Common Sexually Transmitted Diseases: STD 101

1. Common Sexually Transmitted Diseases: STD 101 Developed by The Training and Health Communications Branch, in partnership with the Program Development and Support Branch, Division of STD Prevention Centers for Disease Control and Prevention (CDC)

2. Knowledge About STDs Among Americans

3. Topics Bacterial Infections: curable with antibiotics Chlamydia Gonorrhea (Syphilis) Viral Infections: no cure, but can alleviate or remove symptoms with medication Herpes type 2 HPV (genital warts) Hepatitis B HIV/AIDS Other STDs

4. Chlamydia (Chlamydia trachomatis)

5. Epidemiology of Chlamydia Incidence: Approximately 4 million new cases in U.S. per year Currently, the most common STD in U.S. (and Hawaii), especially in indivs. <25 yrs old Rates 4x higher in females than in males Decreasing prevalence in selected areas with control programs that include clinic-based screening High prevalence of co-infection in partners (>50%) Perinatal transmission results in neonatal conjunctivitis in 30-50% of exposed babies

6. Chlamydia rates by gender in the U.S., 1984�2001

7. Chlamydia: Age- and sex-specific rates in the U.S., 2001

8. Chlamydia rates by state: U.S. and outlying areas, 2001

9. Chlamydia rates among 15-24 yr. old women tested in family planning clinics by state: U.S. and outlying areas, 2001

10. Presentation of Chlamydia Symptoms in Females: 75% are asymptomatic Abnormal vaginal discharge Pain during urination or sex Complications, if not treated: Pelvic inflammatory disease (PID) Infertility or ectopic pregnancy from damaged or scarred reprod. tissue/organs Symptoms in Males: 40% asymptomatic Discharge from the penis (may be runny, whitish) Burning during urination Complications, if not treated Swollen and tender testicles (epididymitis) Infertility from damaged or scarred reproductive ducts or organs

11. Testing & Treatment for Chlamydia Easily detected by a urine test or cervical tissue culture; and Can be cured with antibiotics; but any damage to the body is not repaired by the antibiotics

12. Gonorrhea (Neisseria gonorrhoeae)

13. Epidemiology of Gonorrhea One of the most common STDs in U.S.; about � million new cases per year Incidence remains high in some groups defined by geography, age and race/ethnicity, or sexual orientation As with chlamydia, rates in women are highest among teenagers and young adults About half of infected patients also have an existing chlamydia infection Associated with increased susceptibility to HIV infection

14. Gonorrhea: Reported rates in U.S.1970�2001

15. Gonorrhea rates by gender in U.S. 1981�2001

16. Gonorrhea: Age- and gender-specific rates in U.S., 2001

17. Gonorrhea rates by state: U.S. and outlying areas, 2001

18. Gonorrhea rates among 15-24 yr old women tested in family planning clinics by state in U.S. and outlying areas, 2001

19. Gonorrhea Symptoms in Males Symptoms appear in 70-90% of infected men (usually within 2-5 days, but up to 1 mo.) Discharge from the penis (may be thick, milky white, yellowish, or greenish) Painful burning upon urination

20. Complications in Males Swollen or tender testicles (epididymitis), which can lead to infertility if untreated Disseminated gonococcal infection (DGI), which can lead to skin infections and septic arthritis if untreated Infection can spread up the urethra to the bladder, sex accessory glands and ducts, producing scar tissue that can lead to infertility

21. Swollen or Tender Testicles (Epididymitis)

22. Gonorrhea Symptoms in Females Most women (75%) have no symptoms (at least in the early infectious stages) For those that do show symptoms: Painful urination Pain during sex Whitish or yellowish discharge from vagina or urethra Abnormal uterine bleeding Bartholin�s abscess

23. Bartholin�s Abscess

24. Complications from Gonorrhea in Females Pelvic inflammatory disease (PID) and tubal blockage from scarring, which can lead to infertility Disseminated gonococcal infection (DGI), which can lead to skin lesions and septic arthritis

25. Disseminated Gonococcal (Gonorrhea) Infection

26. Pelvic Inflammatory Disease (PID)

27. Testing & Treatment for Gonorrhea Easily detected by a simple lab test; and Can be cured with antibiotics; but Many antibiotic-resistant strains have evolved; and Any damage to the body is not repaired by the medicine

28. Syphilis Treponema pallidum

29. Syphilis Hits record low in �00

30. Primary and secondary syphilis � Reported rates in the U.S., 1970�2001

31. Primary and secondary syphilis rates by state: U.S. and outlying areas, 2001

32. Genital Herpes (Herpes simplex virus, or HSV)

33. Epidemiology of Herpes-2 The majority of genital herpes outbreaks in the U.S. are caused by HSV-2 (80%) ~ 45 million people in U.S. (age 12 and over) are currently infected, with about one million new cases reported each year 22% of adults over age 12 years have HSV-2 antibodies HSV-2 infection rates show a correlation with level of sexual activity HSV-2 infection rates are higher in HIV-infected persons and indivs. with low socioeconomic status

34. Genital Herpes There are two common kinds of Herpes (I and II) and both are caused by a virus Herpes I most commonly affects the lips and mouth, causing lesions known as cold sores or fever blisters, but can also infect the genitals Herpes II is the usual cause of genital herpes (80%), but can also infect the mouth and lips Both types can also be transmitted to eyes, resulting in infection which can lead to blindness Incubation Period: usually 2-7 days Can survive for a few hours outside of the body (on moist surfaces)

35. Common Symptoms of Genital Herpes Small clear blisters that develop into painful red sores and then itchy ulcer-like lesions Sores can last up to 2-3 weeks, and may be located on the: penis, labia, vaginal opening, perinium, anus, buttocks, thighs, mouth, or finger Symptoms may also include swollen lymph glands, muscle aches, headache, fever, painful urination and sexual intercourse Symptoms may or may not recur. On average, symptoms reappear approx. 5 times a year After the virus has finished being active, it then travels to the nerves at the end of the spine where it stays for a while. Even after the lesions are gone, the virus stays inside the nerve cells in a still and hidden state, which means that it�s inactive. In most people, the virus can become active several times a year. This is called a recurrence. But scientists do not yet know why this happens. When it becomes active again, it travels along the nerves to the skin, where it makes more viruses near the site of the very first infection. That is where new sores usually will appear. Sometimes, the virus can become active but not cause any sores that can be seen. At these times, small amounts of the virus may be shed at or near places of the first infection, in fluids from the mouth, penis, or vagina, or from barely noticeable sores. You may not notice this shedding because it often does not cause any pain or feel uncomfortable. Even though you might not be aware of the shedding, you still can infect a sex partner during this time. After the first outbreak, any future outbreaks are usually mild and last only about a week. An infected person may know that an outbreak is about to happen by a tingling feeling or itching in the genital area, or pain in the buttocks or down the leg. For some people, these early symptoms can be the most painful and annoying part of an episode. Sometimes, only the tingling and itching are present and no visible sores develop. At other times, blisters appear that may be very small and barely noticeable, or they may break into open sores that crust over and then disappear. The frequency and severity of recurrent episodes vary greatly. While some people have only one or two outbreaks in a lifetime, others may have several outbreaks a year. The number and pattern of repeat outbreaks often change over time for a person. Scientists do not know what causes the virus to become active again. Although some people with herpes report that their outbreaks are brought on by another illness, stress, or having a menstrual period, outbreaks often are not predictable. In some cases, outbreaks may be connected to exposure to sunlight. After the virus has finished being active, it then travels to the nerves at the end of the spine where it stays for a while. Even after the lesions are gone, the virus stays inside the nerve cells in a still and hidden state, which means that it�s inactive. In most people, the virus can become active several times a year. This is called a recurrence. But scientists do not yet know why this happens. When it becomes active again, it travels along the nerves to the skin, where it makes more viruses near the site of the very first infection. That is where new sores usually will appear. Sometimes, the virus can become active but not cause any sores that can be seen. At these times, small amounts of the virus may be shed at or near places of the first infection, in fluids from the mouth, penis, or vagina, or from barely noticeable sores. You may not notice this shedding because it often does not cause any pain or feel uncomfortable. Even though you might not be aware of the shedding, you still can infect a sex partner during this time. After the first outbreak, any future outbreaks are usually mild and last only about a week. An infected person may know that an outbreak is about to happen by a tingling feeling or itching in the genital area, or pain in the buttocks or down the leg. For some people, these early symptoms can be the most painful and annoying part of an episode. Sometimes, only the tingling and itching are present and no visible sores develop. At other times, blisters appear that may be very small and barely noticeable, or they may break into open sores that crust over and then disappear. The frequency and severity of recurrent episodes vary greatly. While some people have only one or two outbreaks in a lifetime, others may have several outbreaks a year. The number and pattern of repeat outbreaks often change over time for a person. Scientists do not know what causes the virus to become active again. Although some people with herpes report that their outbreaks are brought on by another illness, stress, or having a menstrual period, outbreaks often are not predictable. In some cases, outbreaks may be connected to exposure to sunlight.

36. Genital Herpes in a Male

37. Herpes in a Male

38. Herpes in a Female

39. You can get herpes infections on other places on your body . . .

40. Herpes Complications If not treated in adults, genital herpes may cause stress and pain In women, some types can increase risk of developing cervical cancer Often transmitted to fetus during birth (causing skin lesions, blindness or brain damage); can be avoided with C-section

41. Testing & Treatment for Genital Herpes Can be detected by various tests (http://www.ashastd.org/pdfs/blood_test.pdf) Symptoms can be treated with prescribed medications, but� There is no cure You can still spread Herpes even if you are taking medicine!

42. Human Papillomavirus (HPV) Also known as �genital warts� One of the most common and highly contagious STDs HPV infection is strongly associated with cervical cancer and probably other anal, penile, vulvar, vaginal cancers

43. Common Symptoms of Genital Warts in Males & Females After a 3 wk - 9 month incubation period, symptoms may include single or multiple cauliflower-like warts around the penis, vagina, anus, urethra May also include: itching, bleeding, or burning, and pain Symptoms may recur from time to time Like Herpes, there is no known cure, but warts disappear with certain medications, or can be physically removed by cryotherapy, heat cauterization or laser surgery

44. Genital Warts in a Male

45. HPV Penile Warts

46. Female Genital Warts

47. Female Genital Warts - Cervix

48. Oral Warts

49. Perianal Warts

50. Complications of Genital Warts(if untreated) Can destroy body tissue around the genitals and anus In women, can lead to cancer of the cervix (Over 99% of cervical cancers have HPV DNA detected within the tumor)

51. Testing & Treatment for Genital Warts Can be detected in a clinical exam; Can be treated by removing the warts; The virus cannot be destroyed, so the warts may grow back.

52. Topics Bacterial Infections: curable with antibiotics Chlamydia Gonorrhea (Syphilis) Viral Infections: no cure, but can alleviate or remove symptoms with medication Herpes type 2 HPV (genital warts) Hepatitis B HIV/AIDS Other STDs

53. Hepatitis B

54. Hepatitis B

55. Hep B Symptoms

56. Chronic Hepatitis B

57. Hepatitis B Treatment

58. Hepatitis B Prevention

59. HIV infection(human immunodeficiency virus)

60. HIV, cont.

61. Transmission

62. Infection step 1

63. Infection step 2

64. Infection step 3

65. Infection step 4

66. Infection step 5

67. Early Symptoms

68. Asymptomatic stage

69. AIDS

70. HIV/AIDS Timeline

71. Topics Bacterial Infections: curable with antibiotics Chlamydia Gonorrhea (Syphilis) Viral Infections: no cure, but can alleviate or remove symptoms with medication Herpes type 2 HPV (genital warts) Hepatitis B HIV/AIDS Other STDs

72. Common Parasitic STDS

73. Symptoms of Trichomoniasis

74. Common Parasitic STDS

75. For more info

76. Review Questions on STDs Name three sexually transmitted diseases (STDs) that are common among men and women under age 25. What types of STDs are caused by a bacterial infection? How are bacterial STDs treated? What types of STDs are caused by a viral infection? In what important aspect are viral STDs different from bacterial STDs? What is currently the most common STD in the US (has the highest number of new cases annually among men and women combined)? What types of STDs can result in PID and/or infertility if they are not treated at an early stage? What types of STDs are often asymptomatic in women? What types are often asymptomatic in men?? What types of STDs can be transmitted from mother to baby during vaginal delivery? What types of STDs are known to increase the risk of developing cervical cancer? What types of STDs are known to increase the risk of contracting HIV from an HIV-infected person? What type of STD is preventable by vaccination? How can HIV be transmitted from one person to another? How long is the "window period" for HIV (whereby an HIV-infected person may not test positive for HIV antibodies)? How long is the asymptomatic period? How does HIV attack and destroy the immune system (CD4 T-cells) of infected individuals? At what point is an HIV-infected person diagnosed with AIDS? What is trichomoniasis and how common is it?