Chapter 14 Preventing Sexually Transmitted Infections

1. Outline: Chlamydia Gonorrhea Pelvic Inflammatory Disease Human Papillomavirus & Genital Warts Genital Herpes Syphilis HIV & AIDS Guidelines for Preventing Sexually Transmitted Infections Chapter 14Preventing Sexually Transmitted Infections

2. The WHO estimates 1 million people worldwide are infected daily with sexually transmitted infections (STIs), not including HIV STIs have reached epidemic proportions in the U.S. Of the more than 25 known STIs, some are still incurable Each year, more than 19 million people in the U.S. are newly infected with STIs, almost half of which are seen in young people between the ages of 15 and 24 Currently, the U.S. has the highest rate of STIs of any country in the industrialized world Preventing Sexually Transmitted Infections

3. Chlamydia Most prevalent STI in the U.S. Caused by a bacterial infection that spreads During vaginal, anal, or oral sex From the vagina to a newborn baby during childbirth Can cause serious damage to the reproductive system Is a major factor in male and female infertility May not produce symptoms; thus 3 of 4 infected individuals don’t know they’re infected until the infection has become quite serious 2.3 million cases are reported each year in the U.S. About 80% of these cases are reported in women between the ages of 15 and 24

4. Chlamydia When symptoms are present, they include abdominal pain, fever, nausea, vaginal bleeding, and arthritis Treatment requires oral antibiotics Damage to the reproductive system is irreversible Sexually active women under 25, older women with multiple partners and/or previous STIs, and those who do not regularly use condoms should be tested regularly for chlamydia

5. More than 25 diseases are spread through sexual contact. About 1 in 4 adults in the United States has a sexually transmitted disease.

6. Gonorrhea Caused by a bacterial infection Transmitted through contact with the vagina, penis, anus, or mouth of an infected person Symptoms in men Typical symptoms include a pus-like secretion from the penis and painful urination Symptoms in women Women also may have discharge and painful urination Up to 80% of infected women don’t experience symptoms until the infection has become fairly serious At this stage, women develop fever, severe abdominal pain, and pelvic inflammatory disease

7. Gonorrhea Untreated gonorrhea can produce Infertility, widespread bacterial infection, heart damage, arthritis Blindness in children born to infected women Treated successfully with penicillin and other antibiotics

8. Pelvic Inflammatory Disease Each year more than 1 million women in the U.S. experience an episode of PID Not a true STI, but rather complications resulting from STIs, especially chlamydia and gonorrhea Often develops when the STI spreads to the fallopian tubes, uterus, and ovaries Sexually active women, especially those under age 25, are at higher risk The more sex partners a woman has, the greater the risk

9. Pelvic Inflammatory Disease Complications include scarring and obstruction of the fallopian tubes, infertility, ectopic pregnancies, and chronic pelvic pain Women with PID who become pregnant may have an ectopic (tubal) pregnancy which destroys the embryo and can result in the woman’s death More than 100,000 women in the U.S. become infertile as a result of PID

10. Pelvic Inflammatory Disease Symptoms include Fever, nausea, vomiting, chills, spotting between menstrual periods, heavy bleeding during periods Pain in the lower abdomen during sexual intercourse, between menstrual periods, or during urination Many women do not know they have PID because symptoms are not always present PID is treated with antibiotics, bed rest, and sexual abstinence Surgery may be required to remove infected or scarred tissue or to repair or remove the fallopian tubes or uterus

11. Human Papillomavirus (HPV) & Genital Warts HPV is one of the most common causes of STI There are over 100 strains of HPV; over 30 are sexually transmitted Some strains of HPV infect the genital area and can cause genital warts Others are “high risk” types and may lead to cancers of the cervix, vulva, vagina, anus, or penis At least 80% of women will acquire genital HPV infection by age 50 Caused by a viral infection that is spread Through genital or oral contact From the vagina to a newborn baby Most people have no signs or symptoms and can transmit the virus to a sex partner

12. Human Papillomavirus (HPV) & Genital Warts Warts appear anywhere from 1 to 8 months after exposure Warts can be found On the penis and around the vulva and vagina In the mouth, throat, rectum, the cervix, or around the anus One million new cases of genital warts are diagnosed yearly in the U.S. In some cities, nearly half of all sexually active teenagers have genital warts

13. Human Papillomavirus (HPV) & Genital Warts Health problems include Increased risk for cancers of the cervix, vulva, vagina, anus, and penis Enlargement and spread of the warts, leading to obstruction of the urethra, vagina, and anus Warts over the bodies of babies born to infected mothers (thus, Cesarean sections are recommended)

14. Human Papillomavirus (HPV) & Genital Warts Treatment requires complete removal of all warts by Freezing them with liquid nitrogen, dissolving them with chemicals, or removing them through electrosurgery or laser surgery Patients may have to be treated more than once because genital warts can recur

15. Human Papillomavirus (HPV) & Genital Warts Prevention is best accomplished through a mutually monogamous sexual relationship with an uninfected partner 2006, the FDA approved Gardasil, the first vaccine to prevent cervical cancer and other diseases in women caused by HPV Gardasil protects against 4 HPV types that cause 70% of cervical cancers and 90% of genital warts The vaccine is approved for females between 9 and 26 To get the full benefits, women should get the vaccine before they become sexually active and not be infected with any of the 4 HPV types covered by the vaccine It has not been widely tested in women over 26

16. Genital Herpes A common STI caused by the herpes simplex virus (HSV) Several types of HSV produce different ailments, including Genital herpes, oral herpes, shingles, and chicken pox The two most common forms of HSV are Types 1 and 2 Type 1 is most commonly known to cause oral herpes Cold sores or fever blisters appear on the lips and mouth HSV Type 2 is better known as the virus that causes genital herpes About 135 million people over the age of 12 carry HSV Type I, most of which acquired the virus as children Another 45 million people over the age of 12 carry HSV Type 2 1 in 4 women, 1 in 5 men, 1 in 5 adolescents are currently infected with genital herpes (HSV 2)

17. Genital Herpes HSV is a highly contagious virus Victims are most contagious during an outbreak HSV spreads by contact with an active sore HSV can also be spread through virus-containing secretions from the vagina or penis A few days following infection, a tingling sensation and sores appear on the infected areas (mouth, genitals, rectum) but may also surface on other parts of the body

18. Genital Herpes Along with sores, victims usually have mild fever, swollen glands, and headaches Symptoms disappear within a few weeks, causing some people to believe they are cured Herpes is presently incurable; its victims do remain infected The virus can remain dormant for extended periods, but repeated outbreaks are common Outbreaks can be precipitated by excessive fatigue, stress, cold, wind, wetness, heat, sun, sweating, friction, lack of sleep, illness, restrictive clothing, popcorn, coffee, peanuts, chocolate, and alcohol

19. Syphilis Caused by a bacterial infection Transmitted through direct contact with a syphilis sore during vaginal, anal, or oral sex In the primary stage, about 3 weeks after infection, a painless sore appears where the bacteria entered the body The sore disappears on its own in 3-6 weeks If untreated, the infection progresses to the secondary stage in which a rough/reddish-brown rash appears on the palms of the hands and bottoms of the feet Additional sores may appear within 6 months of initial outbreak but will also disappear by themselves A latent stage during which victim is not contagious may last up to 30 years (victims think they are healed) Some people develop paralysis, gradual blindness, heart disease, brain and organ damage, or die as a direct result of the infection

20. HIV and AIDS Human immunodeficiency virus (HIV): Virus that leads to acquired immunodeficiency syndrome (AIDS) Acquired immunodeficiency syndrome (AIDS): Any of a number of diseases that arise when the body’s immune system is compromised by HIV Opportunistic infections: Infections that arise in the absence of a healthy immune system, which would fight them off in healthy people

21. HIV and AIDS HIV is passed from one person to another through blood-to-blood (sharing hypodermic needles) and sexual contact Upon infection, the HIV virus multiplies, attacks, and destroys white blood cells White blood cells are part of the immune system, which fights infections and diseases As the number of white blood cells destroyed increases, the body’s immune system gradually breaks down or may be completely destroyed Without the immune system, a person becomes susceptible to various opportunistic infections and cancers

22. HIV and AIDS When the infection progresses to the point at which certain diseases develop, the person is said to have AIDS HIV itself doesn’t kill, nor do people die of AIDS AIDS is the term designating the final stage of HIV infection Death is caused by a weakened immune system that is unable to fight off opportunistic infections

23. HIV and AIDS Early symptoms of AIDS include Unexplained weight loss, constant fatigue, mild fever, swollen lymph glands, diarrhea, sore throat Advanced symptoms include Loss of appetite, skin diseases, night sweats, deterioration of mucous membranes The two most common fatal conditions in AIDS patients are Pneumocystis carinii pneumonia (a parasitic infection of the lungs) Kaposi’s sarcoma (type of skin cancer)

24. HIV and AIDS HIV infection is determined through an HIV antibody test Once infected, the immune system forms antibodies that bind to the virus Most infected people will show these antibodies within 3 months of infection; the average is 20 days In rare cases, they are not detectable until after 6 months or longer

25. Transmission of HIV HIV is transmitted by the exchange of cellular fluids, including blood and other body fluids containing blood, semen, vaginal secretions, and maternal milk These fluids can be exchanged: During sexual intercourse Sharing hypodermic needles with someone who is infected Between a pregnant woman and her developing fetus Infection of a baby from the mother during childbirth During breast feeding (infrequent) From a blood transfusion or organ transplant (rare)

26. Myths about HIV Transmission HIV virus can not be transmitted through perspiration Sporting activities with no physical contact pose no risk to uninfected individuals Blood from an infected person cannot penetrate the skin of an uninfected person except through an opening in the skin A person should use vinyl or latex gloves when performing work that requires direct contact with someone else’s blood or open wound

27. Myths about HIV Transmission HIV is not transmitted through casual contact It cannot be caught by shaking hands with or hugging an infected person; using a toilet seat, dishes, or silverware used by an infected person; sharing a drink, food, a towel, or clothes with a person who has HIV The chances of getting infected during physical or medical procedures are nil as health care workers take extra care to protect themselves and their patients from HIV You cannot catch HIV from animals or insects as animals do not contract HIV

28. Trends in HIV Infection and AIDS As of 2007, estimates indicate that About 33 million people worldwide have HIV More than 25 million have died from AIDS since the epidemic began in 1981 15.4 million women now live with HIV About 1.2 million people in the U.S. have HIV and about 25% of them are unaware of the infection 1 in every 300 Americans is infected

29. HIV Testing A person can be tested in several ways Public Health Department Access the CDC website (www.cdc.gov/hiv) Call the National AIDS Hotline (1-800-CDC-INFO) STI Hotline (1-800-227-8922) www.hivtest.org for local testing facilities