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Sexually Transmitted Infections (STI's)

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Meg Van Houten

on 15 April 2014

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Transcript of Sexually Transmitted Infections (STI's)

Sexually Transmitted Infections (STI's)
How to Prevent STI's
What's the Treatment Like?
Who's at Risk?
- Racial and Ethnic Disparities
- Gender Disparities
- Age Disparities
- SES Disparities
- Other Risk Factors
AIDS: A Global Phenomenon
-If someone is seeking treatment for an STI; their partner(s) should be tested and/or seeking treatment.
The most Effective Form of Prevention
-Use the barrier method to decrease risk of infection.
-Condoms are the most effective; but because they do not cover the entire genital area, the spread of infection can still occur.
-Use a condom for any type of sexual act.
-Getting tested regularly will help if you already have an STI;
-early detection can reduced the chances of infecting others.
If you are having sex...
Early diagnosis is critical in the treatment process.
HIV (Human Immunodeficiency Virus)
Virus that attacks T lymphocytes--makes it difficult for body to fight infection
HIV is the virus that

AIDS (Acquired Immune Deficiency Syndrome)
Body can no longer easily fight infection
Opportunistic diseases infect people with AIDS because of their weakened immune systems (healthy individuals would normally be able to fight these diseases off)
What's The Difference?
Transmitted via bodily fluids (i.e. semen, blood, vaginal fluid, breast milk)
Spread most frequently through vaginal/anal intercourse and intravenous drug use (shared needles)
Can be spread through oral sex and from mother to baby during pregnancy, delivery, breastfeeding
Who is at risk? How does it spread?
-Non-oxynol 9
-a sperm-killing ingredient found in many contraceptive creams, foams, jellies, films, & sponges.

Potential increased risk using contraception methods
- African Americans
- Hispanic
- American Indian/ Alaska Natives
Racial Disparities
- Women have higher rates of STI's than men
* may be asymptomatic and suffer from latency

Gender Disparities
- Sexually active 15-24 year olds
- Aged Population
Age Disparities
- Poverty
- Access to Healthcare
- Substance Abuse
SES Disparities
- Unprotected Sex
- Multiple Partners
- History of STI's
- Abusing Alcohol/Drugs
- Being an Adolescent Female
Other Risk Factors
-Abstinence from sex
-Abstain from oral
-Abstain from anal
-Abstain from vaginal
-Be in a long-term & mutually monogamous relationship with a partner that is free of STIs & infections.
-can increase risk of infection when used more than once a day because it irritates the vaginal cells.
Treatable vs. Curable
-When something is treatable it does not necessarily mean it is curable; it is manageable.
-When something is curable, it is treatable; & it can be rid of.
According to it'syoursexlife.com...
"...1 in 2 sexually active young people will get an STD by the age of 25. The good news, most STDs are curable, & all are treatable..."
HIV & other viral STI's including;
- hepatitis B
-genital herpes
-genital warts
Commonly curable STI's include;
"...A person can have an STI without having obvious symptoms of disease. Therefore, the term “sexually transmitted infection” is a broader term than “sexually transmitted disease” (STD). Common symptoms of STDs include vaginal discharge, urethral discharge in men, genital ulcers, & abdominal pain..."
-World Health Organization (WHO)
Who can help you?/ Get the facts
-Planned Parenthood
-World Health Organization
-STD/HIV Control Program of Rochester
"...more than half of all Americans get a sexually transmitted disease or infection at some time in their lives..."
Estimated new cases of curable sexually transmitted infections (gonorrhea, chlamydia, syphilis and trichomoniasis) by WHO region, 2008
It is important to let your partner(s) know
-There is a
HBV (A & B)
vaccination that can also be used within 2 weeks of possible exposure to lower the risk of infection.
-There is no medical cure for HBV; the infection of HBV tends to go away by itself within 4-8 weeks.
-Most who become infected with HBV will be carriers for the rest of their lives.
"...sexually transmitted infections can increase the risk of getting HIV..."
-Those who have been previously infected with an STI should be even more careful because they are more susceptible to obtaining or passing on HIV.
medicine can help manage the infection and heal/prevent outbreaks.
Genital warts
can be removed by freezing (cryotherapy), burning (electrocauterization), injections, surgery or through the use of lasers.
-Warts can be removed, but later return because the virus remains in the body.
can be easily treated with antibiotics; get retested 3 months later.
can be easily treated with antibiotics in its first stage (first year).
-Damages caused after the first stage are irreversible; no treatment can lead to death.
can be easily treated with antibiotics (one dose or several days).
If left untreated...
-Even when infected with curable STI's, if left untreated the long term effects can be extremely damaging.
-Organ damage
-Brain damage
-Nervous System damage
-In some cases death.
can be easily treated with prescription medication.
-STI's are transferred through bodily fluids including; blood, semen, vaginal lubrication or discharge, & menstrual flow.

-Also through the improper use of needles for steroids, hormones, and/or various other drugs.
Why STI's are so easily contractible during unprotected sexual activity...
More STI's...
Pubic Lice aka "crabs"
-Are treatable with topical cream as well as prescribed medication in certain cases.
Kwell/ Thionex
is an insecticide cream used to treat those who failed the first line of treatment with the more common/safer medications.
-with such high risks one has to decide if the cream is worth using:
-overuse can cause
poisoning and could be fatal if swallowed.
-known to lead to seizures, disorientation, & death.
Types of Sexually Transmitted Infections
Ectoparasitic Infections
Parasites that live on the skin’s surface
Two sexually transmitted varieties:
Pubic Lice


Pubic Lice (A.K.A "Crabs")
Small, wingless insects
that are difficult to detect on light-skinned people
Attach to pubic hair (preferred) by their claws and drink from tiny blood vessels under the skin
Cannot survive longer than 24 hours off the body, but they reproduce rapidly and their eggs are cemented to the hair
HIGHLY contagious
Incidence: common
mild to severe itching
(particularly at night) thought to be due to allergic reaction from their saliva
lice and eggs are visible
Treatment: A lice-killing lotion containing 1% permethrin or a mousse containing pyrethrins and piperonyl butoxide can be used to treat pubic ("crab") lice; clothing and sheets dry cleaned, boiled, or washed in hot water
If HIV is left untreated, AIDS usually develops within 8-10 years
"Acute retroviral syndrome": Initial symptoms resemble the flu--fever, swollen glands, sore throat, fatigue, etc. Not everyone is affected
"Clinical Latency Stage": Symptoms often disappear for a time
AIDS: Later symptoms include significant weight loss, severe diarrhea, fevers, night sweats, mouth sores
Opportunistic diseases take advantage of weakened immune system: pneumonia, toxoplasmosis, cryptococcosis, cytomegalovirus, Kaposi's sarcoma
2 ways to test for HIV: identify HIV in the blood or test for antibodies that have developed to fight HIV
ELISA (enzyme0linked immunoabsorbent assay): Most common antibody test
Western blot test usually follows a positive ELISA test result
False negatives/positives are possible; test results are most accurate within first 6 months of infection
Recent development of rapid testing: OraQuick Rapid HIV Antibody Test uses a drop of blood, oral version uses blood vessels from mucous membranes in the mouth
Rapid tests are not as accurate; blood tests should follow a positive rapid test result
2 tests before treatment for HIV: Viral load test and CD41 T cell count
Determines how much HIV is in the system so a base line for treatment can be established
Treatment: HAART (highly active antiretroviral therapy)
3 or more HIV drugs blended together, sometimes called "drug cocktails"
HAART can have negative side effects
Psychological counseling can help people develop coping methods and lifestyle changes
Behavior needs to change
Better educational programs about AIDS/HIV
After diagnosis, inform all past sexual partners
More data about high-risk sexual practices is needed in order to develop strategies for reducing high-risk behaviors
Research is working on an AIDS vaccine--first vaccine was produced in 2009 in Thailand, but not effective enough for vaccine to be distributed
sarcoptes Scabei
Spread by skin-to-skin contact
Mites can live up to 48 hours off the body
visible to the naked eye
Incidence: Millions worldwide different ethnic groups, people, and social classes
rash and severe itching
Diagnosis: examination of the rash and a skin scraping can confirm diagnosis and treatment is necessary
Typically less than 10 mites on the body during infection
Treatment: topical creams; clothing and sheets washed in hot water

Bacterial Infections
Gonorrhea (A.K.A the "clap" or "drip")


Chlamydia and Nongonococcal Urethritis


Vaginal Infections
Bacterial Vaginosis
Pelvic Inflammatory Disease

neisseria gonorrhoeae
Survives only in mucous membranes, such as the cervix, mouth, urethra, rectum, throat, and eyes.
Transmitted when mucous membranes come in contact with each other
2nd most commonly reported infectious disease in the U.S
Highest rates in the South and Midwest, lowest in the North
most as asymptomatic
, cervix is most common infection site;
urinary frequency, abnormal bleeding
25% are asymptomatic; epididymitis, rethral discharge, painful, frequent & urgent urination
Swelling, pain, and pus in the joints
Rectal gonorrhea: bloody stool and pus
Diagnosis: examine for bacteria in a sample of the discharge; can also run DNA testing of urine
Treatment: antibiotics (oral, injection)
Gonorrhea — Rates by State, United States and Outlying Areas, 2012
treponema Pallidum
Live in the mucous membranes
Typically first infects the cervix, anus, penis, lips, or nipples
Congenital syphilis can transmit through placenta during 1st or 2nd trimester
Incidence: 10,000 cases reported in 2006
High rates in the South, low rates in the Midwest
Higher rates among African Americans
Symptoms = 3 stages:
1st: Primary/early syphilis 10-90 days after infection
(small, round, red-brown, painless sores with a hard raised edge & sunken center)
may appear on the vulva, penis, vagina, cervix, anus, mouth, lips
2nd: Secondary syphilis after chancres disappear (3-6 weeks after chancre has healed)
Syphilis invades the central nervous system
Reddish patches on the skin, possible wart-like growths in area of infection
Lymph glands enlarge and are tender
Headaches, fever, anorexia, flu-like symptoms, fatigue
3rd: Tertiary/late syphilis
Stage of remission and a person feels fine,
though able to transmit the disease for 1 year
If not treated, this stage can cause neurological, muscular, sensory, and psychological difficulties and is eventually fatal
Diagnosis: culture taken from a lesion; blood tests
Treatment: If a person has been infected for
less than a year, a single injections of antibiotics
is the treatment.
If progresses to later stages, not treatable and often fatal
chlamydia trachomatis
Transmitted through vaginal intercourse, oral, and anal sex
most commonly reported infectious disease in the U.S.
- estimated 2.8 million new cases/year
Highest among African Americans
Higher in young women
Under-diagnosed in men
asymptomatic in 75% of women and 50% of men
"silent disease"
Females symptoms
: burning sensation during urination, painful intercourse, pain in lower abdomen, bleeding/spotting, rare for discharge
Male symptoms
: discharge from penis, burning sensation during urination, burning & itching at penile opening, pain or swell of testicles
Bacteria that causes chlamydia may also cause epididymitis and NGU in men
Diagnosis: culture cervical discharge for women, blood test, urine test for men
antibiotics for 7-10 days; some cases have become drug-resistant
hemophilus decreyi
Different from a syphilis chancre as it has soft edges
Incidence: relatively rare in the U.S., through under reported
7,000,000 cases/year worldwide
Prevalent in poor countries
Associated with HIV transmission and common in areas with high rates of HIV
3 Types of Vaginal Infections
Trichomonas vaginalis
Female Symptoms 3-28 days after infection: increase in yellowish, frothy, and foul-smelling vaginal discharge; burning/itching in vagina; asymptomatic
Male symptoms: urethra, asymptomatic, discharge at tip of penis, burning while urinating or ejaculating, mild discharge
Treatment: metronidazole
7.4 million new cases/year
Bacterial Vaginosis
Most common vaginal infection in women of childbearing age, though 1/2 are asymptomatic
Increased susceptibility with: multiple partners, douching, low concentrations of beneficial vaginal bacteria, women having sex with women
Increased risk of PID and endometriosis
Treatment: metronidazole or clinamycin (orally or vaginally)
Candidiasis (Yeast Infection)
Caused by a variety of fungi, most commonly
Candida albicans
Fungi normally common in vagina, but will multiply when the pH balance is disturbed
pH changes due to: pregnancy, oral contraceptives, douching, antibiotics, diabetes, fecal material contacting the vagina
Symptoms: burning, itching, and increase in vaginal discharge that may be thin, white, watery, and include white chunks
75% of women will have at least 1 yeast infection
Recurrences are common
Treatment: anti-fungal prescription or OTC drugs
(cream is topical or inserted into the vagina); misuse of OTC drugs contributes to medication-resistant strains of yeast
Pelvic Inflammatory Disease
Infection of the female genital tract, including endometrium, fallopian tubes, and lining of pelvic area
Most often caused by chlamydia and gonorrhea
PID can cause long-term complications such as ectopic and tubal pregnancies, chronic pelvic pain, and infertility
Estimated 1,000,000 cases in the U.S. each year
Characteristics of a typical PID sufferer:
young, unmarried, multiple partners, had an STI, early age at first intercourse, minority, use douches
acute pelvic pain, high fever, painful urination, abnormal vaginal discharge or bleeding
often asymptomatic
Treatment: antibiotics for 14 days
Viral Infections
Once a virus enters a body, it can reproduce and the person will have it for the rest of their lives
Although they may not experience symptoms while the virus lies dormant, they are still infected

Human Papilomavirus (HPV)
Viral Hepatitis
Infection with herpes simplex virus (HSV)
The virus prefers the mouth and face (herpes simplex I) or the genitals (herpes simplex II)
The symptoms may be less severe if the virus infects a less preferred site
The virus exists in the sores, as well as from the infected skin without the sores present (viral shedding)
HSV can be spread without active symptoms
A person can reinfect themselves on another body part
one of the most common STIs in the U.S.
- 1,000,000 infected each year
More common in women and African Americans
By age 5, 35% of African Americans & 18% of white children are infected with HSV-I, usually from a relative or a friend's kiss
that last 8-10 days, tingling/burning feeling, itching & red swollen genitals, painful urination, blisters with pus, fever, headaches, pain, itching, discharge, fatigue. Symptoms peak within 4 days of blisters appearance
Severity and frequency of recurrent episodes depend on amount of infectious agent, severity of infection, type of herpes, and timing of treatment
Psychological reactions: guilt, anger, anxiety, helplessness, frustration, depression, lowered self-esteem
Diagnosis: presence of blisters, sometimes a scraping will be taken
no cure; therapy with antiviral drugs
(topical, oral, injected) to decrease outbreaks, prevent complications, and reduce viral shedding; ice pack; cooling or drying agent; decrease sugar and nuts
Vaccines are undergoing trials
Human Papillomavirus (A.K.A. HPV)
types of HPV
Almost all cervical cancers can be attributed to HPV
, and HPV can also cause genital warts
Transmitted through intercourse, oral sex, vulva-to-vulva sex, and anal sex
Incidence: estimated 6.2 million Americans infected each year
Related Factors: intercourse before age 16, two or more sexual partners in a year, partner who has had multiple sex partners
; genital warts in 10% of HPV cases (highly contagious); foul-smelling discharge; itching & pain
Women- vagina, vulva, cervix; Men-penile shaft, head, and scrotum
Diagnosis: visual inspection of warts, biopsies,
pap test
13 high risk types for cervical cancer
Treatment: chemical topical solutions, cryotherapy, electrosurgical interventions, laser surgery
May resolve itself
or need many treatments/follow-ups
, first vaccine developed to prevent certain types of HPV that have been found to cause cervical cancer and genital warts
Ideally for girls before they are sexually active. Offered for ages 11-26
Given in 3 doses over 6 months and is 95-100% effective
Mandatory for young women immigrating to the U.S.
Viral Hepatitis
3 Types & their transmission paths:
Hepatitis A (HAV):
Fecal-oral contact; vaccine-preventable
Hepatitis B (HBV):
High-risk sexual behaviors
Hepatitis C (HCV):
Sexual behavior, drug use, bad blood transfusions
Viral Hepatitis
HAV: 32,000 cases in the U.S
. (decreased since HAV vaccine in 1995)
HBV: 46,000 in the U.S.
350 million worldwide
HCV: 3.2 million in the U.S.
HAV: fatigue, abdominal pain, loss of appetite, diarrhea
HBV: asymptomatic, nausea, vomiting, headaches, jaundice, fever, fatigue, darkened urine, liver enlargement, chronic liver disease
HCV: asymptomatic, mild illness, chronic liver infection
Diagnosis: blood test
Treatment: 3 drugs that interfere with the life cycle of the virus and induces an immune response
Vaccines are available for HAV and HBV (possible cure in the works for HCV)
Recommended for high risk individuals
1. Ectoparasitic
2. Bacterial
3. Viral

STIs and Social Stigma
Historically viewed as symbolic of corrupt sexuality and regarded with fear
The "punishment concept"--people with STIs 'got what they deserved' for being sexually irresponsible
This kind of thinking is a psychological defense--we believe that if specific behaviors cause STIs, we are safe if we avoid those behaviors
Negative attitudes about STIs still exist--may prevent people from getting tested

-Antibiotics can treat many of the bacterial infections; but prolonging treatment can lead to serious long-term consequences.
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