SEXUALLY TRANSMITTED DISEASES
Chapter 17
INCIDENCE OF STDs
Startling statistics
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15-29 year-olds get 86% of STDs
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1 in 5 treated for STD by age 21
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50% of US population will get more than one STD by
age 30-35
Why so high?
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more sexual activity
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more sexual partners
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use of oral contraceptive
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no outward signs
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guilt, embarrassment
BACTERIAL INFECTIONS
Chlamydia ? transmitted through sexual contact
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Females: urethritis, cervicitis (lower genital
tract)
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Females: pelvic inflammatory disease (PID)
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Symptoms: disrupted periods; chronic pelvic
pain
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Males: epididymitis
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Symptoms: heaviness in testis
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Consequences: chronic, contagious trachoma;
infertility and sterility; preterm birth
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Treatment: doxycycline or azithromycin (antibiotics)
Gonorrhea (the "clap") transmitted through sexual
contact
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Females: gonococcal cervicitis
Symptoms: 80% have no early symptoms; slight
yellow-green discharge or vulval irritation
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Males: gonococcal urethritis
Symptms: odorous cloudy discharge; urinary burning;
swollen, teder lymph glands in groin
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Consequences:
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female: PID with sterility
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male: prostate abscesses with fever; painful bowel
movement, difficult urination
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both: transmitted to eyes, anus, throat; may enter
blood stream
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Treatment: dual treatment for chlamydia &
gonorrhea; resistant bacteria require special treatment (penicillin or
tetracycline)
Nongonococcal urethritis (any inflammation of the
urethra): transmitted through coitus & fellatio
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Usually caused by Chlamydia or mycoplasma organisms
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Female: few or no symptoms; may be itching,
urinary burning, mild vaginal discharge
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Male: penile discharge
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Consequences: inflamed cervix or PID; spread
to prostate or epididymis
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Treatment: doxycycline or erythromycin
Syphilis
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primary: raised, red, painless chancre
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secondary: painless, non-itching skin rash
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latent: no observable symptoms
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tertiary: heart failure, blindness, ruptured blood
vessels, paralysis, skin ulcers
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other consequences: infected fetus can die
or suffer severe damage
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Treatment: primary, secondary, or first-year
of latent phases cann be treated with benzathine penicillin G or another
antibiotic
VIRAL INFECTIONS
Herpes (viruses = HSV 1 & HSV 2):
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herpes simplex virus types 1 (mouth) & 2 (genitals)
transmitted through touching, kissing, and sexual contact, even when no
blisters are evident.
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symptoms: small, painful, red bumps develop
into fluid-filled blisters that rupture and form open sores; swollen lymph
glands in the groin
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recurrence: symptoms may or may not return;
milder and shorter duration with podromal symptoms (warning of eruption
from nerve fibers) of itching, burning, throbbing or tingling
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consequences: increased risk for cervical
cancer; newborn infected during delivery may die or suffer severe damage;
severe eye infection from touching sore
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treatment: no cure; working on vaccine; acyclovir
may reduce length and severity of initial outbreak and may reduce or supress
recurring attacks
Genital Warts: transmitted through sexual contact,
even when no warts are evident
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caused by Human Papilomavirus (HPV)
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symptoms: moist, pink or red, sioft, cauliflower-like
warts
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consequences: urinary obstruction & bleeding;
greater risk of various genital cancers
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treatment:: no cure; removal of visible warts
by freezing, cauterization, vaporization
Viral hepatitis:
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needle-sharing and sexual transmission (fecal-oral
route for type A; blood, semen, vaginal secretions and saliva for type
B; other types not usually transmitted sexually)
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symptoms: few or none; mild flu-like
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consequences: higher risk for liver cancer;
rare cases of death
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treatment: bed rest and fluids; vaccines are
available
COMMON VAGINAL INFECTIONS
Bacerial vaginosis
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caused by the bacterium family Gardnerella
and factors that altervaginal pH (increased alkalinity)
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symptoms: foul-smelling, usually gray, thin
flour-paste discharge; may be genital irritation or urinary burning; most
men have no symptoms
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consequences: greater risk of PID; premature
rupture of amniotic sac and preterm labor in pregnant women
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treatment: oral, cream or gel application
of Flagyl; male treatment if infection recurs
Candidiasis (moniliasis, yeast infection):
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sexual contact or poor hygiene; factors that increase
sugar stored in vaginal cells or a decrease in lactobacilli, cause
yeats to multiply
-
symptoms: white, clumpy (cottage-cheesey)
discharge with intense itching, soreness and dry tissue
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consequences: confused with other infections
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treatment: vaginal supositories or creams
Trichomoniasis: (Tichomonas vaginalis) transmitted
through sexual contact
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Symptoms: copious, odorous, frothy, white
or yellow-green vaginal discharge
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Consequences: may increase risk of cervical
cancer
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Treatment: simultaneous treatment of female
and her sex-partner; Flagyl by mouth; topical cream
ECTOPARASITIC INFECTIONS
Pubic lice ("crabs"): transmitted through sexual
contact, or from infected linen or clothing
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symptoms: little to severe itching
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treatment: prescription of Kwell; over-the-counter
A-200 pyrinate; launder linens and clothing
Scabies: transmitted through any close physical
or sexual contact, or from infected linen or clothing
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caused by a mite - too small to see with the naked
eye - burrows beneath the skin
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symptoms: small, pimple-like bumps; rash around
primary lesion; intense itching
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treatment: topical scabicide or Kwell; launder
or dry-clean linens and clothing
ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
HIV and AIDS
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HIV = retrovirus that targets and destroys helper
T-4 cells that assist the immune response to disease
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HIV becomes AIDS when: 1) HIV is present, and 2)
T-4 cell count is equal to, or greater than, 200 cells/cubic millimeter
of blood
Incidence
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leveling off in the US
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decreasing MSM (men having sex with men)
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increasing IDU (injection drug use)
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increasing hetrosexual transmission, especially among
women and those in younger age groups.
Transmission
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low risk: saliva, tears, urine, casual hugging, shaking
hands, cooking or eating together
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high risk: sexual contact, sharing infected needles,
multiple sexual partners, unprotected sex
Symptoms
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brief flu-like illness
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depletion of immune system: night sweats, repetitive
fevers, weight loss, chronic fatigue
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developing HIV antibodies (detected using Enzyme-linked
immunosorbent assay -ELISA)
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patterns of proggression
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rapid proggression (3 years)
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usual proggression (8-11 years)
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long-term nonprogression (more than 10 years)
Full-blown AIDS
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pneumocystis carinii pneumonia
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shingles, cytomegavirus
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encephalitis
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meningitis
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tuberculosis and salmonella
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toxoplasmosis
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lymphomas, cervical cancer, Kaposi's sarcoma
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death within 1-2 years
Treatment
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no cure or vaccine at this time
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combination drug therapy shows best results
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prevention is best solution
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strategies to combat HIV reproduction (current research
effort)
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protease inhibitors - block the production of mature,
functional viral proteins
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reverse transcriptase inhibitors (such as AZT)
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vaccines
PREVENTING STDs
100% safety
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only if abstain from partner-sex
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probably if you are in a long-term mutually monogamous
relationship
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histoty of infidelity may increase risk
Guidelines for decreasing the risk
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assess risk ststus for both partners prior to sexual
intimacy
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obtain prior medical examinations
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always use condoms and spermicide
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avoid multiple partners
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inspect your partner's genitals
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wash each other's genitals before and after sexual
contact
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obtain routine medical evaluations
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disclose your STD status