Unit IV Sexually Transmitted Infections (STIs)

1. EDGC 682 Counseling Issues in Sexuality Unit IV Sexually Transmitted Infections (STIs) Dean Owen, Ph.D., LPCC Professor Emeritus Department of Foundational and Graduate Studies in Education

2. The topic of “social diseases” is not particularly appealing but an essential area for counselors since you will have contact with infected individuals throughout your professional life. Preferred current designation: STI Sexually Transmitted Infections… Alternate terms: Sexually Transmitted Diseases (STD) Venereal Diseases (VD) Social Diseases The Clap Crabs The gift that keeps on giving

3. The name "syphilis" was coined by the Italian physician and poet Girolamo Fracastoro in his epic noted poem, written in Latin, titled Syphilis sive morbus gallicus (Latin for "Syphilis or The French Disease") in 1530. The protagonist of the poem is a shepherd named Syphilus, a character in Ovid’s Metamorphoses. Syphilus is presented as the first man to contract the disease, sent by the god Apollo as punishment for the defiance that Syphilus and his followers had shown him. From this character Fracastoro derived a new name for the disease, which he also used in his medical text De Contagionibus ("On Contagious Diseases").

4. Most sources agree that Syphilus was brought to Europe as the result of contact with Indians during Columbus’ explorations to the new world. The first well documented European outbreak of this sexually transmitted disease occurred in 1494. Although possibly existing as early as the 14th century the disease was called “Lepra” until the 16th century. Another term used at the time was the “Great Pox” to distinguish it from smallpox. The Italians, Poles and Germans called it the “French Disease”. The French called it the “Italian Disease”. Dutch….Spanish Disease Russians….Polish disease Turks…Christian’s Disease Tahitians …..British Disease….

5. Poster from WWII

6. A series of videos on the topic of STDs From the website of the CDC Centers for Disease control and prevention http://www.cdc.gov/std/Be-Smart-Be-Well/default.htm#

7. Fact Sheets from the CDC may be obtained from the following site: Sexually Transmitted Diseases http://www.cdc.gov/std/healthcomm/fact_sheets.htm Hepatitis http://www.cdc.gov/hepatitis/Resources/PublicEdMaterials.htm HIV/AIDS http://www.cdc.gov/hiv/resources/factsheets/

8. This presentation will address the topic of infections that cause disease and which are commonly spread through sexual contact. There are three terms that must be defined… Infection Disease Mode of transmission

9. Sexually Transmitted Infection: An organism that has a high probability of being transmitted between humans as the result of sexual activity including vaginal intercourse, oral sex, or anal intercourse. Source:CDC

10. Infection: The presence of a germ (virus, bacteria, or parasite in the human body capable of causing illness/death. An infected person may be asymptomatic. Source:CDC

11. Disease: The effect of such a germ that causes an individual to feel ill or become sick (symptomatic) Source:CDC

12. Significant signs for STD • Is your urine dark and or smell bad? • Is your genital area secreting puss or discharge? • Do you experience a burning sensation when urinating.? • Do you have a strange rash or itching sensation? • Do you have any legions, bumps, or warts in the genital or anus area? • Have you noticed an unusual odor? • Have you noticed a strange blister or open sore? • Do you have pain during intercourse that wasn't there previously? • Do you have abdominal pain? • Have you noticed any unusual or unexplained swelling? • Have you seen small eggs or nits in your pubic hair or armpits? Source: http://yourstdhelp.com/

13. Categories of STIs Protozoal Bacterial Fungal Viral Parasitic Source: CDC

14. Bacterial Infections (Haemophilus ducreyi) Haemophilus ducreyi is a gram-negative coccobacillus causing the sexually transmissible disease chancroid. Chancroid is a major cause of genital ulceration in developing countries characterized by painful sores on the genitalia. Chancroid starts as an erythematous papular lesion which breaks down into a painful bleeding ulcer with a necrotic base and ragged edge. This condition can be treated a macrolide group of antibiotic. Source:CDC

15. Bacterial Infections (Chlamydia trachomatis) Chlamydia infection is a common (STI) in humans caused by the bacterium Chlamydia trachomatis . Chlamydia infection is one of the most common sexually transmitted infections worldwide; it is estimated that about 1 million individuals in the U.S. Source: CDC fact sheet

16. Bacterial Infections Chlamydia (Female) • 50-75% of infected are asymptomatic • 50% of those will develop PID • PID causes scaring and can cause difficulty in becoming pregnant, ectopic pregnancy and other complications. • Chlamydia is known as the "Silent Epidemic“. • This condition can linger for months or years • Symptoms that may occur include: unusual vaginal bleeding or discharge, pain in the abdomen, painful sexual intercourse (dyspareunia), fever, painful urination or the urinary urgency. Source: CDC fact sheet

17. Bacterial Infections Chlamydia (Male) • About 50% of infected me become symptomatic (erethritis) • Symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, swollen or tender testicles, or fever. • Discharge, or the purulent exudate, is generally less viscous and lighter in color than for gonorrhea • May spread to testicles (epididymitis) and can cause sterility Source: CDC fact sheet

18. Categories of Sexually Transmitted Infections: Chlamydia Source: CDC

19. Bacterial Infections Granuloma inguinale Granuloma inguinale is a bacterial disease characterized by ulcerative genital lesions that is endemic in many less developed regions. Source: CDC

20. Bacterial Infections Granuloma inguinale Symptoms: Appearance of small, painless nodules 10-40 post contact with bacteria. Nodules later burst creating open oozing lesions. The infection spreads, mutilating the infected tissue. The infection will continue to destroy the tissue until treated. Locations: Penile shaft, labia or perineum. Treatment: Antibiotics Source: granuloma inguinale at Dorland’s Medical Dictionary

21. Bacterial Infections Gonorrhea (Neisseria gonorrhoeae) Gonorrhea (also gonorrhoea, sometimes referred to as 'the clap') is a common STD. In the US, gonorrhea is the second most common STI among bacterial infections. It can spread throughout the body if left untreated and affects joints and even heart valves. Source: CDC Fact Sheet

22. Bacterial Infections Gonorrhea (Neisseria gonorrhoeae) Gonorrhea is transmitted via vaginal, oral or anal sex (condom use effectively reduces transmission rates) Incubation period is 2-30 days with most symptoms appearing 4-6 days following contact. 30-60% of infected individuals are asymptomatic or have a subclinical infection. Source: CDC Fact Sheet

23. Bacterial Infections Gonorrhea (Neisseria gonorrhoeae) • Male Symptoms: (2-30 days post infection) • yellowish discharge from the penis, associated with painful, and sometimes frequent, urination. • Painful urination • Urethral pus discharge • Pain and swelling often occur and the infection can easily migrate to the epididymis, testicles and prostate causing scrotal swelling. Source: CDC Fact Sheet

24. Bacterial Infections Gonorrhea (Neisseria gonorrhoeae) • Female Symptoms: 50% + of infected women are asymptomatic or have symptoms mild enough to be ignored. • Vaginal discharge • Dysuria (difficulty in urinating) • Projectile urination • Off-cycled menstrual bleeding • Bleeding after intercourse. • Left untreated the infection can progress to PID with all of the consequences. Source: CDC Fact Sheet

25. Bacterial Infections Gonorrhea (Neisseria gonorrhoeae) Source: CDC Fact Sheet

26. Bacterial Infections Syphilis (Treponema pallidum) Syphilis is a STD but there are examples of transmission via mother to child in utero or at birth. Prior to effective laboratory testing the disease was called the “Great Imitator” because it was often confused with other diseases. Syphilis can generally be treated with antibiotics and if left untreated it can cause damage to heart, aorta, brain, eyes, and bones. Syphilis can occur in several phases…. Source: CDC FACT Sheet

27. Bacterial Infections Syphilis (Treponema pallidum) Primary syphilis Primary syphilis is typically acquired via direct sexual contact with the infectious lesions of a person with syphilis. Infection appears as lesion(s) 10–90 days after the initial exposure. This lesion, called a chancre, is a firm, painless skin ulceration localized at the point of initial exposure to the spirochete, often on the penis, vagina, or rectum. The lesion may persist for 4 to 6 weeks and usually heals spontaneously. During the initial incubation period, individuals are otherwise asymptomaic. As a result, many patients do not seek medical care immediately. Source: CDC FACT Sheet

28. Secondary Syphilis • Although initial lesion my heal the organism is still present in the body…. • Secondary syphilis occurs approximately 1–6 months (commonly 6 to 8 weeks) after the primary infection. Symptoms include: • symmetrical reddish-pink non-itchy rash on trunk palms and soles of the feet. • 2. In moist areas of the body (usually vulva or scrotum), the rash becomes flat, broad, whitish, wart-like lesions known as condyloma latum. • mucous patches may also appear on the genitals or in the mouth. • A patient with syphilis is most contagious when he or she has secondary syphilis. Other symptoms common at this stage include fever, sore throat, malaise, weight loss, headache and enlarged lymph nodes. Source: CDC FACT Sheet

29. Latent Syphilis Latent syphilis: Infection without signs or symptoms. May be early latent (two years or less w/o symptoms or late latent (infection for more than two years.) Early latent syphilis may be treated with a single intramuscular injection of a long-acting penicillin. Late latent syphilis requires three weekly injections. Early latent is more contagious than late. Fifty percent of those infected with latent syphilis will progress into late stage (tertiary) syphilis, 25% will stay in the latent stage, and 25% will make a full recovery. Source: CDC FACT Sheet

30. Tertiary Syphilis This form usually develops 1-10 years following initial infection but in some cases it can take as long as 50 years. This stage is characterized by the formation of gummas, which are soft, tumor-like balls of inflammation known as granulomas. The granulomas are chronic and represent an inability of the immune system to completely clear the organism. They may appear almost anywhere in the body including in the skeleton. The gummas produce a chronic inflammatory state in the body with mass effects upon the local anatomy. Source: CDC FACT Sheet

31. Presentation of Syphilis Chancre Secondary Syphilis Source: CDC FACT Sheet

32. Fungal Infections • Tinea cruis, "jock itch," “crotch rot”, “scrot rot” • A fungal infection in the groin area of both males and females but more commonly in males. This common rash is related to similar fungi that cause “athlete’s foot” and can be transmitted by sexual contact. CDC

33. Fungal Infections • Candidiasis, yeast infection • Most candidial infections are treatable and result in minimal complications such as redness, itching and discomfort, though complication may be severe or fatal if left untreated, particularly in individuals whose immune systems have been severely compromised. Normally these are a very localized infection of the skin or mucosal membranes, including the oral cavity (thrush), the pharynx or esophagus, the gastrointestinal tract, the urinary bladder, or the genitalia (vagina or penis) • Candidiasis is a very common cause of vaginal irritation, or vaginitis, and can also occur on the male genitals. In immunocompromised individuals, Candida infections can affect the esphagus with the potential of becoming sytemic. CDC

34. Viral infections • Viral hepatitis (Hepatitis B) • Herpes simplex • HIV/AIDS (Human Immunodeficiency Virus • HPV(Human Papilloma Virus) • Molluscum contagiosum(MCV)

35. Viral infections Viral hepatitis Viral hepatitis is liver inflammation due to a viral infection. It may present in acute (recent infection, relatively rapid onset) or chronic forms. The most common causes of viral hepatitis are the five unrelated hepatotropic viruses Hepatitis A-E. Hepatitis B is the one that is generally believed to be transmissible via venereal fluids saliva,& blood. Cirrhosis & hepatocellular carcinoma are the killers. 500K to 1.2 M die each year. Epidemic in SE Asia.

36. Viral infections • Herpes simplex • Two Forms: Oral and Genital • Following infection through contact with active lesions or bodily fluids, the disease cycles between two states. Active (2-21 days) followed by periods of remission or inactivity. • Genital herpes is frequently asymptomatic • Virus resides for life. CDC

37. Viral infections HIV/AIDS How much do you know about HIV/AIDS?? CDC

38. Viral infections HIV/AIDS Human immunodeficiency virus (HIV) is a lentivirus (retrovirus) that causes acquired immunodeficiency syndrome (AIDS), a condition in which the immune system begins to fail, leading to life-threatening opportunistic infections. The four major routes of transmission are bodily fluids, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth (perinatal transmission). Currently 0.6% of the world’s population is infected. CDC

39. Viral: HIV/AIDS CDC

40. Viral infections HPV Human Papillomavirus More than 200 types are known to exist. 30-40 types are thought to be transmitted via sexual contact and infect the anogenital region of humans. Infection by some types cause genital warts while other forms are believed to cause precancerous lesions and invasive cervical cancers. CDC

41. Viral infections Molluscum contagiosum(MCV) Molluscum contagiosum (MC) is a viral infection of the skin or occasionally of the mucous. There are four types of MCV, MCV-1 to -4; MCV-1 is the most prevalent and MCV-2 is seen usually in adults and often sexually transmitted. This common viral disease has a higher incidence in children, sexually active adults, and those who are immunodeficient,and the infection is most common in children aged one to ten years old. MC can affect any area of the skin but is most common on the trunk of the body, arms, and legs. It is spread through direct contact or shared items such as clothing or towels. CDC

42. Parasitic Infections Pubic Lice Crab lice (also known as "crabs," Phthirus pubis, Pthirus pubis, and "pubic lice”)are parasitic insects notorious for infesting human genitals. The species may also live on other areas with hair, including the eyelashes. They feed exclusively on blood. Humans are the only known hosts of this parasite CDC

43. Parasitic Infections Scabies (Body lice) This infection is the result of a parasitic mite (Sarcoptes scabiei). Close physical contact can permit transmission of mites from one to another and the infection causes intense itching and can generate severe secondary infections. Highly contagious through direct contact with the skin or even objects. CDC

44. Protozoal Infections Protozoa: Trichomoniasis Trichomoniasis, sometimes referred to as "trich", is a common cause of vaginitis. It is a sexually transmitted disease and caused by the single-celled protozoan parasite Trichomonas vaginalis. Trichomoniasis is primarily an infection of the urogenital tract; the most common site of infection is the urethra and the vagina in women. CDC

45. Protozoal Infections Trichomoniasis Typically a condition found in women. Symptoms include: Inflammation of the cervix, urethra, and vagina Vaginal discharge Lower abdominal pain Itching and burning Symptoms appear 5-28 days following exposure. 7.4 million cases: most common of all curable STD’s among young, sexually active women. American Social Health Association, http://www.cdc.gov/std/Trichomonas/STDFact-Trichomoniasis.htm

46. Source: CDC

47. Source: CDC

48. Source: CDC:http://www.cdc.gov/std/stats08/trends.htm

49. Reportable STDs for the State of Kentucky 2008 Cases Rate Chlamydia 8779 1568.3 Gonorrhea 2697 481.8 P&S Syphilis 25 4.5 CDC

50. Chlamydia CDC