice) Headache vomiting pain in liver area
(under ribs)
78
HARMFUL EFFECTS of Hepatitis B Virus
Severe Liver Damage Cirrhosis of the
Liver Cancer of the Liver Chronic Carrier State
DEATH is severe cases, or due to above
complications NEWBORN INFECTIONS Unless
treated within an hour of birth, most become
carriers of the virus, contagious for
life, develop liver disease or cancer (40 50
get cancer).
79
HEPATITIS B VACCINE
THERE IS A VACCINE for Hepatitis B!!!
You can get vaccinated at your doctors office or
local Health Department Three shots are needed
(boosters 1 month apart) Employees in hospitals
or medical fields should get this series of
vaccinations
80
Treatment of VIRAL STDS
  • SEE A DOCTOR or CLINIC, both partners need to be
    seen
  • Treatment involves relieving the SYMPTOMS ONLY.
  • There is NO CURE.
  • The VIRUS WILL REMAIN IN THE BODY FOR LIFE
  • Rashes can be soothed, warts can be removed, pain
    can be relieved. But the symptoms may return
    later, off and on, for the REST OF YOUR LIFE.
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