Unit 13: Sexually Transmitted Infections (STI’s)

1. Unit 13: Sexually Transmitted Infections (STI’s)

2. HIV/AIDS

3. Natural history of HIV/AIDS • Probably originated in Africa • AIDS (acquired immune deficiency syndrome) is caused by the HIV virus (Human immunodeficiency virus) • The HIV virus infects T-cells (white blood cells) • makes copies of itself • then destroy these T-cells • Body make antibodies for virus (HIV test checks for their presence) • Our body can’t get rid of HIV fully because • HIV weakens the immune system to begin with • HIV replicates too fast for our immune system to fight it • HIV can mutate (therefore changing its antigen), to avoid elimination • A ‘positive HIV’ test means you have HIV antibodies in your blood • Sometimes takes weeks to months to show antibodies • Concern = _______________________________________

4. Natural history of HIV/AIDS • Early symptoms include fever, fatigue, swollen lymph glands (often mistaken for flu/cold) • Most people who get HIV will eventually develop AIDS • However, AIDS has a long latent period (≈10 years) • People may infect others without even knowing because they don’t show the signs/symptoms of infection • Destroyed T cells leave a person very susceptible to opportunistic infections

5. Transmission • NOT highly contagious • Transmission requires intimate contact between body fluids (blood, semen, breast milk) often through: • Unprotected sex • Unsterile needles • Mother to fetus or infant • Blood transfusion • Risk from highest to lowest: Anal intercourse > vaginal intercourse >>>>oral sex >>>>>>>>>> wet kissing , urine, sweat, tears

6. Transmission • More likely to occur during anal intercourse than vaginal intercourse because: • Rectum lining is thin • Rich blood supply in the rectum • Rectum has a lot of white blood cells that have the HIV receptor • The skin is often damaged • The vagina has better natural lubrication

7. HIV Stages after Transmission • First Stage – primary HIV disease • Early cold/flu like symptoms, may have a rash • Not early enough to show a + HIV blood test • Second Stage – chronic asymptomatic disease • of immune cells without disease symptoms – cont. swollen glands • vulnerability to opportunistic infections • Third Stage – chronic symptomatic disease • Thrush – yeast infection of the mouth • Body weakness and discomfort, sustained fever, night sweats, weight loss, and frequent diarrhea

8. HIV Infection http://www.hivcenternyc.org/newsletter/preview/300px-Symptoms_of_acute_HIV_infection.png

9. High Risk Groups

10. Canada • Female incidence is increasing • It used to be that most cases (80%) were in men who have sex with men (MSM) (1989), now more heterosexuals are being diagnosed • The decline in mortality is attributed to: • Public education to use condoms • Antiretroviral drugs (ART) reduce infectiousness and transmission

11. HIV Prevalence

12. New HIV Cases

13. HIV/AIDS Epidemiology Kilmarx 2009

14. Epidemiology of HIV/AIDS • Higher risk groups include: • Men who have sex with men • Sex trade workers • Injection drug users • Aboriginals

15. Treatment/ prevention • No effective vaccine exists • Some recent progress (published in New England Journal of Medicine): • canarypox vector vaccine (ALVAC-HIV [vCP1521]) + boasters administered to heterosexual healthy individuals in Thailand • monitored for 3yrs at 6 mn intervals • “community-based, randomized, multicenter, double-blind, placebo-controlled efficacy trial” • New infections= • Vaccine group= 51 of the 8,197 • Placebo group= 74 of the 8,198 • statistically significant difference • Still very far from eradication!!

16. Treatment/ prevention • Prevention is the key: • Practice safer sex! • Wear a condom, avoid multiple sex partners, know your partner’s sexual history/last STI test • Don’t combine drug use and sex • Avoid injection drugs • Avoid “sketchy” tattoos and body piercing • HIV testing (prevents transmission)

17. Herpes Simplex

18. Herpes Simplex Overview • Caused by the herpes virus • Two types • HSV1 typically affects the mouth/lips • HSV2 typically affect the genitals • Appears as recurrent temporary lesions (ex. Cold sores) on the lips, mouth genitals etc) • 1/5 of sexually active people have had HSV infection in Canada

19. Herpes “fever blisters” If you think this slide is bad.... Be thankful I didn’t post any genital herpes pictures! Wear a Condom!!!!

20. Herpes simplex overview • There is no cure • Antiviral drugs may shorten episodes • Have it for life • HSV2 is easier to protect against • Don’t touch genitals as much • Can use a condom

21. Secondary Prevention • List of things one can try to decrease episodes • Stress Management – Vit B • Exercise – Decrease production of cortisol • Amino Acid L-Lysine - seems to help with type 1 (Smirnova IP et al. 1998) • Mutations can occur between Herpes Simples 1 and 2 - oral sex?

22. Hepatitis

23. Hepatitis Overview • Hepatitis = inflammation of the liver • There are six variations of the virus that causes it (A,B,C,D,E and G) • Initial symptoms are similar to the flu, may progress to nausea, vomiting, dark urine, abdominal pain, jaundice (yellow skin) • Chronic hepatitis can cause cirrhosis of the liver, liver cancer and death

24. Hepatitis

25. Hepatitis Overview • Hep A and Hep E transmitted through fecal-oral contact, typically through contaminated water • Hep B, and C transmitted through the exchange of bodily fluids • Sexual intercourse (B, not C), contaminated needles main route of transmission • Hep D/G usually occur as co-infections, not on their own

26. Prevention/Treatment Prevention • Vaccines are effective against HepA and B • HepB vaccine also confers protection against HepD/G • Safe sex (B, D, G) • Clean drinking water (A, E) Treatment • There is no cure • Antiviral drugs may help • Liver transplants indicated in advanced cases

27. Genital Warts- HPV • Genital warts are caused by the human papilloma virus (HPV) and often show no symptoms • If left untreated, genital warts can lead to cervical cancer and perhaps cancers of other genitalia an association of 90% • Warts can be surgically removed, burned/frozen off

28. HPV • There are more than 100 known strains (Mayo Clinic, 2010) • Symptoms show up months or years after exposure • Color range from pink in moist areas, greyish- white warts in dry area • Can be painless, or cause itching and inflammation • Appear on penis, vulva, anal area, or urethra • Risk increase of HPV leading to cervical cancer if the woman is also infected with herpes (J.S. Smith, 2002, Kelly, 2006)

29. HPV

30. Other STI’S

31. Chlamydia • Most commonly reported STI in Canada • ≈63,000 cases (2004) highest number of cases since 1990 (first reported) • Chronic long-term consequences: infertility, chronic pelvic pain and ectopic (out of place)pregnancy (life-threatening)

32. Chlamydia • Incubation Period 7-21 d from vaginal or anal intercourse • Symptoms • Genital discharge • Burning during urination( not specific to men) • Lower abdominal pain or during intercourse (women) • ¾ of cases in women have no symptoms (Kelly, 2006)

33. Chlamydia Treatment • Treatment • Weeklong regimen of azithromycin, doxycycline, or erythromycin • Who is the most at risk? ______________________________ (Kelly, 2006)

34. Gonorrhea • Second most commonly reported STI in Canada • Rates have doubled from 14.9 per 100,000 (1997) to 28.9 per 100,000 (2004) • > 60% of reported cases = males. • Incubation period – 2-6 days up to 30 d • Treatment – oral doses of ceftriaxone, ciprofloxacin or ofloxacin

35. Symptoms of Gonorrhea/Chlamydia Often occur together! • Increased vaginal discharge • Irregular bleeding • Abdominal pain • Pain while urinating • Thick greenish-yellow penile discharge • Pain in testicles

36. Syphilis • Rates increasing in Canadian males and females. • 0.4 per 100,000 (Males, 1997) • 6.3 per 100,000 (Males, 2004) • 15 times higher! • 82% of all reported cases = men 30-59 • 1st symptom typically = sore • 2nd symptom = body rash, flu-like symptoms • Untreated can damage heart, brain, eyes, nervous system, bones and joints • Treatment: single injection of penicillin, tetracycline, erythromycin, or doxycycline

37. Chlamydia, Gonorrhoea and Syphilis • Bacterial infections, all on the rise • Treated with antibiotics • Symptoms sometimes hard to identify

38. Pubic Lice • Aka “crabs” • Live by feeding on blood in the pubic area • Sexual transmission – eggs hatch 5-10 days • Non-sexual contact • Towels, bed sheets, mattresses • Treated with creams, shampoos

39. TAKE HOME MESSAGE WEAR A CONDOM!!!!!!