Chapter 5: Sexually Transmitted and Sexually Related Diseases

1. Chapter 5: Sexually Transmitted and Sexually Related Diseases For use with Human Sexuality Today (4th Ed.) Bruce King Slides prepared by: Traci Craig

2. What causes ST/SRD? Gonorrhea Chlamydia & NGU Syphilis Bacterial STDs Herpes Hepatitis HPV Molluscum Contagiosum HIV/AIDS Parasitic Infestation Vaginitis Cystits/Prostatitis Safer Sex Getting Help Positive Sexuality Chapter Overview

3. Not caused by sin. Not even caused by sexual behavior. Behaviormode of transmission Bacteria—small single celled organisms, RNA & DNA, reproduce themselves Viruses—protein shell around nucleic core, RNA OR DNA, cannot reproduce, invade host cells. Occurs to people of all demographic groups. ChlamydiaEpidemic in colleges What causes ST/SRDs?

4. Sexually Related Diseases • Diseases of the sexual organs • Overgrowths of yeast or fungal organisms found naturally in the body • Can be passed during sex (also can happen for other reasons) • Infestations (pubic lice and scabies) are not diseases but are also transmitted during sexual contact.

5. Where did they come from? • Sex with animals? Not likely, animals don’t seem to have gonorrhea or syphilis. • Mutation of bacteria & viruses. • Around for a few thousand years.

6. Epidemics • Epidemics attributed to: • Penicillin & Antibiotics—less afraid of getting STD’s • Drop in federal funds available for prevention. • Sexual freedom gained from the birth control pill. • Shift from condom use to the pill. • Lack of education. • You can have an STD with no symptoms.

7. Gonorrhea • Oldest STD—Old Testament 1500BC • Now less than 400,000 cases per year (under reported?) • CDC estimates 800,000 new cases this year • US rates higher than other developed nations (except Russia).

8. Gonorrhea: Symptoms • Bacterium (gonococcus)mucous membranes • Menurethra inflammation, thick, puslike white or yellowish discharge (‘the drip’), frequent painful urination. • WomenNo symptoms early on. Abnoraml dicharge and irritation of vulva and urethra. UntreatedPID • Pregnantfetus not infected, but during delivery infant’s eyes are exposedblindness. Antibiotic or silver nitrate drops. • Adult eyes can also become infected.

9. Gonorrhea: Diagnosis & Treatment • People w/ symptoms seek treatment. • Culture test—cotton swab of infected area • Urine testmore common today • Penicillin • 1940150,000 units • 19805,000,000 unitstetracycline • Now resistant to tetracycline too • New treatments are more expensive and often are injectable antibiotics.

10. Chlamydia • Nongonnococcal urethritis (NGU) • Chlamydia trachomatischlamydia • 4 million new cases each year • Prevalent in teens and young adults • Higher in US than other developed countries • Lives on mucous membranes

11. Chlamydia: Symptoms • Early symptoms 1-3 weeks after infection • Irritation and burning of the urethra and a discharge (thin and clear) • Untreated—spreads in men to the prostate and epididymis leads to sterility. WomenPIDsterility • Pregnancy: eye infection at delivery or nose-throat, or pneumonia.

12. Chlamydia: Diagnosis and Treatment • Culture test has been replaced with urine test. • Treated with tetracycline, doxycycline, or erythromycin • No symptoms early on so seek treatment if partner has been exposed.

13. Pelvic Inflammatory Disease (PID) • General term for an infection that goes from vagina and cervix to the fallopian tubes, ovaries, and pelvic cavity. • 1 million cases each year in the US • 1 in 7 women of reproductive age has PID • Tenderness or pain in the lower abdomen, fever and chills.

14. PID • Long termpelvic adhesions and abscesses • Fallopian tube (diam=1 hair): scar tissue can cause ectopic pregnancy • Increases risk from early intercourse, douching, and smoking. • Barrier methods reduce risk of PID

15. Syphilis • Causes over 100 million deaths worldwide in the 20th century (Chiappa & Forish, 1976). • Treponema pallidum  1905 • Outbreaks in 10 year cycles • South US and Urban areas • Peaked in 1990—50,578 cases • 1998—6,993 cases

16. Syphilis: Symptoms • Can pass through any cut or scrape (not just mucous membranes) • 1st symptoms 2-4 weeks later (10-90 days) • Primary stage: ugly ulcerlike sores—chancres on the penis, cervix, lips, tongue, anus. (Women can’t see cervix) • Painless and disappears in 10-14 days

17. Syphilis: Symptoms • Secondary Stage: 4-6 wks later • Itchless, painless, rash all over the body including palms and soles. On the genitals looks like large sores which break and ooze a highly infectious liquid • Sore throat, low grade fever, loss appetite, nausea, pains, and sometimes hair loss. • Disappear within a few weeks or a year and do not return.

18. Syphilis: Symptoms • Latent stage: no longer contagious • Lasts for years • Bacteria attacks internal organs—heart, brain, and spinal cord • 1/3 develop serious complications enter the Late Stage • Large ulcers on skin and bones—paralysis, insanity, and/or deafness • Congenital syphilis—Pregnancy: unborn baby can contract syphilis

19. Syphilis: Diagnosis and Treatment • Blood tests • False positives from lupus, arthritis, and flu vaccine • Penicillin G is effective • Cannot reverse damage to organs

20. Bacterial STDs • Chancroid: small bumps on the genitals that rupture into soft, craterlike sores. • 3-14 days from infection to symptom onset • Not painful, groin area lymph nodes inflamed and swollen • 250 cases per year in the United States • Treated with antibiotics.

21. Bacterial STDs • Granuloma inguinale • Fewer than 50 cases per year in the US • Painless pimple that ulcerates and spreads to surrounding areas • Permanently destroys the tissue and causes death if not treated • Treated with Doxycylcline and Trimethroprim-sulfame-thoxazole

22. Bacterial STDs • Shigellosis • Contracted from exposure to feces (oral stimulation of the anus is a likely mode of transmission) • Acute diarrhea, fever, and pain. • Treated with tetracylcine or ampicillin.

23. Herpes • Infects 1 million Americans per year • No cure. • 1 in 5 Americans over age 12. • Spread by skin to skin contact (from the infected site) • Herpes Simplex Virus Type I—Oral herpes • Herpes Simplex Virus Type II—genital herpes

24. Herpes • Both can be transmitted to genitals from oral contact and vice versa. (autoinoculation) • Can spread via kissing • Canker sores are not herpes caused, but fever blisters and cold sores are herpes caused.

25. Herpes: Symptoms • Prodromal Stage—tingling, burning, itching, or anestheticlike sensation on the skin. • Pain running down the buttocks and thighs. • Rash within a few hoursVesicle Stageherpes lesions • Flulike symptoms, aches, pains, headache, fever, swollen lymph nodes, painful urination, walking and sitting are also painful.

26. Herpes: Symptoms • Crusting over stage: Sores develop scales and scab over. • Heal without scars still contagious during scab phase. • From Prodormal to Crusting over is about 16 days • Recurrent attacks can occur in some cases. These are usually less severe.

27. Asymptomatic/Unrecognized Infections • Herpes transmission can occur even when symptoms are absent. • Many people do not know they have Herpes and never have a severe primary attack. • Herpes blisters can appear anywhere • Leading cause of infection related blindness in the US—ocular herpes

28. Complications • Neonatal herpes—baby can catch herpes during the delivery • 4-21 days after birthDeath, permanent severe neurological problems • Eye infections, skin eruptions, damage to itnernal organs • C-section is one preventative step for mothers with herpes

29. Herpes: Diagnosis and Treatment • Antiviral drugs can alleviate symptoms and speed healing from primary attack. • Acyclovir, valacyclovier and famciclovir—cannot cure but can prevent recurrent attacks. • Avoid stress, wash hands frequently, avoid tight fitting underwear, do not share towels/toothbrushes. • Blood test can identify the presence of antibodies to the herpes virus.

30. Hepatitis A • Infectious Hepatitis: caused by HAV, spread via direct or indirect oral contact with contaminated feces. • Shell fish from contaminated waters. • 180,000 new cases each year in the US • Vaccination available.

31. Hepatitis B • Serum hepatitis—transmitted via saliva, semen and vaginal secretions • Liver diseases: cancer and cirrhosis • 350 million people infected worldwide • 1 million deaths per year • Can pass to babies during pregnancy • Interferon (antiviral drug) is effect

32. Hepatitis C • 300 million people infected world wide • 10 to 20 years with no symptoms • 1/5th develop cirrhosis • Blood-to-blood contact • Less than 20% of cases transmitted sexually • No vaccine • Treated with interferon in combination with ribavirin but only effect in 30-40% of cases.

33. Genital Human Papillomavirus • HPV infects 24 million Americans. • 1 in 3 sexually active adults have it. • Genital warts1st symptoms 3 weeks to 8 months after contact • Irritation, itching, and or bleeding • Menwarts on penis, scrotum, anus, or within urethra • Womencervix, vaginal walls, vulva, anus • Pregnancytransmitted during delivery

34. HPV • Cervical cancer (women) time from infection to cancer is 5 to 25 years. • Major risk factors: • Number of partners and partners’ number of partners • Male partners may have no visible symptoms. • Most infections dissappear on their own (eventually people test negative) • Removing warts is possible (doesn’t eliminate contagion. • Vaccine is still being developed.

35. Molluscum Contagiosum • Painless growth caused by a pox virus • Spreads via direct skin-to-skin contact • 100,000 cases per year • Incubates from 2 weeks to 6 months. • Dome-shaped growths are are 1-5 mm in diameter • Look like small pimples filled with kernels of corn • Growths can be removed or will disappear on their own in 6-9 months.

36. HIV Infection and AIDS • Human Immunodeficiency Virus—HIV • Acquired Immunodeficiency Syndrome—AIDS • Retrovirus—reverses the normal pattern of reproduction in cells • Many different types and subtypes. • HIV has undergone extensive mutation.

37. HIV Infection and AIDS • Virus infects helper cells and kills the cell in a day and a half. • Eventually the body cannot regenerate enough helper cells and becomes defenseless against viruses, bacteria, and other infection-causing agents.

38. Progression of HIV • Primary HIV Infection: several weeks to a few months. Flu-like symptoms. • Immune system launches attack on the virus. • Asymptomatic HIV infection: lasts for years • Showing symptoms when helper cell count (CD4+) falls below 500 cells per cubic millimeter • Normal CD4+ counts in healthy individuals=1,000 to 1,200.

39. Progression of HIV • Symptoms include: fatigue, headaches, appetite loss, recurrent diarrhea, loss of body weight, low-grade fever, swollen lymph nodes, colds flus, and yeast infections that linger. • This is called Symptomatic HIV Infection.

40. Progression of HIV • When CD4+ count approahces 200 per cubic mm of blood • Opportunistic infections • Lymphomas, Kaposi’s sarcoma, Pneumonia, bacterial pneumonia, Pulmonary tuberculosis, cryptococcal meningitis, wasting syndrome, invasive cervical cancer. • HIV-associated dementia

41. AIDS • When CD4+ cell count drops to 200 CD4+ per cubic mm of blood or less even without opportunistic infectionAIDS • Viral load (HIV RNA) is the best predictor of progression. • Without treatment survival after AIDS is about 1 year. • Drug therapies work to lower viral load. • HIV infected peoplemedian survival time 12.1 years

42. HIV Transmission • Not via casual contact • 1—sexual contact with an infected person • 2—exposure to infected blood (needles) • 3—mother-to-infant transmission

43. HIV Transmission: Sexual Contact • Within 60 days of infection and during syptomatic HIV and AIDS stages risk is highest. • Sex involving blood (i.e., anal sex) and open sores increase risk.

44. HIV Transmission: Needle Sharing • Sharing needles during drug use • Blood transfusion • Today only 1 in 677,000 units are likely to be infected • If infection was recent the tests of the blood are not able to identify it. • Not by GIVING blood.

45. HIV Transmission: Mother—Child • Likely when viral load is high late in pregnancy • Breast feeding—rate of transmission 16% • Children develop symptoms by 6 months • By 1 year of age—25% have AIDS

46. HIV: Pandemic • 16,000 new infections a day • 36.1 million people living with HIV • 3 million people die every year Number of adults and children living with HIV/AIDS at the start of 2001.

47. HIV: Population? • Heterosexual transmission accounts for the largest percentage of AIDS cases. In the US, heterosexual contact and intravenous drug users are still the primary mode of transmission.

48. Testing for HIV • Antibody test of the blood • Recent flu vaccinefalse positive • Several months to produce antibodies • Newer less accurate tests use urine or saliva

49. HIV/AIDS: Treatment • Antiretroviral drugs—slow progression • Newest drugs are protease inhibitors that block the enzyme required for late stage HIV replication.

50. AIDS: Public Reactions • Stigmatizes those who are infected. • Public reports feelings of anger, disgust or fear and 1/3 would want segregation. • Homes have been burned—hemophiliac children infected via transfusion • Educating the public • Needle exchanges and Sex Education