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Sexually Transmitted Disease

Sexually Transmitted Disease. Significant health problem $16 billion per yr in costs Many unaware of risks Hidden epidemics (some types are asx, undiagnosed) Difficult to track. How widespread?. Incidence

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Sexually Transmitted Disease

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  1. Sexually Transmitted Disease • Significant health problem • $16 billion per yr in costs • Many unaware of risks • Hidden epidemics (some types are asx, undiagnosed) • Difficult to track

  2. How widespread? • Incidence • 18.9 million new cases each year U.S. (9 million cases age 15-24 50 % of cases thogh 25% of U.S. pop.) • Half of these will become lifelong infections • Prevalence • 65 million people U.S. have incurable STD

  3. Most Common STDs Name Incidence Prevalence Chlamydia 2.8 million Gonorrhea 700,000 not avail. Syphilis 32,000 not avail. Herpes 1 million 45 million HPV 6.2 million 20 million Hepatitis B 73,000 1.5 million Trichomoniasis 7.3 million not avail. Bacterial Vaginosis not avail. not avail.

  4. Possible Consequences: • tubal occlusion (infertility, ectopic pregnancy) • neonatal morbidity and mortality • genital cancers • epidemiologic synergy with HIV transmission

  5. Biological sexism • Special impact on women • suffer more severe long term effects • more often asx, therefore undiagnosed • greater risk for infection from one time exposure due to fluid dynamics of IC

  6. Chlamydia: The Silent STD Cause: Chlamydia Trachomatis • Most common bacterial STD • Leading cause of preventable infertility, ectopic pregnancy in U.S. • 40% will develop PID if not treated • 1/5 with PID becomes infertile • M: nongonoccocal urethritis (30-40% caused by chlamydia)

  7. Transmission: • Contact with infected discharges from mucous membranes • Vaginal, anal, oral sex • Child sexual abuse

  8. SX Incubation: 1-3 weeks • Milder than gonorrhea M: dysuria, urethral discharge (50% asx) • Later sx, epididymitis: swelling, pain in testicles, fever F: vaginal discharge, dysuria (75% asx) • Later sx: PID sx (PID Sx: abdominal pain, bleeding between periods, fever, bleeding during IC)

  9. Dx: culture, urine test   Tx: antibiotics

  10. Complications: F: • PID (occurs in 40% of untx F) • 1 in 5 infertile • 1 in 10 ectopic pregnancy Pregnancy • Preterm labor • Premature rupture of membranes

  11. M: • epididymitis • proctitis • rarely: infertility Both: 3-5x increased risk of acquiring HIV Newborns: • conjunctivitis, pneumonia

  12. Gonorrhea Cause: Neisseria gonorrhoeae Transmission: same as chlamydia  Incubation: 2 to 3 possibly as long as 30 days Sx: M: dysuria, urethral discharge (25% asx) F: Mild, vaginal discharge, dysuria, PID Sx (50% asx) Rectal sx: discharge, itching, painful bowel movements

  13. Dx: Urine or cervical swab for genes; culture Tx: antibiotics • 20-40% have coexisting chlamydial infection • Dual therapy often recommended  • Antibiotic resistant strains endemic

  14. Complications F: PID M: Epididymitis Both, Rarely: arthritis (permanent joint damage possible), endocarditis (death possible), septicemia Newborns: conjunctivitis Blindness if not treated rapidly Silver nitrate or antibiotic ointment placed in eyes of all babies

  15. Syphilis 56% of cases in south; more in Af. Am. Cause: Treponema pallidum Transmission: • Direct contact with Syphilis sore (stage I & II) • Vaginal, anal, oral sex • Sores occur: rectum, genitals, vagina, mouth ·  Vertical transmission (mother to fetus, any stage) • Crosses placental membrane • Likelihood decreases in relation to length of time from mother’s initial infection

  16. Sx by stage Incubation: 10-90 days (21 avg.) Primary Stage (I): Chancre • firm, round, painless • appears where bacteria entered body • lasts 1-5 weeks • heals without tx 

  17. Secondary Stage • up to 10 weeks • skin rash (“copper penny” spots) hands, feet, torso: lasts 2-6 weeks (heals without tx) • enlarged lymph nodes, fever, fatigue, headache, hair loss, weight loss I &II: easier to transmit and acquire HIV Latent Stage • No apparent sx (asx) • Begins to damage brain, nerves, eyes, heart, liver, bones, joints, blood vessels

  18. Tertiary (late) Stage: paralysis, dementia, blindness, cardiovascular complications Dx: blood test for antibodies Tx: penicillin

  19. Herpes • HSV-1: 66% of pop. • HSV-2: 20% of pop. • F:1/4 • M: 1/5 • Lifelong infection • Cause: Herpes Simplex Virus (HSV)

  20. Sx • Asx • Mild symptoms • Recurrent, painful, genital ulcers • About 5 outbreaks first yr; freq.declines over time • Sx most severe if immune-suppressed • Can infect eyes, brain

  21. Transmission • Skin-to skin contact, kissing, sexual contact (oral, anal, vaginal) • Viral shedding (with and without associated sx) • Asx shedding occurs about 3% of days per yr • Mother to baby at birth (neonatal herpes) • Rare • Most likely if HSV-2 acquired while preg. • C-section may prevent infant exposure

  22. Course of infection • Infects nerves in skin • Travels to nerve roots near spinal column • Returns back to skin/mucous membranes • Prodrome: itching, tingling • Initial outbreak: small blisters, painful; flu-like sx, swollen lymph nodes (lasts 2-4 weeks) • Tx shortens outbreak 40-50%

  23. Course Con’t • Immune systems attacks HSV, sx clear • Remains hidden in nerve roots for life • Latent phase • Can recur producing active sx (4-5 first yr of inf. is avg) • Influenced by HSV type • Less common with genital HSV-1 • Less asx shedding • Duration of infection (recurrences decrease over time)

  24. Dx • Culture of lesions within 48 hours (can be typed) • If no lesions, antibody blood tests • Some types can’t tell oral from genital • POCkit Rapid Test – HSV-2 only, finger stick • HerpeSelect ELISA Kits – HSV-1&2

  25. Tx • Antiviral medications • Acyclovir, Valacyclovir, Famcyclovir • Episodic therapy • Only during outbreaks, shortens duration • Suppressive therapy • Taken daily, reduces recurrences by 75%, asx viral shedding by 90%

  26. Complications • Increased risk of transmitting/getting HIV • Psychological distress • Risks to babies

  27. Prevention • Abstain during outbreaks • Condoms • Anti-viral meds • Spermicides inactivate HSV in test tube (human applications?) • Topical microbicides • Vaccine research in progress

  28. Human Papillomavirus HPV • 20 million cases; 6.2 million per yr. • 50% sexually active F&M believed infected • 80% of F will get HPV by age 50 • >100 types of HPV (30 trans. sexually) • Low risk types: 6, 11, 42, 43, 44 (raised genital warts) • Highest risk types: 16 & 18 appear flat, nearly invisible, associated with abnormal Pap results, invasive cancers • Genital warts

  29. Course of infection • Long incubation period weeks to years • hard to know exactly when, from whom infection occurred • Episode (sx or subclinical) • Recurrences possible • Healthy immune system helps fight virus *80% undetectable within 2 yrs *Small % of persistent infections -if high risk type: cervical ca risk

  30. Sx: • often asx (sub-clinical HPV) • genital warts (penis, scrotum, anus, vulva, vagina) Dx: acetic acid (vinegar) applied to genitals, warts turn white, view with magnifying lens -sometimes on Pap smear -Most infections subclinical, not detected on exam or by cytology, only with HPV DNA probe

  31. Tx • Cryosurgery • Laser • Excision • Caustic agents (TCA, Podofilox cream) • Imiquimod cream (Aldara): stimulates immune system • Interferon (rarely) *Vaccine research progressing rapidly

  32. Complications • Increased risk cancer of cervix, anus, vagina, penis • High risk HPV types found in 99% of cervical cancers worldwide • Babies: can get HPV in voice box (rarely)

  33. Bacterial Vaginosis (BV) • Vaginal infection • Transmission: probably sexually related; change in vaginal environ. causes increase in harmful bacteria; not seen in non-sexually active F • Sx: gray/white discharge, odor (“fishy”), pain, itching, burning with urination • Dx: lab test of discharge • Tx: metronidazole (sometimes clears w/o tx) • Complications: Usually none; sometimes PID, pre-term births, LBW infants, Increased risk of transmitting/getting HIV

  34. Trichomoniasis • Cause: parasite • Transmission: sexual activity • F: vagina; M: urethra • Sx: asx or irritation, discharge (F-frothy, yellowish, storing odor), burning with urination • Dx: lab test of discharge • Tx: metronidazole (tx both partners) • Complications: Usually none; sometimes PID, pre-term births, premature rupture of membranes, increased risk of transmitting/getting HIV

  35. Pubic Lice (Pediculosis pubis) • Also known as crabs • Lice attached to pubic hair • Feed on blood of host • Live 30 days, die within 24hrs when removed from host • Sx: Itching • Dx: observation of lice/eggs on pubic hair • Tx: OTC shampoos, prescription shampoos Wash clothing and bedding

  36. AIDS • AIDS: 20 million deaths since 1981 • 2.9 million in 2003 alone • U.S.: 406,000 people with AIDS at end of 2003 • African Am.: 50% of AIDS cases; 50% of deaths • Af Am M highest new infection rate (7X that of whites • 69% of HIV/AIDS cases in F (2001-2003) were Af Am • HIV/AIDS dx in Af-Am F: • 19 X higher than white F • 5 X higher than Hispanic F 

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