Sexually Transmitted Infections/Diseases

1
Sexually Transmitted Infections/Diseases

• STD rates are 50-100 times higher in the US than
  any other industrialized nation, with an
  estimated 20 million new cases and 30,000 deaths
  each year from unsafe sexual behavior.
• 62 of adverse health events effect women. More
  than 100,000 women become infertile each year as
  a result of PID. Cervical cancer was the leading
  cause of sex-related mortality for women,
  followed by HIV.
• Men suffer the majority of deaths (60 ),
  primarily from HIV.

2
Transmission

• A. Any oral or genital contact

• B. Contaminated body fluids (blood, semen,
  vaginal fluids, saliva, breast milk, mucous
  membranes, other)

• C. Skin to skin contact

• D. Contact with contaminated objects (bedding,
  towels, toilet seats, clothing, etc.)

3
Chlamydia

• Most common bacterial STD in US (Chlamydia
  trachomatis).
• 3 million new cases each year.
• Highest rates of infection are in 15 19 year
  olds. It is estimated that 1 in 15 sexually
  active females aged 14-19 years has chlamydia.
• Costs about 2 billion annually.

4
Symptoms

• 75 of women and 50 of men have no symptoms.
• 1 to 3 weeks after exposure there may be
  discharge, painful urination, pelvic pain,
  bleeding between periods, sore throat or
  conjunctivitis.

5
Diagnosis Treatment

• Several tests available (urine, swab, etc.)
• Treated with antibiotics.
• Both partners should be treated and then retested
  3-4 months later due to the high rates of
  reinfection.

6
Complications

• 40 of untreated women develop PID, which can
  lead to chronic pelvic pain, infertility and
  ectopic pregnancy. (100,000 women each year
  become infertile due to PID)
• Cystitis (bladder infection)
• Prostatitis and epididymitis may cause painful
  swelling, scarring or infertility in men.

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Pelvic Inflammatory Disease
Drips
Source Cincinnati STD/HIV Prevention Training
Center
8
C. trachomatis Infection (PID)
Drips
Normal Human Fallopian Tube Tissue
PID Infection
Source Patton, D.L. University of Washington,
Seattle, Washington
9
Complications

• Reiters syndrome arthritis, redness of the
  eyes urinary tract problems.
• Can cause conjunctivitis, blindness, pneumonia
  and death in infants.
• HIV link 5 times more likely to become
  infected, also more contagious.

10
Normal Cervix
Drips
Source Claire E. Stevens, Seattle STD/HIV
Prevention Training Center
11
Chlamydia Cervicitis
Drips
Source St. Louis STD/HIV Prevention Training
Center
12
Herpes

• Contagious viral infection
• (HSV-1 HSV-2)

• 45 million cases (1 out of 5 ages 12 )
• 776,000 new cases each year

• HSV-2 more common in women - 1 in 4

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Symptoms

• Many people do NOT have symptoms
• HSV-1 usually causes mouth sores, but can infect
  genitals
• HSV-2 usually causes genital sores, but can
  infect the mouth

• Sores can appear on other body parts where broken
  skin has come into contact with HSV
• Transfer to the eye is particularly dangerous

14
Symptoms

• Typically, blisters appear around genitals,
  rectum, buttocks and thighs within 2 weeks

• Blisters break, leaving tender ulcers that may
  take 2 4 weeks to heal

• May also have flu-like symptoms, including fever
  and swollen glands

• Most experience 5 outbreaks the first year

15
Diagnosis Treatment

• Visual diagnosis or blood test

• No cure, but antiviral medications may shorten
  and/or minimize outbreaks

16
Complications

• Proctitis (inflammation of the rectum)

• Herpes keratitis (possible blindness)

• Potentially fatal infection and/or brain damage
  in newborns (a C-section may be necessary)

• HIV link more susceptible and more infectious

17
Genital Herpes Simplex
Sores
Source Diepgen TL, Yihune G et al. Dermatology
Online Atlas
18
Herpes in a Man
Herpes
Source Cincinnati STD/HIV Prevention Training
Center
19
Genital Herpes Simplex
Sores
Source CDC/NCHSTP/Division of STD, STD Clinical
Slides
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Herpes in a Woman
Herpes
Source CDC/NCHSTP/Division of STD, STD Clinical
Slides
Source Cincinnati STD/HIV Prevention Training
Center
23
Genital Herpes Simplex in Females
Sores
Source Centers for Disease Control and
Prevention
24
Genital Herpes Simplex
Sores
Source Florida STD/HIV Prevention Training Center
25
You can get herpes anywhere . . .
Herpes
Source Cincinnati STD/HIV Prevention Training
Center
26
Gonorrhea ( NGU )

• A bacterial infection (Neisseria gonorrhoeae)
  that thrives in warm moist environments such as
  the reproductive tract, urethra, mouth, throat,
  eyes and anus
• Sometimes called clap
• 321,849 cases reported to CDC in 2011
• An estimated 800,000 new cases each year

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Symptoms

• 1 14 days after contact men may have a burning
  sensation when urinating or a white, yellow or
  green discharge and/or swollen testicles.
• Most women are asymptomatic. Some may experience
  burning when urinating, increased vaginal
  discharge, or bleeding between periods.
• Rectal infections may cause discharge, itching,
  soreness, bleeding or painful bowel movements
• If not treated, gonorrhea can also spread to the
  blood or joints and can be life-threatening.

28
Diagnosis Treatment

• Swab/Culture is used to diagnose
• Historically, penicillin has been used to treat
  gonorrhea, but antibiotic resistant strains have
  emerged

29
Complications

• Epididymitis A painful swelling of the
  testicles that can lead to infertility.
• Salpingitis Inflammation and scarring of the
  fallopian tubes which may be resolved in ectopic
  pregnancy and/or sterility.
• A major cause of PID, which can lead to chronic
  pelvic pain, ectopic pregnancy and infertility.
• Reiters syndrome - Arthritis
• Eye infections and pneumonia in newborns
• HIV link Increased susceptibility and
  infectiousness

30
Gonorrhea
Drips
Source Florida STD/HIV Prevention Training
Center
31
Swollen or Tender Testicles (Epididymitis)
Gonorrhea
Source Health Awareness Connection,
http//www.healthac.org/images.html
32
Disseminated Gonococcal (Gonorrhea) Infection
Gonorrhea
Source CDC/NCHSTP/Division of STD Prevention,
STD Clinical Slides
33
Bartholins Abscess
Gonorrhea
Source CDC/NCHSTP/Division of STD Prevention,
STD Clinical Slides
34
Hepatitis

• A viral inflammation of the liver
• Of the 200,000 new HBV infections each year,
  approximately half are sexually transmitted.
• There are 5 major types of hepatitis
• Hepatitis A (HAV) - Acute
• Hepatitis B (HBV) Severe complications
• Hepatitis C (HCV) - Chronic
• Hepatitis D (HDV) Only present with HBV
• Hepatitis E (HEV)

35
Symptoms

• Liver cells are damaged and scar tissue is
  formed.
• Jaundice, chronic fatigue, and flu-like symptoms.

36
Diagnosis Treatment

• A blood test is used to diagnose.
• HAV and HBV vaccines exists (prevention)
• There is no cure for hepatitis. Treatment
  includes bed rest, a healthy diet, and avoidance
  of alcohol. Iterferon alpha (protein) may also be
  used with HBV and HCV.

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Complications

• Cirrhosis, liver carcinoma, liver failure and
  possible death.

38
Syphilis

• Bacterial infection (Treponema pallidum), known
  as the pox and/or the great imitator
• Around 56,000 new cases annually

• 46,042 cases reported in 2011 (rates are
  increasing, especially among MSM 72)

39
Symptoms

• 1st Stage/Primary a chancre (sore) appears
  after 10 to 90 days (lasts 3 6 weeks)

• 2nd Stage/Secondary 2 - 6 months later a red
  non itchy rash appears. Other symptoms include
  fever, swollen glands, headache, hair loss,
  muscle aches and fatigue.
• 3rd Stage/Latent 2 plus years later internal
  organs are damaged (brain, nerves, eyes, heart,
  liver, bones/joints). Other symptoms include
  paralysis, blindness, dementia, insanity, and
  death.

40
Diagnosis Treatment

• Visual diagnosis and/or blood tests
• Easy to cure in the early stages. A single
  intramuscular injection of penicillin if infected
  less than a year, otherwise additional doses are
  needed.
• Cannot treat or cure 3rd/latent stage.

41
Complications

• Birth defects (neurological problems), stillbirth
  and/or death soon after birth.
• HIV link 2 to 5-fold increased risk of acquiring
  HIV.

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Primary Syphilis Chancre
Sores
Source Florida STD/HIV Prevention Training
Center
43
Primary Syphilis
Sores
Source Centers for Disease Control and Prevention
44
Secondary Syphilis Rash
Sores
Source Cincinnati STD/HIV Prevention Training
Center
45
Secondary Syphilis
Sores
Source Diepgen TL, Yihune G et al. Dermatology
Online Atlas
46
Secondary Syphilis Body Rash
Syphilis
Source CDC/ NCHSTP/ Division of STD Prevention,
STD Clinical Slides
47
Secondary Syphilis Rash
Sores
Source Cincinnati STD/HIV Prevention Training
Center
48
Secondary Syphilis Condylomata Lata
Sores
Source Florida STD/HIV Prevention Training Center
49
Late Stage Syphilis Ulcerating Gumma
Syphilis
Source CDC/ NCHSTP/ Division of STD Prevention,
STD Clinical Slides
50
HIV

• The virus that causes AIDS. It compromises the
  immune system.
• Originated in monkeys in Africa. Hunters may
  have become exposed to contaminated blood.
• First human blood sample in 1959.
• Around 900,000 cases in the US.

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Symptoms

• Lowered helper T-cell count.
• Thrush, fatigue, night sweats, weight loss,
  recurrent fever, skin rashes, diarrhea and
  opportunistic infections, such as Kaposis
  sarcoma and Pneumocystis carinii pneumonia.

52
Diagnosis Treatment

• Blood tests can detect the presence of
  antibodies. T-cell count and the occurrence of
  opportunistic infections are also considered.
• No cure, antiviral drugs help manage symptoms.
• Other conditions/infections are treated.

53
Complications

• Reoccurring infections chronic conditions such
  as cancer.
• Death.

54
Crabs

• Pubic lice is an infestation of crab-like
  parasites that attach themselves to pubic hair or
  other course body hair.
• While they need blood to survive, they can live
  for 24 hours off the human body.
• There are an estimated 3 million cases each year.

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Symptoms

• Intense itching, about 5 days after infestation.
• Dark or bluish spots as the result of the bites,
  and/or pin head blood spots in underwear.

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Diagnosis Treatment

• Crabs and/or nits are often visible.
• Medicated creams and shampoos are used.
• All clothing and bedding needs to be laundered
  (water 130 degrees, 20 min. in hot dryer)
  and/or placed in a plastic bag for 2 weeks.

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Complications

• Usually just discomfort and inconvenience.
• Occasionally, secondary bacterial infections
  occur due to excessive scratching.

59
HPV

• Human papillomavirus is a group of more than 100
  strains, 40 of which are sexually transmitted.
• At least 80 million people in the US already have
  contagious genital HPV. There are about 14
  million new cases each year.
• 50 of sexually active men and women acquire
  genital HPV. By age 50, 80 of women will have
  acquired genital HPV.

60
Symptoms

• Most people have no symptoms around 360,000
  people develop warts each year
• Warts appear as soft, moist, pink or
  flesh-colored swellings, usually in/around the
  genital region, anus or thighs and sometimes in
  the mouth or throat. They can be flat or raised,
  single or multiple, small or large, and sometimes
  cauliflower shaped.
• The warts may appear within weeks, months, or not
  at all. The most cancerous strains of HPV dont
  produce warts.

61
Diagnosis Treatment

• Warts are diagnosed visually. Vinegar may be
  applied to improve visibility.
• Most women are diagnosed with HPV on the basis on
  abnormal pap smears (pre-cancerous changes).
• No cure exists. Warts may be treated with
  creams, acid, freezing, burning, lasers or
  surgery.
• Sometimes alpha interferon is injected directly
  into warts that have returned, but this is very
  expensive.

62
Complications

• The major cause of cervical cancer (killing more
  than 200,000 women around the world each year).
  Around 12,000 cases in the US each year
• HPV also causes cancer of the anus, vulva,
  vagina, penis and oropharynx (middle of the
  throat, soft palate and base of tonsils).
• Urination may become difficult during pregnancy.
  Warts make the vagina less elastic and cause
  obstruction during delivery. Some infants
  develop warts in their throats. This is a life
  threatening condition requiring laser surgery.
• HIV link increased susceptibility
  infectiosness

63
HPV Warts on the Thigh
HPV and Cervical Cancer
Source Cincinnati STD/HIV Prevention Training
Center
64
HPV Penile Warts
HPV and Cervical Cancer
Source Cincinnati STD/HIV Prevention Training
Center
65
Genital Warts in a Woman
HPV
Source CDC/NCHSTP/Division of STD, STD Clinical
Slides
66
Perianal Wart
HPV and Cervical Cancer
Source Cincinnati STD/HIV Prevention Training
Center
67
Molluscum Contagiosum

• A viral skin disease (MCV) causing small
  lesions/bumps.
• Once primarily a childhood disease, it has
  evolved into a STD in adults.

68
Symptoms

• The incubation period is from 1 to 6 months after
  contact.
• The lesions may begin as small bumps which can
  develop over a period of several weeks into
  larger sores/bumps. The lesions can be flesh
  colored, gray-white, yellow or pink. They can
  cause itching or tenderness. Lesions can last
  from 2 weeks to 4 years.
• In adults, lesions usually appear on the thighs,
  buttocks, groin and lower abdomen.

69
Diagnosis Treatment

• Diagnosis is made visually or by examining a
  sample from a lesion using a microscope.
• Most symptoms are self-resolving.
• Lesions can be surgically removed, treated with
  chemicals or cryotherapy.
• Autoinoculation is common.

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Complications

• Often a progressive disease in those with HIV.

73
Vaginitis

• Trichomoniasis is caused by a single-celled
  protozoan parasite (Trichomonas vaginalis).
• 7.4 million new cases each year.
• Bacterial Vaginosis is the most common vaginal
  infection in women of childbearing years
  (commonly called a yeast infection).

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Symptoms

• Imbalance between good and bad bacteria in
  the vagina. (In BV, this can result from
  douching, new/multiple sex partners, IUD,
  antibiotics, tight/damp clothing or poor diet).
• Abnormal discharge with a strong, unpleasant
  odor.
• Burning or itching during urination or
  intercourse.
• Symptoms usually occur within 5 to 28 days of
  exposure.

75
Diagnosis Treatment

• Physical exam and lab tests of fluids are used
  for diagnosis.
• Both partners should be treated with antibiotics.
• Women should wear cotton underwear, wipe front to
  back, avoid douching, tight pants and panty hose
  in hot weather.
• Men women should wash carefully every day,
  limit sexual partners and take antibiotics only
  when necessary.

76
Complications

• Increased risk for PID.
• Pregnancy complications, such as early delivery
  and/or low birth weight (less than 5 pounds).
• Increased susceptibility to other STDs, such as
  Chlamydia and Gonorrhea.
• HIV link increased risks of infection and
  transmission.