Sexually Transmitted Diseases(STDs) Prepared by: Nadia JradiMasri, M.D
STDs? • Sexually Transmitted Infections (STIs) Preferred terminology, as MANY patients may be silent carriers, with NO apparent signs of a disease, however fully capable of SPREADING the germ! • Venereal Diseases (VD) Old terminology, (derived from Venus, Roman goddess of love)
Definition An illness that has a significant probability of transmission between humans by means of human sexual behavior An infection that has a negligible probability of transmission by means other than sexual contact.
Definition • Some STIs can also be transmitted via other sophisticated means: • The use of IV drug needles after its use by an infected person, • Infected Blood Transfusion • Through childbirth (Vertical transmission) or breastfeeding
WHY?? • STIs may get transmitted through: • Mucus membranes • Minute abrasions/cuts of the skin • Germs are usually present either in body fluids (Venereal fluids, Saliva) or on the surface of mucus membranes/skin.
WHY?? • Mucus membranes differ from the skin in that they are thinner, thus allowing certain pathogens to pass through into the deeper tissues and occasionally reaching the blood. • Mucus membranes are present in: - penis, - vulva, - Anus/rectum, - urinary tract, - mouth, - Throat, - eyes.
WHY??? Mucus membrane Skin
Types of Infections • Bacterial • Viral • Fungal e.g. Candidiasis (yeast infection) • Parasites: e.g. Pubic Lice Scabies Trichomonas Vaginalis
Types of Infections Bacterial Viral • Chancroid (Haemophilusducreyi) • Chlamydia (Chlamydia trachomatis) • Granulomainguinale or (Klebsiellagranulomatis) • Gonorrhea (Neisseriagonorrhoeae) • Syphilis (Treponemapallidum) • Hepatitis B virus.(Note: Hepatitis A and E are transmitted via the fecal-oral route; Hepatitis C is rarely sexually transmittable) • Herpes simplex virus 1, 2 • HIV • HPV (Human Papilloma Virus). • Molluscum contagiosum Virus
Prevention (Safe sex) I. Condoms: only provide protection when used properly as a barrier, and only to and from the area that it covers. Uncovered areas are still susceptible to many STDs. • Avoid condoms made of substances other than latex or polyurethane, as they do not protect against HIV. • Avoid the use of oil based lubricants with latex condoms, as oil can eat holes into them.
Prevention (Safe sex) I. Condoms: While not perfect, the condom is effective at reducing the transmission of organisms that cause : • AIDS(80- 95%) • genital herpes • HPV (70%) • syphilis • chlamydia • gonorrhea • and other diseases Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom.
Prevention (Safe sex) II. Vaccines: • Hepatitis B Virus (HBV): recommended for everyone, protect against liver cancer • HPV: should be offered to males and females9 to 26 years of age, as recommended by the ACIP, protect against cervical cancer
Prevention (Safe sex) III. Screening (to detect asymptomatic cases): a. In pre-marital testing: for HIV & HBV b. In pregnancy to protect the newborn: For HBV, HIV, Syphilis & Chlamydia c. During the blood transfusion process.
Symptoms of STDs Infected persons can be completely asymptomatic (showing no symptoms) and fully capable of transmitting the pathogen!!!
Diagnosis • a sample of blood, urine, or discharge from the vagina or penis : Culture for the organisms to be grown • Sometimes genetic testing is required to identify the organism's unique genetic material. • Other tests vary depending on the STD suspected.
Complications of STDs • Pelvic Inflammatory Disease (PID): Infection spreading from cervix to uterus & tubes • Vertical spread to newborn • Swollen & tender testicles in males (Epididymitis) • Infertility in males and females • Serious, even life-threatening problems: heart and brain infections due to syphilis, AIDS due to HIV, and cervical cancer due to HPV
Specific STDs: gonorrhea and chlamydia • Gonorrhea and chlamydia are the most common STDs worldwide, caused by bacteria, often occur together! • Infected persons can be asymptomatic (e.g>50% of females with gonorrhea) • Can lead to serious long term complications • EASILY treated with oral antibiotics!
Specific STDs: Syphilis • Cause: A bacteria called TreponemaPallidum • Three Stages: I. Primary (Early) Stage II. Secondary stage III. Tertiary (late) stage
Primary Syphilis • A painless sore called a chancre may be located on the genitals, lips, anus, or other area of direct contact • The chancre will last 1-5 weeks and heal without treatment • The person can easily pass it on to sex partners • About half of the women and one third of the men who have the initial sore of syphilis do not notice it.
Secondary Syphilis • Skin Rashes • Lasts for 2-6 weeks • MAY infect partner
Tertiary Syphilis • Late stage (After years if untreated) • NOT infective • Major complications involving - Brain, - Main vessels - Joints - Eyes
Syphilis • Easily detected by a BLOOD test • Treatment is available & effective with variable duration.
Genital Herpes • Cause: Herpes simplex viruses (HSV) • There are 2 types of HSV: HSV-1 and HSV-2. - HSV-2 causes most genital infections. - HSV-1 causes oral infections and some genital infections.
Genital Herpes • Numerous painful lesions (sores) • ANYWHERE: On the penis, vagina, anus, buttocks, thighs, mouth, or finger • Last up to 4 – 21 days
Genital Herpes • Many people with herpes do not have any symptoms or do not recognize that they have symptoms. • Most people with herpes can pass the virus to sex partners even when they do not have symptoms. • Symptoms may or may not come back.
Genital Herpes • HSV-2 causes serious problems when it is passed to newborns during birth.
Genital Herpes • Can be detected by: • culturing the lesion • blood test • Herpes cannot be cured, but symptoms can be treated with medicines called antivirals. • You can still spread herpes even if you are taking antiviral medicine!
Human Papillomavirus (HPV) • The types of HPV that infect the genital area are labeled “low-risk” or “high-risk”: a. Low-risk HPV types: can cause genital warts. b. High-risk HPV types: can cause serious cervical lesions, cervical cancer, and other genital cancers.
Genital Warts • Genital warts grow rapidly and cause no symptoms in most people but sometimes cause burning pain. • Doctors identify visible externalwarts based on their appearance, and they examine the cervix and anus to check for less visible internal warts. • Most infections go away within 1 to 2 years, but some persist. Persistent infection can increase the risk of certain types of cancer.
Cervical HPV • Usually no symptoms • MAY cause cervical cancer in a small percentage of patients • Detected by Pap smear: Pap smear screening is recommended for ALL sexually active women
Prevention: The best treatment! • Regular and correct use of condoms • Avoidance of unsafe sex practices, such as frequently changing sex partners or having sexual intercourse with partners who have other sex partners or with prostitutes • Circumcision (which can reduce the spread of HIV ) • Prompt diagnosis and treatment of STDs (to prevent spread to other people)
Prevention • Identification followed by counseling or treatment of the sexual contacts of infected people • The only vaccines available are those for HPV infection and hepatitis A and B.
Treatment • Most STDs caused by bacteria or fungi can be effectively treated with drugs. • People who are being treated for a bacterial STD should abstain from sexual intercourse until the infection has been eliminated. Sex partners should be tested and treated simultaneously. • Viral STDs, especially herpes, hepatitis B and C, and HIV infection, usually persist for life. Antiviral drugs can control but not yet cure all of these infections
AIDS Acquired Immune Deficiency Syndrome
Epidemiology AIDS is considered a Pandemic
Epidemiology AIDS is considered a Pandemic
History • AIDS was first reported June 5, 1981, when the U.S. Centers for Disease Control recorded a cluster of Pneumocystis carinii pneumonia (PCP) in 5 homosexual men in Los Angeles. • Early names of AIDS where: - GRID, which stood for Gay-related immune deficiency, & - The 4H disease, as it seemed to single out Haitians, Homosexuals, Hemophiliacs, and Heroin users.
History • Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century. • The HIV virus descends from the a related virus SIV, which infects apes and monkeys in Africa. • There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV • However, the adaptation of this virus to humans and its spread is subject to many theories.
HIV • Human Immunodeficiency Virus • A Retrovirus • Target: immune cells Specifically CD4 cells
Transmission A. Sexual transmission: Due to contact of contaminated body fluid: - Semen, - preseminal fluid or - vaginal fluid with the mucus membrane of the partner: Anus > Vaginal > Oral mucosa
Transmission B. Blood products exposure: a.Particularlyintravenous drug users,constituting >1/3 of cases in USA, Europe & China The risk of being infected with HIV from a single prick with a needle that has been used on an HIV-infected person is thought to be about 1 in 150 b. Recipients of blood transfusions (Rare now) c. people who give and receive tattoos and piercings using non sterile techniques. d. Accidental needle stick accidents in health care workers.
Transmission C. Perinatal transmission: • The transmission of the virus from the mother to the child can occur in uteroduring the last weeks of pregnancy and at childbirth. • In the absence of treatment, the transmission rate is 25%. • However, when the mother takes therapy and gives birth by caesarean section, the rate of transmission is just 1%. • Breastfeeding increases the risk of transmission
Transmission • HIV cannot reproduce outside the human body. • It is not spread by: - Air or water. - Insects, including mosquitoes. - Saliva, tears, or sweat. - Casual contact (like shaking hands or sharing dishes). - Closed-mouth or “social” kissing.(Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids, extremely rare transmit HIV)
High risk population • People with a history of a STIs • Sexual partners of persons who are infected with HIV • Victims of sexual assault • Men & women who have unprotected sex with multiple partners. • Men and women who exchange sex for money or drugs. • Men who have sex with men, • Injection drug users who share needles, • Health care workers with needlestick exposure.
Stages oh HIV infection • Acute Stage: directly after exposure • Incubation stage • AIDS