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Sexually Transmitted Infections (STIs) 101
- 1. Sexually Transmitted InfectionsSexuallyTransmitted Infections 101101 Jill Smith, MHS, CAC-AD Program Managers Center for HIV Prevention & Health Services Last updated January 31, 2018
- 2. 2 The United Stateshas the highest rates of Sexually Transmitted Infections among industrialized nations in the world, with nearly 20 million new cases each year Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018 Sexually Transmitted Infections (STIs)
- 3. STIs in USin 2016 Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 3
- 4. 4 • STIs aremore easily transmitted from males to females • Women tend not to have symptoms and hence usually have more serious complications of STIs+ Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018 Sexually Transmitted Infections (STIs)
- 5. 5 HIV and STIsHIVand STIs The CDC says that people with an STI are at least two to five times more likely than an uninfected person to acquire HIV. That’s because STIs create breaks in the skin and entryways for HIV, and also because the inflammation from the STI causes the body to create more white blood cells, which are the targets for HIV. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 6. Reportable STIs Regulations varyfrom state to state Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 6 Chlamydia Gonorrhea Syphilis Chancroid Hepatitis B HIV/AIDS Reportable in all states Human Papillomavirus Genital herpes Trichomoniasis Generally not reportable
- 7. 7 3 Most CommonSTIs • Increasing numbers of Chlamydia infections have made it the most widespread bacterial STI in the United States. • Gonorrhea remains the second most commonly reported bacterial STI in the United States. • Syphilis is the third highest reported STI. • Of the three main STIs reported, only syphilis has more male than female cases. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 8. 8 Most Common STIsAmong TeensMost Common STIs Among Teens • The most common infection is HPV (human papillomavirus), which can cause genital warts and cervical cancer. • About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. • HPV is found in 18% of young women. HPV is NOT even a reported STI in most states! • In second place is chlamydia, with a 4% infection rate • A study presented in 2008 revealed that around 26% of young American women aged 14-19 are infected with at least one of the four most common sexually transmitted infections (Nationally Representative CDC Study Find 1 in 4 Teenage Girls has A STD, CDC Press Release, 11 March 2008). Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 9. 9 The Major STI’sTheMajor STI’s Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018 • Herpes Simplex Virus (HSV) • Human Papilloma Virus (HPV) • Human Immunodeficiency Virus (HIV) • Hepatitis B Virus (HBV) Not curable, some life-long • Syphilis • Chlamydia • Gonorrhea • Trichomoniasis • Pubic Lice (crabs) Treatable, but repeatable
- 10. 10 Causes?Causes? • Bacteria -A type of microorganism that are usually treated with antibiotics. – It is estimated that each person carries 100 trillion bacteria on and in our bodies. Some bacteria create disease in people and can be harmful. However, there are also bacteria that co-exist with the human body without causing disease. • Virus - A virus is a parasitic organism because it totally depends upon the human cell for nutrients to survive. – Infection with a virus stimulates an antibody response from the body. Once in the body, they cannot be removed. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 11. 11 Causes?Causes? • Protozoa -These are the simplest form of animals. – Most protozoa are single-celled and have mobility, using tail-like structures called flagella. Protozoa are larger than both viral and bacterial organisms. There are medicines that kill protozoa and are used in treatment of infected people (Ex: Flagyl for treatment of Trichomoniasis). • Parasites- Tiny insects. – They can be killed by multiple treatments with insecticides such as RID. • Yeast and Bacterial Vaginitis are NOT considered STIs even though the symptoms may mimic having an STI. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 12. Close Up onSTIs Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 12 • Trichomoniasis • Public Lice • Scabies • Genital Herpes (HSV) • Human Papilloma Virus (HPV) • Gonorrhea • Syphilis
- 13. Trichomoniasis:Trichomoniasis: KEY POINTSKEY POINTS •Caused by Trichomonas vaginalis, a tiny parasite(protozoa). • In women, causes malodorous yellow-grey, that may be thin and frothy, with irritation and vulvar itching, pain when passing urine or with sex. • In men, usually gives no symptoms but can cause urethritis, (thin white discharge from tip of penis, pain and burning when urinating). Men tend to act as carriers. • Resistance to common treatment (metronidazole) does occur. Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 13
- 14. Pubic Lice (Crabs) •Pubic lice have six legs, but their two front legs are very large and look like the pincher claws of a crab; this is how they got the nickname "crabs." Pubic lice are tan to grayish- white in color. • A lice-killing shampoo is recommended to treat pubic lice. Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 14
- 15. 15 Pubic Lice (Crabs) •Pubic lice (crabs) are tiny parasitic insects that live in pubic hair, underarm hair, hair on the body and, occasionally, in eyebrows and eyelashes. • The eggs are called 'nits' and appear as brownish dots fixed to coarse body hair. • They're easily passed through close body/sexual contact. Photo: www.bbc.co.uk Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 16. 16 Pubic Lice Symptoms •It can take several weeks after coming into contact before any symptoms appear. You might notice: – Itching in the affected areas – Black powdery droppings from the lice in underwear – Brown eggs on pubic or other body hair – Irritation and inflammation in the affected area, sometimes caused by scratching – Sky-blue dots (which disappear within a few days) or very tiny specks of blood on the skin Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 17. And now this… Lastupdated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 17 http://www.cc.com/video-clips/cdnpoy/the-daily-show-with-jon-stewart-beasts-of-the-southern-wild
- 18. 18 Scabies mite • Scabiesis an infestation by the human itch mite. • The microscopic mite burrows into the upper layer of the skin where it lives and lays its eggs • The mite is usually spread by direct, prolonged, skin to skin contact with a person with scabies. • Scabies can spread rapidly under crowded conditions such as nursing homes, child care and extended care facilities. Prisons are often sites of outbreaks. • A person usually only had 10-15 mites, unless they have crusted scabies (Norwegian) Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 19. 19 Scabies Symptoms Scabies causingeczema-like hand condition • The most common symptoms are intense itching and a pimple like skin rash. • If a person never had scabies, symptoms may take 4-6 weeks. (The person is still contagious) • If a person has been infected before, symptoms usually appear in 1-4 days. • Itching and rash may be any where or limited to sites such as the wrist, elbow, armpit, webbing of fingers, nipple, penis, waist, belt-line, and buttocks. • Scabies may live 1-2 months on a person and 48-72 hours off a person. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 20. 20 Scabies Treatment: Topical Treatmentis by a product called a scabicide available by prescription only. – Apply a mite-killer like permethrin (Elimite). These creams are applied from the neck down, left on overnight, and then washed off. This application is usually repeated in seven days. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 21. 21 Scabies Treatment: Oral •Ivermectin, is an oral antiparasitic medication that has also been shown to be an effective scabicide, although it is not FDA- approved for this use. It is taken at a dosage of 200 micrograms per kilogram body weight as a single dose, followed by a repeat dose two weeks later. • It is typically used only when topical medications have failed or cannot be tolerated. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 22. 22 Genital Herpes: Epidemiology •Estimated annual incidence: 600,000 to 1 million cases • NHANES data provided new view of HSV-2 prevalence in the U.S. – Twenty-two percent of adults estimated to be infected with HSV-2 – Rates are higher in HIV infected persons, African Americans and adults of lower socioeconomic status – Most infections are unrecognized because of mild symptoms or absence of symptoms Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 23. 23 Genital Herpes • Herpesis caused by a virus called herpes simplex (HSV). – HSV I - the mouth and nose (cold sores), fingers and hand (whitlows). – HSV II - genital and anal area (genital herpes). Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 24. Genital Herpes: Transmission •Major routes: sexual & mother-to-infant (usually during delivery) • Most sexual transmission probably occurs when infected person is asymptomatic* (not having any symptoms) • Efficiency of transmission is greater from men to women than women to men 24Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 25. 25 Genital Herpes: Infection •Initial infection – Virus enters through microscopic breaks in skin • Establishes chronic infection – Virus becomes latent in nerves cells along spinal cord – Infection persists despite immune response – Virus may remain latent indefinitely or can reactivate • Virus can reactivate – Precipitating factors: trauma, fever, UVL, stress – Virus reproduces and moves along nerve axon to skin or mucosa, and recurrent lesions can occur – Reactivation (shedding) can also be asymptomatic (no symptoms) Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 26. 26 Genital Herpes: Asymptomatic Shedding •Multiple studies have documented asymptomatic shedding • Occurs in up to 90% of patients with HSV-2 – Most common in first two years after infection (5-10% of days), less common thereafter (2% of days) – Shedding may occur from cervix, vulva, urethra, rectum, penis – Asymptomatic shedding reduced by antiviral suppression medication Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 27. 27 Genital Herpes Symptoms •Flu-like symptoms: fever, tiredness, headache, swollen glands, aches and pains in the lower back, legs or groin • Stinging, tingling or itching in the genital or anal area • Small, fluid-filled blisters in the genital or anal area, on the buttocks and tops of the thighs; these burst within a day or two leaving small red sores • Pain when urinating (caused by urine touching the sores) Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 28. 28 Genital Herpes: Treatment •Treatment of symptomatic outbreaks • Suppression of symptoms by daily medication • Daily medication to lessen chance of transmission Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 29. 29 Genital Herpes (HSV): KEYPOINTS • About 1/5 of adult Americans have HSV 2 • Most do not recognize or get symptoms • New type-specific blood tests can accurately diagnose HSV 2 infection even when no symptoms are present • Treatment to control symptoms and lessen the chance of transmission are available Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018 HSV is a virus and is not CUREABLE!
- 30. 30 Human Papillomavirus (HPV): GenitalWarts • Genital warts are caused by the human papillomavirus (HPV). • HPV is the most common STI. • Genital warts can be passed from one person to another during sex, and by skin-to-skin contact. • The virus can remain in the body and be passed on before warts are noticeable, or after they have disappeared. • Warts can be external or internal. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 31. 31 Human Papillomavirus (HPV): GenitalWarts • Two disease processes caused by different viral types – Pre-cancer and cancer of the genital tissues (abnormal Paps and anal cancer) – Skin growths in the genital area (genital warts) Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 32. 32 Genital Warts: Symptoms •Most people infected will not have any visible signs or symptoms at all. • It can take from two weeks to several months after coming into contact with the virus before warts appear. • The highest rates of genital warts are diagnosed in women aged 16 to 19 and men aged 20 to 24. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 33. 33 Genital Warts DOIA Website,2000 Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 34. 34 Condyloma acuminata, anal InfectiousDisease Prevention and Health Services BureauLast updated January 31, 2018
- 35. HPV among U.S.Females 14-34 Years Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 35 Figure 46. Human Papillomavirus — Cervicovaginal Prevalence of Types 6, 11, 16 and 18 Among Females Aged 14–34 Years by Age Group and Time Period, National Health and Nutrition Examination Survey (NHANES), 2003–2006 and 2009–2012
- 36. 36 The GARDASIL Vaccine •There are over 30 types of HPV. The vaccine treats types 6,11,16,18. • It is estimated that 75% to 80% of people will be affected in their lifetime • Each day in the U.S., 30 women are diagnosed with cervical cancer, it is est. that each minute there is a new case of genital warts. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 37. 37 The GARDASIL Vaccine •In females aged 9 to 26, GARDASIL helps protect against 2 types of HPV that causes 75% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases • In males aged 9 to 26, GARDASIL helps protect against 90% of genital warts cases. • GARDISIL does not treat cancer or genital warts. GARDASIL is given as 3 injections over 6 months Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 38. 38 Genital Warts (HPV): KEYPOINTS • Extremely common virus • Some types cause genital warts • Other types cause cervical and anal cancer • HPV tests can help in managing female patients with abnormal Paps • Best approach to anal dysplasia (abnormal cell growth) is unclear • Vaccination before first sexual debut can prevent up to 90% of HPV infections. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018 HPV is a virus and is not CURABLE!
- 39. 39 Gonorrhea (GC) • Gonorrheais caused by a bacteria found mainly in semen and vaginal fluids. • Gonorrhea is usually passed from one person to another during vaginal, oral or anal sex, or by sharing sex toys. • It can live inside the cells of the cervix, the urethra, the rectum, the throat and, occasionally, the eyes. • Gonorrhea can also be passed from a pregnant woman to her baby. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 40. 40 Gonorrhea in Maryland Marylandhad 6,858 cases of Gonorrhea in 2015 In 2015 Maryland ranked 24th in the nation for new cases of Gonorrhea Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 41. 41 Gonorrhea: Symptoms • Womenmight notice: – Unusual vaginal discharge - this may be thin, watery, yellow or green – Pain when urinating – Lower abdominal pain or tenderness – Bleeding between periods • Men might notice: – Unusual discharge from the tip of the penis - this may be white, yellow or green, and there may be inflammation of the foreskin – Pain when urinating – Painful or tender testicles Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 42. 42 Gonococcal ophthalmia Infectious DiseasePrevention and Health Services BureauLast updated January 31, 2018
- 43. 43 Gonorrhea Infections Infectious DiseasePrevention and Health Services BureauLast updated January 31, 2018
- 44. 44 Gonorrhea: KEY POINTS • Secondmost common bacterial (curable) STI in the U.S. • Infects the mucous membranes of the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. • Highest reported rates of infection are among sexually active teenagers and young adults (especially ages 15-24), and African Americans. • Resistance to medications is a growing problem. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 45. 45 Chlamydia • Chlamydia isa bacterial infection, which is found in semen and vaginal fluids. • Up to one in ten sexually active young people have chlamydia. • Chlamydia is usually passed from one person to another during vaginal, oral or anal sex, or by sharing sex toys. It can live inside cells of the cervix, urethra, rectum and sometimes in the throat and eyes. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 46. 46 Chlamydia: Symptoms • Mostdon't have any obvious signs or symptoms. • Symptoms can appear 1 – 3 weeks after contact, many months later, or not until the infection spreads to other parts of your body. • Women notice: discharge/ bleeding between periods/ pain during sex or when passing urine/abdominal pain • Men notice: White, watery discharge from the tip of the penis / Pain when passing urine or painful testicles. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 47. Pelvic Inflammatory Disease •Not an STI itself, pelvic inflammatory disease (PID) is a serious complication of untreated STIs, especially chlamydia and gonorrhea. It happens when bacteria spread to infect the uterus and other female reproductive organs. Prompt treatment is essential to prevent damage to a woman's fertility. • Signs and Symptoms: Lower abdominal pain, fever, unusual discharge, painful intercourse, painful urination, and spotting. There are often no warning signs. 47Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 48. 2016 New ChlamydiaCases in U.S. Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 48 Figure 5. Chlamydia — Rates of Reported Cases by Age Group and Sex, United States, 2016
- 49. 49 Chlamydia in Maryland Marylandhad 27,450 cases of Chlamydia in 2015 In 2015 Maryland ranked 23rd in the nation for new cases of Chlamydia Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 50. 50 Chlamydia: KEY POINTS • Mostcommon bacterial (curable) STI in the U.S. • Most common STI among • Most cases in women and men give no symptoms • Leading cause of Pelvic Inflammatory Disease (PID) and infertility in women • All sexually active women 25 yrs. and younger should be tested at least annually. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 51. 51 Syphilis Syphilis was almosteliminated in the U.S. until a resurgence in 2001 Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018 treponema pallidum
- 52. 52 History of Syphilis •Syphilis has been around since early history. The first large outbreak was in Europe in 15th century. (Babies were born with it, adults were taken outside of the city and banned) • 1890 Control of the disease focused on prostitutes. Syphilis was associated with sin and sex outside of marriage. • 1905 German researchers discovered the bacteria that causes syphilis • 1932 The Tuskeegee Study began in Macon County, Alabama • 1943 Use of penicillin to treat syphilis began. Tuskeegee participants excluded • 1947 2nd Syphilis outbreak in U.S. • 1972 End of Tuskeegee Study • 1997 President Clinton apologizes for Tuskeegee Study Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 53. 53 Syphilis • Syphilis iscaused by a bacteria known as Treponema pallidum. • Syphilis is usually passed from one person to another during vaginal, oral or anal sex. • It can be passed on by direct skin contact with someone who has syphilis sores or a syphilis rash, and by sharing sex toys. • Syphilis can be passed from a pregnant woman to her unborn baby. This is known as congenital syphilis Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 54. 54 Syphilis • Primary (1o )syphilis manifests as a single, painless, clean- based ulcer which untreated resolves in 4-6 weeks • The lesion usually appears within 3 weeks of infection (can range from 10-90 days) • In women the labia and vaginal wall are most often affected, but the cervix may also be involved • Primary stage: a sore, usually painless, at the site where the bacteria entered the body. Occurs within 3 weeks of exposure (range from 10 to 90 days). A person is highly contagious. MANIFESTATIONS (1O ) Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 55. 55 Primary Syphilis Photos: Dr.Joseph Engelman, San Francisco City ClinicInfectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 56. 56 Primary Syphillis Infectious DiseasePrevention and Health Services BureauLast updated January 31, 2018
- 57. 57 Syphilis The signs andsymptoms of 2o syphilis usually resolve even without treatment Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 58. 58 Secondary Syphilis • Symptomsinclude: – Rash – generalized and inclusive of palms and soles that appears 4-6 weeks after first sore – Lesions which may occur on the mucous membranes and in the genital region – Systemic symptoms: • Fever • Arthralgias (joint pain) • Pharyngitis (hoarseness) • Lymphadenopathy (swollen glands) Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018 MANIFESTATIONS (2O )
- 59. 59 Secondary Syphilis Photo: Dr.Joseph Engelman, San Francisco City ClinicSTD Atlas, 1997 Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018 Rash caused by secondary syphilis
- 60. 60 Secondary Syphilis Infectious DiseasePrevention and Health Services BureauLast updated January 31, 2018
- 61. 61 Secondary Syphilis: OtherSymptoms Photo: Dr. Joseph Engelman San Francisco City Clinic Comdyloma lata DOIA Website, 2000 STD Atlas, 1997 Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 62. 62 Secondary Syphilis: OtherSymptoms Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018 Alopecia: hair loss caused by syphilis
- 63. 63 Latent Syphilis • Thelatent stage of syphilis is a period of time when there are no visible signs or symptoms of syphilis. • If you do not receive treatment, you can continue to have syphilis in your body for years without any signs or symptoms. • The diagnosis is only through serologic testing. • Illness occurring up to 1 year after inoculation is considered “early” latent disease. • Illness presenting more than 1 year after inoculation is considered “late” latent disease. • The stage of disease has important treatment implications. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 64. 64 Tertiary Syphilis • Tertiary(late) syphilis develops in about 10%-40% of untreated persons. • Most people with untreated syphilis do not develop tertiary syphilis. However, when it does happen it can affect many different organ systems. – These include the heart and blood vessels, and the brain and nervous system. – Tertiary syphilis is very serious and would occur 10–30 years after infection began. In tertiary syphilis, the disease damages your internal organs and can result in death. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018 MANIFESTATIONS (3O )
- 65. Syphilis Cases inU.S.: 2007-2016 Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 65 Figure 31. Primary and Secondary Syphilis — Rates of Reported Cases by Region, United States, 2007–2016
- 66. 66 Syphilis in Maryland Marylandhad 509 cases of P&S Syphilis in 2015 In 2015 Maryland ranked 10th in the nation for new cases of Syphilis Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 67. 67 Syphilis: KEY POINTS • Outbreaksin MSM in urban areas since 1970 • MSM accounted for the majority of reported P&S syphilis cases in the U.S. and in Maryland in 2016. • Nationally, the highest rates of P&S syphilis in 2016 were observed among men aged 20–34 years, among men in the West, and among Black men. • Serious systemic infection • Strong connection with HIV transmission • Yearly testing of all HIV-positive patients is recommended Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 68. 68 STI Transmission • STIsare transmitted through direct contact via oral, anal, vaginal sex as well as activities that involve sexual rubbing or grinding. The common direct contact STIs are HPV, HSV, and syphilis. • STIs are transmitted through the exchange (or discharge) of infected sexual fluids. Infectious fluids are vaginal fluids, semen, and pre-cum for some STIs. Common STIs transmitted via fluid are Trichomonasis, Chlamydia, Gonorrhea, HIV, Hep B • STIs transmitted through blood are HIV, Hep B, and Hep C. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 69. 69 Are STI’s Serious? •A young girl or woman with an STI could end up with: – Cervical cancer – Pelvic inflammatory disease – Tubal pregnancy – Chronic pelvic pain – Infertility • In men or women STI’s can lead to: – Anal cancer – Liver disease / cancer – Nervous system problems – AIDS – Death Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 70. 70 Partner Management • Transmissibility: –Male to female: 50 - 90% – Female to male: 20 - 80% • Partners with contact during the 60 days preceding the diagnosis should be evaluated, tested and treated • If no sex partners in previous 60 days, treat the most recent partner Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 71. 71 STIs and Pregnancy Ifsomeone has an STI while pregnant, the baby could end up with: – Eye infections causing blindness – Lung infections – Brain infections – Birth defects – Death (still-birth) Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 72. 72 How Do YouProtect Yourself ? • By NOT having sex. • By having ONE partner, who only has sex with you and does not have an STI. • By using BARRIER protection. • By TALKING about STI and HIV risk behaviors and how to stop the spread. • By NOT having sex while under the influence of alcohol or drugs. • By getting TESTED for HIV and other STI’s each year . Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 73. 73 Condom EffectivenessCondom Effectiveness Latexcondoms, when used consistently and correctly, are highly effective for: – HIV And can reduce the risk of: – GC, CT, and Trichomonas – Genital herpes, syphilis, chancroid, and HPV, only when the infected areas are covered by the condom CDC, 2002 Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 74. 74 Quick Facts • Birthcontrol pills, the shot (Depo), the ring, the birth control patch DO NOT protect against STI or HIV transmission. • Latex condoms REDUCE the possibility of transmission. Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 75. 75 STI Wrap-up • Questions •Comments Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 76. 76 Content & DataContributors • Maryland Department of Health, Center for STI Prevention • Centers for Disease Control and Prevention • Dermnet Skin Disease Image Atlas • Baylor Pediatric AIDS Atlas • Screening for Infectious Diseases Among Substance Abusers • Google Images Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
- 77. Last updated January31, 2018 Infectious Disease Prevention and Health Services Bureau 77 Prevention and Health Promotion Administration Jill Smith, MHS, CAC-AD (410) 767-5373 • [email protected] http://health.maryland.gov
Editor's Notes
- #9 The danger of HPV is that some types of HPVs are considered to cause cervical cancer, which kills nearly 4000 women every year in the USA. Cervical cancer can be prevented and regular Pap Tests are essential for sexually-active females. • In general, about 10% of people infected with HPVs may be infected for life. The immune system in the vast majority of HPV-infected persons will “clear” HPV viruses from the body within a couple of years. • Genital herpes is a life-long infection. When the sores or blisters of genital herpes are present, the chances for HIV infection AND HIV transmission are increased by as much as five times. • Trichomoniasis (“trich”) is a very common STD that also increases the chance of HIV transmission and infection. • Chlamydia is often asymptomatic in females. When it goes untreated, it can cause a serious infection of the female reproductive organs (pelvic inflammatory disease) • Untreated Pelvic Inflammatory Disease (P.I.D.) can result in infertility, ectopic pregnancy (which can be life-threatening) and permanent pelvic pain. • Untreated Chlamydia is the leading cause of infertility among women.
- #10 What do the diseases in green have in common? (Bacterial which are curable, but you can get infected again and again – they are Treatable but repeatable) What do the diseases in purple have in common? (Viruses – for which there is no medical cure – and some of these are life-long infections – herpes and HIV) Why is Trichomoniasis a different color than the others? (Protozoans which are curable) Why are “Crabs” a different color? (Pubic lice are insects, “curable” by treatment with a type of insecticide) In case you are asked, here is some background on basic types of microorganisms: Bacteria - A type of microorganism that features three different shapes (round, rodshaped, and spiral). Most bacteria have the ability to move independently. Some bacteria have mucous surrounding each cell and this makes the bacteria stronger and more infectious. It is estimated that each person carries 100 trillion bacteria on and in our bodies. Some bacteria create disease in people and can be harmful. However, there are also bacteria that co-exist with the human body without causing disease. Bacteria that cause disease are usually treated with antibiotics. Most bacteria grow best at moderate temperatures. Protozoa - These are the simplest form of animals. Most protozoa are single-celled and have mobility, using tail-like structures called flagella. Protozoa are larger than both viral and bacterial organisms. There are medicines that kill protozoa and are used in treatment of infected people (Ex: Flagyl for treatment of Trichomoniasis). Virus - A virus is a parasitic organism because it totally depends upon the human cell for nutrients to survive. There have been over 300 types of viruses isolated from animals, but not all of these are harmful to humans. Infection with a virus stimulates an antibody response from the body. This means that special proteins are formed in people to defend itself against the virus. There are viruses that cause everything from the
- #14 Trichomonas vaginalis (TV) is caused by a tiny parasite found in the vagina and urethra (the tube where urine comes out). It is passed on through: vaginal sex, from a mother to her baby at birth and/or sharing sex toys. Symptoms in women: increased discharge from the vagina, which may be thinner or frothy, change in colour and have a musty or fishy smell, itching, soreness and inflammation in and around the vagina pain when passing urine or having sex, tenderness in the lower abdomen Symptoms in men: Men especially tend to act as carriers and not show symptoms. thin, whitish discharge from the tip of the penis, which can stain underwear , pain or burning when passing urine
- #19 What Is Scabies? Scabies is an infestation by the itch mite, Sarcoptes scabiei. Mites are small eight-legged parasites (in contrast to insects, which have six legs). They are tiny, just 1/3 millimeter long, and burrow into the skin to produce intense itching, which tends to be worse at night. The mites which cause scabies are not visible with the naked eye but can be seen with a magnifying glass or microscope. Scabies Scabies is an itchy infestation caused by a tiny mite that burrows into human skin to lay eggs. It is not always an STD, as it can spread through any skin-to-skin contact. But among young adults, the mites are often acquired during sex. Scabies is treated with prescription mite-killing creams. Symptoms: Intense itching especially at night and a pimple-like rash. It may take 2-6 weeks for symptoms to appear. . How is scabies tested and diagnosed? Most cases of scabies can be diagnosed by describing the symptoms to the doctor and by examination of the skin. There is no blood test for scabies. Sometimes, the doctor will do a skin scraping to make or confirm the diagnosis. This is performed by placing a drop of oil or saline on top of an affected area. Then using a scalpel, the area is scraped, and the material that was collected is placed on a slide to examine under a microscope. The doctor will look for the mite or its eggs. The doctor may perform a felt-tip-marker test by drawing a washable felt-tip marker across the rash and then wiping it off with alcohol. This may help to identify a burrow because the ink penetrates deep into the skin. Often, there are a few mites that can be hard to find. Therefore, even if the scrapings are negative, the doctor may still recommend treatment if he or she is very suspicious that scabies is present. Are Cases of Scabies Often Misdiagnosed? Scabies (right) is very easy to misdiagnose because early subtle cases may look like small pimples (left) or mosquito bites (center). Over a few weeks, however, mistakes like this become evident as patients feel worse and worse with symptoms they can't ignore. In What Special Situations Can Scabies Be More Easily Spread? The elderly and people with weakened immune systems in nursing homes and similar institutional settings may harbor scabies without showing significant itching or visible signs. In such cases, there can be widespread epidemics among patients and health-care workers. Such cases are dramatic but, fortunately, uncommon. What Is “Norwegian Scabies”? The term "Norwegian scabies" refers to a particularly severe form of scabies that is also known as crusted scabies. Crusted scabies has been called Norwegian scabies because the condition was first described in Norway in the mid-19th century. Norwegian scabies is different from traditional scabies as there seems to be a problem with the immune response to the mites, allowing for the infestation of an individual with hundreds of thousands of the mites. Crusted scabies almost always affects people with a compromised immune system and is observed most frequently in the elderly, mentally or physically disabled, and in patients with AIDS, lymphoma, or other conditions that decrease the effectiveness of the immune response. The lesions of this distinctive form of scabies are extensive and may spread all over the body. The elbows, knees, palms, scalp, and soles of the feet are most commonly the original sites of involvement, and the scaly areas eventually take on a wart-like appearance. The fingernails can be thickened and discolored. Interestingly, itching may be minimal or absent in this form of scabies. More Reading on Scabies and Other Skin Diseases Scabies Shingles Psoriasis Hives and Angioedema Eczema Impetigo Skin Rashes in Children Previous 5/17 Next Advertisement Previous 5/17 Next
- #20 What Are the Signs and Symptoms of Scabies? Scabies produce small red bumps and blisters and affect specific areas of the body. Scabies may involve the webs between the fingers, the wrists and the backs of the elbows, the knees, areas around the waist and umbilicus, the axillary folds, the areas around the nipples, the sides and backs of the feet, the genital area, and the buttocks. The bumps (medically termed papules) may contain blood crusts. It is helpful to know that not every bump is a bug. In most cases of scabies affecting otherwise healthy adults, there are no more than 10 or 15 live mites, even if there are hundreds of bumps and pimples." What Do Scabies Look Like? Textbook descriptions of scabies always mention "burrows" or "tunnels." These are tiny thread-like projections, ranging from 2 mm-15 mm long, which appear as thin gray, brown, or red lines in affected areas. The burrows can be very difficult to see. Often mistaken for burrows are linear scratch marks that are large and dramatic and appear in people with any itchy condition. Scratching actually destroys burrows as shown on this slide. The scaly patch at the left is due to scratching of the original papule. The mite traveled from there to the upper right, where it can be seen as a dark spot at the end of the burrow. What Does a Scabies Infection Feel Like? Itching is the most common symptom of scabies. The itch of scabies is insidious and relentless. The itch is usually worse at night. For the first weeks, the itch is subtle. It then gradually becomes more intense until, after a month or two, sleep becomes almost impossible. What makes the itch of scabies distinctive is its relentless quality, at least after several weeks. Other itchy conditions -- eczema, hives, and so forth -- tend to produce symptoms that wax and wane. These types of itch may keep people from falling asleep at night for a little while, but they rarely prevent sleep or awaken the sufferer in the middle of the night
- #21 Scabies Treatment: Cream Applications Apply a mite-killer like permethrin (Elimite). These creams are applied from the neck down, left on overnight, and then washed off. This application is usually repeated in seven days. An alternative treatment is 1 ounce of a 1% lotion or 30 grams of cream of lindane, applied from the neck down and washed off after approximately eight hours. Since lindane can cause seizures when it is absorbed through the skin, it should not be used if skin is significantly irritated or wet, such as with extensive skin disease, rash, or after a bath. As an additional precaution, lindane should not be used in pregnant or nursing women or children younger than 2 years of age. Lindane is only recommended if patients cannot tolerate other therapies or if other therapies have not been effective. Scabies Treatment: Oral Medication Ivermectin, is an oral antiparasitic medication that has also been shown to be an effective scabicide, although it is not FDA-approved for this use. It is taken at a dosage of 200 micrograms per kilogram body weight as a single dose, followed by a repeat dose two weeks later. Although taking a drug by mouth is more convenient than application of the cream, ivermectin has a greater risk of toxic side effects than permethrin and has not been shown to be superior to permethrin in eradicating scabies. It is typically used only when topical medications have failed or cannot be tolerated. Scabies Treatment: Antihistamines Antihistamines, such as diphenhydramine (Benadryl), can be useful in helping provide relief from itching. Scabies Treatment: Wash Linens and Bedclothes Wash linens and bedclothes in hot water. Because mites don't live long away from the body, it is not necessary to dry-clean the whole wardrobe, spray furniture and rugs, and so forth. Scabies Treatment: Additional Tips Treat sexual contacts or relevant family members (who either have symptoms or have the kind of relationship that makes transmission likely). Cut your nails, and clean under them thoroughly to remove any mites or eggs that may be present. Thoroughly vacuum your rugs, furniture, bedding, and car interior and throw the vacuum-cleaner bag away when finished. Try to avoid scratching. Keep any open sores clean. Just as the itch of scabies takes a while to reach a crescendo, it takes a few days to subside after treatment. After a week or two, relief is dramatic. If that doesn't happen, the diagnosis of scabies must be questioned.
- #24 Some people can shed the virus from their skin or mucous membranes without any symptoms of genital herpes. This is called asymptomatic or viral shedding. It's possible to pass the virus during this time, but for most people the risk is low. What are the symptoms? Many people don't have any visible signs or symptoms, or are unaware of them. Symptoms can occur within four to five days of coming into contact with the virus, but it can be weeks, months or even years before they appear. This means that when symptoms occur, it doesn’t necessarily mean you've recently come into contact with the virus.
- #25 Herpes Simplex Virus Type 1 That painful cold sore you get on your lip every now and then? It's probably caused by a type of herpes virus called HSV-1. This virus is usually not an STD; it spreads easily among household members or through kissing. But it can be spread to the genitals through oral or genital contact with an infected person. Though there is no cure, drugs can shorten or prevent outbreaks. Signs and Symptoms: Occasional cold sores or “fever blisters” on the lips. Small blister or sores on the genitals are also possible. Who's at Risk for STDs? Anyone who is sexually active is at risk for an STD, regardless of gender, race, social class, or sexual orientation. That said, teenagers and young adults acquire STDs more easily than older people. By age 25, half of sexually active adults get an STD. Having multiple sex partners also raises your risk. The CDC has noted that some STDs are on the rise in men who have sex with men, including syphilis and LGV. Can Virgins Get STDs? Yes, they can. Many STDs spread through any type of sexual activity, including skin-to-skin contact and oral sex. This is especially true of STDs that produce genital lesions or sores. Preventing STDs The best ways to avoid getting an STD are to abstain from any sexual contact and be in a monogamous, long-term relationship with an uninfected partner. To reduce your odds of getting STDs: Ask your partner if he or she has an STD. Ask partners to be tested before sexual activity. Use condoms. Avoid sexual activity if your partner has signs of an STD. Be aware of symptoms and get regular checkups with your health care provider. The Limits of Condoms While condoms are effective in preventing the spread of some STDs, they are not perfect. Condoms are better at protecting against gonorrhea, chlamydia, HIV, and trichomoniasis. But they offer less protection against herpes, syphilis, and genital warts. These infections can spread through contact with skin lesions that are not covered by a condom. Finally, condoms offer virtually no protection against crabs and scabies. How to Tell Your Partner If you think you have an STD, tell your partner(s) as soon as possible. You may be able to spread the infection even if you have already begun treatment or are using condoms. With some STDs, doctors recommend treating both partners at the same time. This may be a difficult conversation. Some people find it helpful to write a script ahead of time. Be sure to let your partner ask questions and express his or her feelings. STDs and Pregnancy It is important for pregnant women to be checked for STDs. They can cause women to go into labor too early and may complicate delivery. Many STDs can be passed from mother to baby during pregnancy, childbirth, or after the baby is born. STDs effects on babies can include stillbirth, low birth weight, neurologic problems, blindness, liver disease, and serious infection. But there are treatments to minimize these risks. Treatment during pregnancy can cure some STDs and lower the risk of passing the infection to your baby. Can STDs Come Back? Most STD treatments do not protect you from getting the same infection again. A course of drugs may cure gonorrhea, syphilis, chlamydia or trichomoniasis, but a new exposure can start a new infection. If you're partner is not treated, you can continue to pass infections back and forth. And if you're not taking the right precautions to protect yourself, you can be re-infected quickly or even pick up a second STD. More Reading on STDs Sexually Transmitted Diseases(STDs) Genital Herpes Chlamydia Trichomoniasis Gonorrhea Genital Warts (HPV Infection) Syphilis HIV/AIDS Previous
- #27 Herpes Simplex Virus Type 2 Most cases of genital herpes are caused by a virus called HSV-2. It's highly contagious and can spread through intercourse or direct contact with a herpes sore. As with HSV-1, there is no cure. But antiviral drugs can make outbreaks less frequent and help clear up symptoms more quickly. Symptoms: Fluid-filled blisters that form painful, crusted sores on the genitals, anus, thighs, or buttocks. Can spread to the lips through oral contact.
- #31 Genital Warts (HPV) You don't have to have sex to get an STD. Skin-to-skin contact is enough to spread HPV, the virus family that causes genital warts. Some types cause warts and are usually harmless, but others may lead to cervical or anal cancer. Vaccines can protect against some of the most dangerous types. Signs: Pink or flesh-colored warts that are raised, flat, or shaped like cauliflower. Often there are no symptoms.
- #33 If warts are suspected you will have an examination of the whole genital area, including the anus. They might use a solution of weak vinegar over the area as this can help detect warts. A new type of cervical screening test is being introduced which can diagnose the wart virus. From 2008, young women will be able to be vaccinated against cervical cancer and the wart virus. There are a range of treatments for visible warts depending on where and how many warts there are, including: Special cream or liquid put onto the warts. This can be done at the clinic or at home. Do not use wart preparations that you can buy from the pharmacy, these will not work on genital warts Heat treatment to burn them off, freezing them or using a laser Surgery to remove them Injecting a drug directly into the wart - this is less common
- #40 If the infection is in the rectum or eye, you may experience discomfort, pain or discharge. Gonorrhoea in the throat usually has no symptoms. Gonorrhoea is easy to treat with a single dose of antibiotics, either by tablets or injection. The antibiotics used to treat gonorrhoea interact with the combined oral contraceptive pill and the contraceptive patch making them less effective, so check this with your doctor or nurse. To avoid reinfection, any sexual partners should be treated too. If complications occur, another treatment might be needed. What happens if it isn't treated? Without treatment, the infection can spread to other parts of the body causing damage and long-term health problems, including infertility. In women, gonorrhoea can spread to the reproductive organs causing pelvic inflammatory disease. This can lead to: Long-term pelvic pain Ectopic pregnancy (when a pregnancy develops outside the womb, usually in the fallopian tube) Blocked fallopian tubes (the tubes that carry the egg from ovary to womb) In men, gonorrhoea can lead to painful infection in the testicles and the prostate gland. It may reduce fertility. Less commonly, gonorrhoea can cause inflammation of the joints and tendons. Rarely, it can cause inflammation of the brain, spinal cord and heart.
- #46 Chlamydia is easy to treat with antibiotics, either as a single dose or longer course for up to two weeks.
- #54 Syphilis Most people don't notice the early symptoms of syphilis. Without treatment, it can lead to paralysis, blindness, and death. Syphilis can be cured with antibiotics. Signs and Symptoms: The first sign is usually a firm, round, painless sore on the genitals or anus. The disease spreads through direct contact with this sore. Later there may be a rash on the soles, palms, or other parts of the body (seen here), as well as swollen glands Syphilis can develop in three stages, known as primary, secondary and tertiary syphilis. If you do get symptoms, you might notice the following: Primary syphilis: One or more sores (chancres) - usually painless, they appear where the bacteria entered the body, usually two to three weeks after you've come into contact with syphilis The sores can appear anywhere on the body - in women they're found mainly in the genital area and on the cervix, in men they're found mainly in the genital area and on the penis Less commonly, they may be found in the mouth, lips, tonsils, fingers or buttocks The sores are very infectious and can take up to six weeks to heal. By this time, the bacteria will have spread to other parts of the body, becoming known as secondary syphilis. Secondary syphilis: A painless, non-itchy, very infectious rash that can occur all over the body or appear in patches, mostly on the palms of hands and soles of feet Flat, warty-looking growths on the vulva of women or anus in men and women Flu-like illness, tiredness and loss of appetite, with swollen glands, possible patchy hair loss and white patches in the mouth Tertiary syphilis: If left untreated, after many years syphilis can cause serious damage to the heart, brain, eyes and other internal organs, and lead to death.
- #70 Long term hepatitis b and hepatitis c infection usually results in cirrhosis of the liver, liver failure, and liver cancer - all of which are life threatening. HPV infection in the anus can lead to anal cancer. Late syphilis (normally 20-40 years after untreated infection) can cause severe tissue damage in the heart, aorta, nervous system, eyes, and other organs. The STDs most commonly causing death to adults are HIV, HPV (cervical cancer), Hepatitis b (liver cancer), Chlamydia (ruptured ectopic pregnancy), and syphilis (ruptured aorta). Chlamydia and gonorrhea can infect a newborn’s eyes during birth if the mother is infected and has not been treated. • Chlamydia can infect the nasal passages during birth if the mother is infected with Chlamydia. This infection can spread to the baby’s lungs resulting in pneumonia. • Herpes can enter a baby’s eyes during birth, move along the ocular nerve into the brain, causing inflammation of the lining of the brain (encephalitis) which can result in death. • Syphilis can cross the placenta during fetal development and infect many tissues in the developing fetus, including the brain. The earlier this occurs in fetal development, the more serious the infection. Sometimes the damage is so severe that the baby is stillborn. Sometimes the baby is born with permanent birth defects. Although the congenital syphilis can be successfully treated, the birth defects are permanent. • HIV, HSV, and HBV can cause life-long chronic infections for newborns. Pelvic Inflammatory Disease Not an STD itself, pelvic inflammatory disease (PID) is a serious complication of untreated STDs, especially chlamydia and gonorrhea. It happens when bacteria spread to infect the uterus and other female reproductive organs. Prompt treatment is essential to prevent damage to a woman's fertility. Signs and Symptoms: Lower abdominal pain, fever, unusual discharge, painful intercourse, painful urination, and spotting. There are often no warning signs.