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Sexually Transmitted Infections/Diseases

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Title: 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.

7
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

13
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
20
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21
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22
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

27
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.

37
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.

42
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.

51
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.

55
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.

56
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.

57
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58
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.

70
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71
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72
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).

74
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.
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