Sexually Transmitted Diseases NSCC NetID Personal Web Space PowerPoint Presentation

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Sexually Transmitted Diseases/Infections

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Recent History In the first half of 20th century, STD information: Fear driven Military Abstinence only Men vs Women Changes in last 50 years Less on abstinence only More on safe sex practices Humor

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Vintage Photos (eBaum’s World)

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Vintage Photos (eBaum’s World)

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Current Campaigns

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Current Campaigns

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Current Campaigns Alberta Health Video

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Disclaimer, Warning, & Support Incidence variation Per DOH: STIs comprise 75% of communicable conditions reported in 2010 State report requirements vary WA: chlamydia, gonorrhea, HIV, AIDS, syphilis, herpes, hepatitis, chancroid, lymphogranuloma venereum, granuloma inguinale (latter three are rare in US) OR: chlamydia, gonorrhea, HIV/AIDS, syphilis, lymphogranuloma venereum, chancroid, hepatitis (all forms), pelvic inflammatory disease ID: chlamydia, gonorrhea, syphilis, HIV/AIDS

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Disclaimer, Warning, & Support Graphic Graphics Where to get tested More testing sites, Seattle area

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General Information 20 million new infections cost $16 billion in medical costs (CDC, 2013) Most STI’s are caused by viral or bacterial infections Bacterial = usually curable Complications caused by bacterial infection may be irreversible Viral = usually treatable, not curable STI’s may be asymptomatic, esp. in women

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General Information Transmission: vaginal sex, anal sex, oral sex Other Breastfeeding: per US HHS, OK if have chlamydia or gonorrhea; syphilis and herpes = can transmit via sores; HIV = can transmit; others = check with physician Kissing: herpes, syphilis (outbreak), hepatitis B Injection drug users Mother to fetus: syphilis & HIV (about.com) Vaginal delivery: gonorrhea, chlamydia, hepatitis B, herpes

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Testing Information

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Testing Information Resources Avert.org Planned Parenthood Mayo Clinic Iwannaknow.org

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Chlamydia

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About Chlamydia Among the most common STD’s seen in the US US: 1,412,791 cases in 2011 (CDC) WA State: 23,237 cases in 2011 (DOH) King County cases: 5946 in 2010 3906 women 2039 men Bacterial infection Chlamydia can be passed via oral, vaginal, anal sex with an infected partner

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Chlamydia Rates (CDC, 2011)

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Chlamydia Prevalence by State (CDC, 2011)

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Chlamydia Rates by Age & Sex, 2011 (CDC)

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Chlamydia Rates by Race/Ethnicity, 2002-2011 (CDC)

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Chlamydia Symptoms Sometimes no symptoms are present Symptoms generally appear within three weeks of infection Abnormal discharge (mucus, pus) from cervix, penis Pain during urination Illustration Photos (Sexually Transmitted Disease Guide, 6 images)

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Chlamydia Treatment Antibiotics Take all medication Communicate with all sex partners Sexual intercourse should be avoided until treatment plan is finished Condoms can help prevent the spread of chlamydia

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Chlamydia Complications Conjunctivitis in newborn (eye drops given) Reiter’s Disease (sensitive photos) Pelvic Inflammatory Disease (Illustration, MD guidelines.com) Infection Disease-causing organisms migrate to uterus, fallopian tubes, ovaries Untreated, PID leads to scarring, pelvic pain, tubal pregnancy, infertility Treatment includes antibiotics Approximately 1 million women affected each year Approximately 100,000 women become infertile each year Video clip (2:05 via medicalvideos.us)

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Chlamydia Complications Epididymitis 600,000 cases a year Inflammation of epididymis Tube located in back of testicle Holds maturing sperm Disease-causing microbe enters urethra, travels Symptoms include fever, pain, discharge, swelling Treatment includes antibiotics, STD treatment if applicable Chronic epididymitis may threaten fertility (rare MayoClinic) Sensitive photos, (Seattle STD/AIDS Prevention Training Center)

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Lymphogranuloma Venereum

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Lymphogranuloma venereum From different chlamydia bacteria More prevalent in Asia, Africa, South America, but increasing in North America; now required to be reported in WA Per DOH, one case in 2011 Painless pimple or lesion on genitals Infection spreads to lymph tissue

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Gonorrhea

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About Gonorrhea Incidence US: 321,849 cases reported to CDC in 2011 WA State: 2,730 cases in 2011 King County: 1570 reported cases in 2010 404 in women, 1166 in men Bacterial infection Gonorrhea can be passed via vaginal, oral, anal intercourse, mother to child (vaginal delivery)

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Gonorrhea Rates, 1941-2011 (CDC)

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Gonorrhea Rates by State, 2011 (CDC)

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Gonorrhea Rates by Age & Sex, 2011 (CDC)

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Gonorrhea Rates by Race, Ethnicity, 2002-2011 (CDC)

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Gonorrhea Symptoms Symptoms usually appear within 10 days of contact with infected partner Some cases are asymptomatic Among women: bleeding/pain during intercourse, vaginal discharge, burning during urination Among men: pus-like discharge from penis, burning during urination, swollen testicles Anal infection: burning, itching, fresh blood in feces; painful bowel movements Illustration Photos (Sexually Transmitted Diseases Guide)

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Gonorrhea Treatment Antibiotics Take all medication Communicate with all sex partners regarding infection Refrain from sexual activity until infection is gone Condoms can help prevent the spread of gonorrhea

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Gonorrhea Complications Gonorrhea passed to newborns during delivery Antibiotic eyedrops PID Epididymitis Rarely, gonorrhea may spread bacteria to the body, infecting blood, joints, heart Those with gonorrhea are more susceptible to HIV

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Human Papillomavirus (HPV)

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About HPV Incidence, Prevalence: Incidence numbers = new cases Prevalence numbers = those living with a condition Other interpretation = those who may experience a condition at some point in their lives US: Several million a year new cases; 20-40 million already infected (King County Public Health); 75-90% of population may expect to have HPV at some point in their lives No required reporting The most common STD

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About HPV Virus; therefore, incurable A group of many viruses 200+ strains 40+ HPV forms can be sexually transmitted (CDC) Transmission via vaginal, oral, anal sex

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HPV Symptoms Sometimes HPV provides no symptoms Most common symptom is genital warts Appearing days, weeks or longer after infection Less common among men Illustration Photos: common & plantar warts, men, women , other images (OSU Student Health Services, afraidtoask.com, MayoClinic.com, avert.org)

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Physician Visits: Genital Warts, 1966-2011 (CDC)

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STD Surveillance Network: Genital Warts (CDC)

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HPV Prevention & Treatment Genital warts may disappear on their own Topical ointments/creams provided by physician Freezing/burning/laser treatments for smaller warts Communicate with all sex partners regarding HPV Refrain from sexual activity until warts are gone Condoms may help prevent HPV transmission (less definite than other conditions)

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HPV Complication: Cancer Approximately 30 of the HPV strains are thought to cause cervical cancer HPV-16, HPV-18 thought to cause the most cervical cancer cases (Gardasil specific to these, also strains HPV-6, HPV-11, which are associated with warts ) WHO/ICO Information Centre: world statistics Women should have regular pap tests HPV may also increase risk of vulvar, anal, penile, and oral cancers (ABC News, January 2012, 3:28)

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HPV Prevalence, High- and Low-Risk, Among Females 14-59, 2003-2006

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HPV Vaccines Vaccines for several HPV strains HPV Vaccine Safety (Dr. Mona, FOX News, 4:56) Gardasil FDA approved for males & females, age 9-26 yrs 3 injections across 6 months Protects against four high-risk HPV types (6, 11, 16, 18) Side effects (4:10; CNN, 2009, via YouTube) Cervarix (1:04; NHS, 2009, via YouTube) FDA approved for females, aged 10-25 3 injections Protects against HPV types 16, 18

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Syphilis

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Syphilis

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About Syphilis Researchers tracing origins (CBC, 5:03) Incidence US: 13,970 in 2011 (CDC) Top 13 states = 75% of cases per CDC Data by sex (males on the increase, females on the decrease) King County: 329 early syphilis cases in 2011 In 2010, 285 - men, 4 - women Over 90% among men (MSM) Source: 2009 King County STD Epidemiology Report Caused by bacteria, therefore curable Transmission via vaginal, oral, anal sex

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Syphilis Rates, 1941-2011 (CDC)

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Syphilis Rates by State, 2011 (CDC)

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Early Syphilis Rates by Age and Sex, 2011 (CDC)

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Syphilis Symptoms Syphilis is a multi-stage disorder: Primary stage - painless, infectious chancre Several days-few months after infection Genitals, mouth, rectum, other areas Sometimes there is no chancre Ulcer heals; many may think there is no problem Illustration: male (MayoClinic) Photos: oral, male, female, mix (CDC, Univ. of South Carolina Integrated Biomedical Sciences; University of Quebec; Cincinnati STD/HIV Prevention Training Center; istdpictures.com)

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Syphilis Symptoms Secondary stage Infectious rash 3-6 weeks following infection Hands, soles of feet; other areas Fever and flu-like symptoms may also be apparent Rash typically heals after several weeks More photos, including rash pix (Hardin Library, CDC) Condylomata Lata Wart-like lesions (on female, male, CDC)

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Syphilis Symptoms Latent Stage Infection hides in body, often central nervous system Infected person can remain in this stage for years There may be no symptoms for a long time Disease begins to attack organs Latent further divided into early, late, or unknown stages based on when infection occurred Late/Tertiary Stage Severe symptoms develop: paralysis/numbness; blindness; heart disease; dementia

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Syphilis Treatment Penicillin or other antibiotic Communicate with all sex partners regarding syphilis Refrain from sexual activity until infection is gone Condoms may help prevent syphilis transmission

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Syphilis Complications Late-stage syphilis If blood vessels affected, stroke,other cardiovascular incident may occur Nervous system (brain) damage Al Capone Apparently knew, did not treat Became confused, disoriented

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Syphilis PBS “Frontline:” The Children of Rockdale County Tuskegee Syphilis Experiment Began in 1930s ~400 African American males with syphilis observed When penicillin became available, not provided Ended in 1972 as a result of a news leak; settlement in 1974; Al Gore overview (1:35, usrf.org) Formal apology did not occur until 1997 (1:10, usrf.org) Over 100 individuals died from syphilis complications PBS “Nova” - “The Deadly Deception” (1:30-9:44/20:41/22:13/23:45/ 26:39/31:08 via Youtube)

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Syphilis Guatemala Experiment (3:07, NBC News) March 14, 2011 - lawsuit filed after demands for out-of-court settlement were not met June 2012 – lawsuit dismissed in federal court

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Herpes

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About Herpes STD caused by the herpes simplex virus Incidence US: 500,000 to 1,000,000 new cases/year WA, 2011: 2149 new cases, 8 neonatal cases (DOH) King County: 700 initial infections in 2006 Prevalence: 45 million adolescents and adults have had “genital herpes” (CDC) Caused by a Herpes Simplex I (HS-1) or Herpes Simplex II virus (HS-2) HS-1 generally causes oral lesions; HS-2 generally causes genital lesions; not exclusive

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Genital Herpes, Physician Visits, 1966-2011

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About Herpes Transmission via vaginal, oral, anal sex Transmission of virus can also occur through fingers (touching a sore, then touching a membrane) Transmission of virus possible when no sores present Transmission to fetus possible, but not typically if herpes was contracted before pregnancy If pregnant woman contracts herpes toward end of pregnancy, transmission to fetus more likely If pregnant woman has active herpes, Cesarean performed Transmission may occur outside body contact, but no proof

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Herpes Symptoms Most common symptom is blisters First (primary) outbreak occurs within a few weeks of contact May continue for a couple weeks, longer for those with compromised immune system May feel painful, itchy, tingle/burn

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Herpes Symptoms Flu-like symptoms (headache, fever, swollen lymph glands, muscle aches, etc) Burning during urination About.com video (1:45) Illustration (catalog.nucleusinc.com) Photos: oral lesion, male, female (lib.uiowa.edu, dermnet.com, www.stdservices.on.net)

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Herpes Symptoms Many people (numbers difficult to estimate; some references cite 25-60%) asymptomatic Recurring outbreaks usually less severe Episodes are shorter Episodes become less frequent 50-80% (HS-1 vs HS-2) will experience recurrence Asymptomatic shedding of virus less prevalent

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Herpes Treatment No cure; herpes simplex remains in body for life 2009 research revealed re HS-1 Published in Nature Immunology A cellular combat process against HS-1 has been identified Infected cell can stimulate immune system to fight HS-1 “Hidden” infected cells can show themselves when infectious state thrives (low-grade fever) Information from work might be used to develop therapies HS-1, HIV, other viral infections Information from work might be used to keep virus hidden

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Herpes Treatment Symptoms are treatable Antiretroviral medications, usually prescribed for genital herpes, may also be prescribed for oral cold sores Supplements (lysine) Abreva Avoid touching sores Keep affected area clean Wash hands Communicate with all sex partners regarding herpes Refrain from sexual activity until outbreak is gone Condoms may help prevent herpes transmission (during outbreak blisters are highly contagious)

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Herpes Complications In otherwise healthy individuals, herpes does not cause serious complications Among those with compromised immune systems, herpes outbreaks can be very severe, last a long time Having herpes increases one’s vulnerability to HIV

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HIV and AIDS

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About HIV and AIDS Human Immunodeficiency Virus (HIV) causes Acquired Immune Deficiency Syndrome (AIDS) Incidence: WA, 2011: 514 new cases (1/3 = later stage) King County - HIV: ~300-400 each year; AIDS: ~100-200; ~6,500 to 8,000 living with HIV (WA State/Seattle-King County HIV/AIDS Epidemiology Report, 1st Half of 2011) US: 56,300 new HIV cases in 2006 (CDC, presentation)

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About HIV and AIDS Transmission via vaginal, oral, anal sex, needle sharing, mother to infant, rarely via blood transfusions or healthcare settings One 1990s incident of transmission between infected health care worker (dentist) and five patients Per CDC (2011), 57 cases of HIV transmission to healthcare workers through 2001,with no cases since 1999

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About HIV and AIDS HIV not transmitted via: Toilet seats Mosquito bites Sharing eating utensils Food Shaking hands, hugging Donating blood No scientific evidence HIV is transmitted other ways

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About HIV and AIDS Currently, HIV does not survive well in the environment HIV found in sweat, tears, saliva - but no documentation of transmission 2009: pre-chewed food thought to cause three HIV transmission between caregivers and children Blood in saliva (bleeding gums) An issue where pre-chewing food for infants is common (Africa) No known risk in the workplace, school, etc. AIDSinAfrica.com HIV and AIDS in the World (PBS)

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HIV Symptoms Symptoms unreliable in diagnosing HIV First symptoms experienced may be flu-like (fever, headache, muscle aches, fatigue, etc) Symptoms may occur days to weeks after infection Symptoms may last days or weeks Diagnosis requires testing for HIV antibodies

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HIV Symptoms After early flu-like symptoms disappear: There may be no symptoms for a long time Virus replicates As HIV leads to AIDS: Boils, warts, herpes infections, skin rashes Fatigue Diarrhea Frequent fevers Yeast infections Weight loss

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HIV Treatment Medications provided as a “cocktail” Antiretroviral drugs interfere with HIV’s ability to reproduce Entry inhibitors may prevent HIV from entering a cell Reverse transcriptase inhibitors interfere with the beginning of HIV’s reproductive cycle Protease inhibitors interfere with the end of HIV’s reproductive cycle Integrase inhibitors interferes with HIV genetic material moving into a CD4 cell, halting replication Research continues on vaccine Clinical trial results 2010 - antiretrovirals may prevent HIV transmission

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HIV Complications AIDS Status of HIV is monitored through CD4 count and viral load every few months If HIV progresses, CD4 count reduces, viral load increases Normal CD4 often referenced as 500-1000 AIDS diagnosis requires CD4 of 200 Low viral load ~40-500 High viral load ~5,000-10,000 (can be higher)

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AIDS Symptoms AIDS diagnosis includes specific white cell count and diagnosis of one of over two dozen opportunistic infections Nearly all organs are affected Respiratory problems Seizures, lack of coordination Confusion, forgetfulness Gastrointestinal pain, cramping, vomiting Weight loss Fever Severe diarrhea

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HIV/AIDS Program, Seattle 400 Yesler Way, 3rd floor http://www.kingcounty.gov/healthservices/health/communicable/hiv/about.aspx hivstd.info@metrokc.gov HIV & Testing resources: http://www.hivtest.org/

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Hepatitis

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About Hepatitis Virus Types B, C, D often due to sexual transmission Type B, WA State, 2011: 35 acute cases; 1100-1400 chronic cases (DOH) Type C, WA State, 2011: 41 acute cases; 5700 chronic cases (DOH) Type D, WA State, 2011: no numbers reported, “rare”

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Hepatitis Symptoms

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Hepatitis Treatment

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Hepatitis Complications