STD 101 Unlocking Good Health with Prevention and Control

1. STD 101Unlocking Good Health with Prevention and Control Miami-Dade STD Program Florida Department of Health

2. “Early knowledge of STD infection is a critical component in preventing & controlling the spread of STDs, including HIV.”

3. Who Are We?

4. STD Program objectives: • Intervene in the spread of HIV and other sexually transmitted diseases • Reduce the complications brought on by sexually transmitted diseases • Protect the community from sexually transmitted disease related outbreaks

5. STD Clinic offers: • Four convenient sites • Routine voluntary HIV test with STD exam • Multilingual & culturally competent trained staff • Private Setting • Client Confidentiality • Community & Case Specific Screenings • Educational Presentations

6. STD Screening & Care “Clients who are HIV-infected or at increased risk for HIV are at risk for other STDs and should receive or be referred for STD screening and treatment.”

7. Comprehensive Exam & Screening for common STDs Chlamydia Gonorrhea Syphilis Herpes BV Trichomoniasis Genital Warts HIV Testing Blood Orasure Rapid Test Treatment available for common STDs Hepatitis A & B & C Testing Hepatitis A vaccination for eligible clients Hepatitis B vaccination available Pap Smear Testing Start-up Birth Control for STD Clients Pregnancy Testing for STD Clients Types of STD Clinical Services NEW

8. Disease Intervention & Prevention Services • General & Specific Patient Education & Counseling • HIV Counseling & Testing in Field Setting • Confidential • Anonymous • Risk & Harm Reduction Counseling • HIV Post Test Counseling • Negative • Positive • Indeterminate • Disease Intervention Interviews • Partner Counseling & Referral Services (PCRS) • Community Awareness & Sexual Health Promotion • Referrals • Other STD Testing in Field Setting

9. How We Work?

10. STD Prevention & ControlAt-A-Glance Goes to Doctor for Exam DIS locates & refers client for RX, evaluation, interview, & PCRS Gets STD Test Does Not Get Treated Residents & Visitors Send Lab Report to STD Gets Treated Surveillance Verifies Treatment/PTC Doctor &/Lab reports to MDCHD

11. What’s A STD?

12. Sexually Transmitted Disease (STD)? A sexually transmitted disease is a broad term that refers to as many as 20 different infections, all of them transmitted by sex. STDs are serious, sometimes painful and can cause a lot of damage in your body. Some STDs infect your reproductive and sexual organs. Others (HIV, hepatitis B, and syphilis) cause general body infections.

13. How are STDs spread? • Through the exchange of body fluids such as semen, vaginal fluid, and blood with someone who is infected. • Through vaginal, anal and oral sex. • STDs can be given by mothers to their babies • You can get some STDs, such as herpes, by kissing and caressing or close contact with infected areas—not just intercourse.

14. Asymptomatic Vs Symptomatic disease Asymptomatic – Sometimes a person can have an STD with no signs or symptoms. Symptomatic – Other times, a person will have symptoms that go away on their own. Either way, the person will still have the STD until he/she gets treated. A few STDs can not be cured. But most can be cured with treatment.

15. How common are STDs? STDs are increasingly common in the United States today. That’s distressing news, because STDs are also easy to prevent.

16. STD FACT SHEET According to CDC, each year • An estimated 19 million new infections occur, almost half of them among young people ages 15 to 24 • Direct medical costs associated with STDs in the United States are estimated at up to $14.1 billion annually • An estimated 2.8 million new cases of chlamydia occur in the United States • Gonorrhea is the second most commonly reported infectious disease in the U.S. Like chlamydia, however, gonorrhea is substantially under-diagnosed and under-reported, and approximately twice as many new infections are estimated to occur each year as are reported.

17. Types of Organisms responsible for STDs • Bacteria • Viruses • Fungi • Protozoa • Metazoa

18. Bacteria (including mycoplasmas and chlamydiae) Types of Bacteria that affects humans • Spirilla-syphilis, yaws • Cocci-gonorrhea, meningitis • Bacilli-typhoid fever, tetanus • Mycoplasmas-nongonococcal urethritis (NGU), pneumonia • Chlamydia trachomatis-chlamydial urethritis, mucopurulent cervicitis (MPC)

19. Viruses A few of the significant viral STDs are • hepatitis B • genital herpes • condylomata acuminata (genital warts) • acquired immunodeficiency syndrome (AIDS)

20. Fungi Fungi causes • Candidiasis • Other vaginal yeast infections • Lung diseases • Ring worm

21. Protozoa Protozoa are responsible for • Trichomoniasis • Malaria

22. Metazoa • Metazoa causes many diseases and infestations • Scabies • Guinea worm infection • Pediculosis pubis

23. Common STDs • Bacterial Vaginosis (BV) • Chlamydia • Gonorrhea • Genital Warts • Herpes (HSV types I and II) • Hepatitis B (Hep B) • Human Immunodeficiency Virus (HIV) • Lice & Scabies • Syphilis • Trichomoniasis (Trich)

24. Chlamydia • Chlamydia is a sexually transmitted disease that is caused by the bacterium Chlamydia trachomatis. Signs and Symptoms • Pain and burning when urinating, discharge. 75% of women and 50% of men have no signs or symptoms. Diagnosis • Lab exam of fluid from the infected area Treatable? • Yes Therapy • Antibiotic pills that kill bacteria Result if Left Untreated • Pelvic infections such as Pelvic Inflammatory Disease (PID).

25. Chlamydia • Chlamydia trachomatis in a Thin Prep PAP Test Because chlamydia is most common among young women, CDC recommends annual chlamydia screening for all sexually active women under age 26, as well as for older women with risk factors such as new or multiple sex partners

26. Chlamydia • Chlamydia urethritis, penile • Chlamydia Trachomatis in a Thin Prep PAP Test

27. Gonorrhea • Gonorrhea is a sexually transmitted disease that is caused by the bacterium Neisseria gonorrhoeae. Signs and Symptoms • Pain or burning when urinating, yellow discharge Diagnosis • Lab exam of fluid from the infected area Treatable? • Yes Therapy • Antibiotic pills that kill bacteria Results if Left Untreated • Pelvic Infections, PID, and Sterility

28. Gonorrhea Studies suggest that the presence of gonorrhea infection makes an individual three to five times more likely to acquire HIV, if exposed Positive Gram Stain from Urethral Discharge Gonoccocal Urethritis Gonoccocal Cervicitis

29. Gonorrhea Bartholin’s abscess Gonococcal ophthalmia • Bartholin’s abscess

30. Gonorrhea Disseminated gonorrhea – skin lesion • Disseminated gonorrhea – skin lesion

31. Genital Warts • Genital warts is a sexually transmitted disease that is caused by the virus Human Papilloma. Signs and Symptoms • Bumpy warts on/near genitals Diagnosis • Visual Treatable? • Yes (but can’t be cured) Therapy • Burning or liquid removal of warts Result if Left Untreated • May lead to some cancers

32. Genital Warts • Condyloma acuminata, vaginal wall

33. Genital WartsCondyloma Acuminata Anal Meatus

34. Genital WartsCondyloma Acuminata Vulva Meatus

35. Herpes • Herpes is a sexually transmitted disease caused by the herpes simplexvirus (HSV). Signs and Symptoms • HSV-type 1 (oral herpes) commonly causes fever blisters on the mouth or face • HSV-type 2 (genital herpes) typically affects the genital area causing red bumps/blisters. However, both viral types can cause either genital or oral infections. Diagnosis • Lab exam of fluid from the sore Treatable? • Yes (but can’t be cured) Therapy • Pills and ointment Results if Left Untreated • Prolonged and more severe symptoms

36. Herpes Primary Same Patient, 4 Days Later

37. Herpes Primary Recurring

38. Herpes Vulva Cervicitis

39. Lice and Scabies • Lice (Crabs) is a sexually transmitted diseases caused by the metazoa Pediculosis Pubis. You get crabs by having sex, sharing clothes, bed sheets, or towels with someone who is infected. Scabies is a contagious skin disease caused by the metazoa Sarcoptes scabiei, a very small mite. Signs and Symptoms • Severe itching, rashes Diagnosis • Visual Treatable? • Yes Therapy • Over-the-counter or prescription lotion Results if Left Untreated • Continuing symptoms

40. Lice Female Crab Louse Lice in the pubic Area

41. Scabies Scabies Mite Eczema Scabies

42. Syphilis • Syphilis has been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those caused by other diseases.

43. Syphilis • Syphilis is a sexually transmitted disease caused by the bacterium Treponema Pallidum. Signs and Symptoms • Chancre sore, rash, genital ulcers Diagnosis • Lab exam of tissue, fluids/blood test Treatable? • Yes Therapy • Penicillin shots to kill bacteria or antibiotic pills Results if Left Untreated • Blindness, Heart disease, Brain damage

44. Syphilis Treponema Pallidum Stages: • Primary • Secondary • Latent • Late Latent

45. Primary Stage The most infectious stage of the disease.

46. Primary Syphilis Chancres Vaginal Penile

47. Primary Syphilis Vaginal Anal Chin

48. Secondary Stage Lesions of the mouth, throat, and cervix (mucous patches) frequently occur during this stage.

49. Secondary Syphilis Papulo-pustular rash Condyloma Lata

50. Secondary Syphilis Nickel and Dime Lesion Palmer Rash Alopecia