Chapter 18

Sexually Transmitted Diseases (STDs)

Also known as Sexually Transmitted Infections (STIs) Spread of an infection from person to person mainly through sexual activity. STDs that pose a major health threat:

1. 2. 3. 4. 5. 6. 7.

HIV/AIDS Hepatitis Syphilis Chlamydia Gonorrhea Herpes Human papillomavirus (HPV)

CDC (2008) estimated 65 million Americans were infected with an STD, and about 19 million Americans become newly infected with an STD each year.

Table 18-1 Annual New Cases of STDs in the United States

Table 18-2 Sexually Transmitted Pathogens and Associated Disease

Acquired Immunodeficiency Syndrome (AIDS)

Leading cause of death in many parts of the world.

Worldwide, AIDS is the leading cause of death for

people age 15-59

Approximately 65 Million people around the world have been infected with Human Immunodeficiency Virus (HIV) since the epidemic began.
Nearly 1% of the worlds population About 3 million infections per year

1.1 million Americans have been infected and about 500,000 have died since the start of the epidemic. Human immunodeficiency virus (HIV) is the virus which causes AIDS.
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What is HIV Infections?

HIV attacks and invades CD4 T-cells, monocytes and macrophages. HIV enters a human cell and coverts its own genetic material, RNA, into DNA AIDS opens the possibility for a opportunistic infections. Once initial symptoms resolve, the asymptomatic period may last from 2 to 20 years.

Figure 18-1 The general pattern of untreated HIV infection

Transmitting the Virus

HIV lives only within cells and body fluids. 3 primary means of transmission are: (1)Specific

kinds of sexual contact, (2) direct exposure to infected blood, and (3) HIV-infected women to her fetus.

Sexual contact Direct contact with infected blood. Mother-to-Child transmission.

Vertical or perinatal, transmission

Not through casual contact.

Sexually Transmitted Diseases

Populations of Special Concern for HIV infection

Most common exposure has been sexual activity between men; injection drug use, and heterosexual contact. African American men and women are vastly overrepresented among people newly diagnosed with AIDS.

See HIV/AIDS Among African Americans

and Latinos

Figure 18-2 Routes of HIV transmission among adults

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Symptoms of HIV Infection

Few days or weeks, half the people will develop (Flu like symptoms)
Fever, fatigue, rashes, headache, swollen lymph

nodes, body aches, night sweats, sore throat, nausea and diarrhea.

Specialized test HIV RNA assay. Pneumocystis Carinii pneumonia (fungal infection). Kaposis sarcoma. Difficult to treat yeast infections in women Tuberculosis

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Diagnosing HIV Infection

Most common is tests for the presence of antibodies to the virus.

HIV antibody test ELISA (first test) if positive then the. Western blot ((second test),

Immunoflourescence assay))

IF HIV-positive then check the status of the CD4-t cells. New diagnostic test HIV Replication Capacity.

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Diagnosing AIDS

Infection defined as an AIDS indicator. Reporting.

All diagnosed cases of HIV or AIDS must be reported to public health

authorities

Treatment (NO CURE).

Antiviral drugs. Reverse transcriptase inhibitors. Zidovudine (AZT). Inhibiting the enzyme reverse transcriptase, uses to integrate its genetic material into human cells. Protease inhibitors. Highly active antiretroviral therapy (HAART). Structured intermittent therapy. Entry inhibitors
Enfuvirtide (Fuzeon) Block HIV from entering and infecting cells.

Integrase inhibitor
chromosome.

Blocks the incorporation of newly formed HIV DNA into the host cells

Post-Exposure prophylaxis. Treatment for opportunistic infections. HIV and Pregnancy

Sexually Transmitted Diseases 13

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What about a Vaccine?

Vaccines are being tested in humans Licensed AIDS vaccine is not estimated to be at least a decade away

Some experts concede the possibility that a

vaccine may never be devleoped

How Can You Protect Yourself?

Make careful choices about sexual activity.

Do Not share drug needles.

Participate in an HIV educational program.
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Chlamydia Trachomatis
Most prevalent bacterial STD in the U.S. Bacterial infection
Can cause sterility in men and women
WOMEN infects the cervix and to urethra, fallopian tubes

& ovaries, PID, bladder infections. MEN- Epididymitis, urethra to testes, urethritis, bladder infections, watery discharge.

Symptoms ASYMPTOMATIC : Discharge, pain and

burning while urinating, vaginal bleeding, painful intercourse, abdominal pain, nausea, fever, inflammation of rectum or cervix, swelling and pain in the testes.

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Chlamydia Trachomatis

Spread - vaginal and anal intercourse,

from the birth canal to the fetus

Diagnosis - Examination of tissue samples

or urine

Treatment - Both partners treated fully with

antibiotics

Protection - Condoms and safe sex

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Gonorrhea

350,000 new cases reported to the CDC in 2006.

5.5% increase over 2005.

Bacterial infection - Can cause sterility,

arthritis and heart problems PID, can cause ectopic pregnancy, premature labor and still birth, arthritis, and rashes Gonococcal conjunctivitis
Eye infection of a infant that can cause

blindness if not treated

Symptoms
Women - Asymptomatic - Frequent burning urination,

menstrual irregularities, pelvic pain, discharge. Males thick yellow-white discharge, painful urination.
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Gonorrhea
Spread - Vaginal, anal and oral sex. Diagnosis - Microscopic exam of discharge. Treatment - Oral antibiotics - People often

have chlamydia at same time.

Protection - Condoms and safe sex.

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Pelvic Inflammatory Disease PID

Progressive infection that harms a womens reproductive system. Can lead to sterility, ectopic pregnancy and chronic pain - treated or not. Caused by chlamydia and gonorrhea. Symptoms - long and painful periods, discharge, spotting, low abdominal pain, fever, chills, nausea, vomiting, pain during intercourse.

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Pelvic Inflammatory Disease PID

Treatment - Antibiotics, bed rest, sexual

abstinence and maybe surgery to remove scarring

Diagnosis - Pelvic Exam, cultures, laparoscopy Protection - Condoms and safe sex

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Human Papilloma Virus

More than 80% of sexually active individuals will have been infected with HPV by the age of 50. Vaccine
Is not a treatment for HPV for girls or women who are

infected with HPV.

Symptoms
Small bump on the skin or a large, warty growth Cauliflower-like mass May cause irritation and bleeding

How is it spread Diagnosis

Appearance of the lesions Women who are positive should have a Pap test very 12

months

Treatment
Removed by cryosurgery, electrocautery or laser surgery

Protection
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Genital Herpes

1 in 5 adults in the U.S. has genital herpes Two forms - Herpes simples virus-1 and -2.
HSV 1 (Type 1) is associated with cold sores and fever blisters.
Oral-labial herpes
50-80% of U.S. adults have antibodies to HSV-1

HSV 2 (Type 2) Usually occurs during adolescence and early adulthood

Between 18 -25 years old Approximately 22% of adults have antibodies to HSV 2

Remains in the body for life. Symptoms 90% have no symptoms

Recurring rash, pain ulceration's. Primary outbreak - pain and discomfort around infected area,

itching, burning during urination. 2-20 days after infection - may years before outbreak.

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Herpes

Spread - Touching, sexual intimacy -

including kissing, vaginal, oral and anal sex Diagnosis - Examination of sores and culturing of fluid taken from sores Treatment - No cure - symptoms are relieved by drugs Protection - Refrain for sex during out break

HSV-1 and 2 can cause miscarriages or still births along with serious health issues of newborns

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Hepatitis B Virus (HBV)

Can cause liver disease and death

Inflammation of the liver

Preventable with vaccination. Transmission - Semen, saliva, blood and urine Symptoms - Extreme fatigue, headache, fever, hives, lack of appetite, nausea, vomiting, tenderness in lower abdomen Diagnosis and Treatment

Blood Test No cure

Prevention

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Syphilis

7000-10,000 new cases of early syphilis in the U.S. Syphilis organism remains in the body for life and
leads to disfigurement, neurological disorders, or death. Effective antibiotics and condom use. Symptoms
(chancre) and swollen glands.

Primary phase- 3 weeks - 90 days - painless sores and wet ulcers Secondary Phase - 3-6 weeks - up to 2 years body rash, mild fever, fatigue, sore throat (Flu like symptoms), and hair loss. Late phase (tertiary)- Damage to organs and nervous system.

Diagnosis and Treatment

Examination of infected tissues and with blood tests Treated by antibiotics

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Other STDs

Trichomoniasis
Trich Single-celled organism

Bacterial vaginosis (BV)

Abnormal vaginal discharged caused unhealthy

species of normal vaginal bacteria

Pubic Lice Crabs

Contagious parasitic infections

Scabies
Contagious parasitic infections

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What You Can Do

Education. Diagnosis and Treatment

Get vaccinated Be alert for symptoms Get tested Inform your partners Get Treated

Prevention
Use a barrier defense. Know your potential partner.

Ask. Are you ready to have sex?

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Chapter 18