Chapter 12: Sexually Transmitted Infections

People at first though AIDs was Kaposi's sarcoma:

A rare cancer of the blood vessels that serve the skin, mucous membranes, and other glands in the body.

When was AIDs first documented?

Around 1980s

What are lymphocytes?

Immune cells that help prevent cancer and other chronic illnesses by controlling cell growth Guard infection by producing antibodies

______ are primary control measures for respiratory infections, HIV/AIDS, and tuberculosis.

Improved treatment and caregiving

Acquired immunodeficiency syndrome (AIDS):

The most advanced stages of HIV infection, defined by a T cell count of less than 200 and the occurrence of opportunistic infections or HIV-related cancers that take advantage of a weakened immune system.

Hepatitis A (HAV) and hepatitis E (HEV)

Usually spread via contaminated food or water, not sexual contact.

_______ is the primary control measure for infections such as smallpox, meningitis, tetanus, and influenza.

Vaccination

___________ are primary control measures for malaria, West Nile virus, avian influenza, and the Zika virus.

Vector control and containment

Previously limited mostly to ________ in the United States, AIDS began surfacing among other demographic groups during the late 1980s and through the 1990s.

White gay men and injection drug users

Zika may cause microcephaly:

a serious birth defect of the brain, as well as other poor birth outcomes in mothers who were infected with the virus while pregnant

Hepatitis

-Inflammation of liver -Five main types

Syphilis Latent stage

Symptoms disappear

HIV progresses through four stages of infection, which vary in length from person to person 4th stage:

# T cells (sometimes called CD4 cells) drops from a healthy count of 1,000 to 200 cells or less per cubic milliliter of blood, and almost all natural immunity is lost. HIV has developed into AIDS. T cell levels drop below 100, the balance of power in the immune system shifts to favor the invading virus. HIV levels soar, and microorganisms that the immune system normally would destroy easily begin to proliferate. Without treatment, death generally occurs within a year or two.

Social-cognitive theory, which focuses on the interaction of environmental events, our internal processes, and our behaviors, has served as the framework for a number of interventions Three factors addressed by this model appear to be particularly important in successful intervention programs:

(1) perceived social norms regarding peer acceptance of HIV risk-reducing behaviors; (2) self-efficacy beliefs controlling one's own thoughts, emotions, and behaviors in order to avoid unsafe behaviors; and (3) social skills, the ability to respond assertively in negotiating risky behaviors.

Primary prevention of STIs

-Abstain -Mechanical means of prevention -Open communication -Limiting one's sexual partners

Chlamydia

-Bacteria that creates infection in throat, genitals, and anus -Most frequently reported bacterial STI in US -Women do not usually show symptoms while men do

Gonorrhea

-Bacterium that infects genitals, anus, and throat -Most women show no symptoms while men do

Why is the HPV vaccine so underutilized?

-Beliefs about sexuality -Parental concerns -Cost -Perceived effectiveness -Safety -Lack of information about timing of vaccine

Genital Herpes

-Caused by herpes simplex virus -Spread through direct skin-to-skin contact -Especially contagious if the infected person is having an outbreak

Genital human papillomavirus (HPV)

-Group of more than 100 different viruses passed through genital contact -So common that nearly all sexually active people have become infected at some point but never develop symptoms or health problems

Syphilis

-Spiral-shaped from of bacteria called spirochete -Predictable course of stages: Primary, secondary, latent, and tertiary

HIV progresses through four stages of infection, which vary in length from person to person 1st stage:

1-8 weeks Immune system destroys most HIV, so people experience only mild symptoms Symptoms are often so mild that they go unnoticed or unremembered.

An untreated person with active TB may infect 10 to 15 other people each year, about ____% of whom will develop the disease themselves.

10

Although the average time from HIV infection to AIDS is about ____ years, people with HIV who start treatment with anti-AIDS drugs have life expectancies only about 20% shorter than that of the general population, provided they start treatment before their CD4 count drops below ______

10, 200 cells per microliter

Of the ____ million children worldwide living with HIV, most were infected by their HIV-positive mothers during pregnancy, childbirth, or breast feeding. Globally, the annual incidence of new infections among children has been reduced by nearly ___% since 2010

2.1, 50

Ebola now has human fatality rates in the range of _____.

25% to 90%

Pandemic:

A disease or ailment that affects people over a large geographical area, such as multiple continents or worldwide; for example, the global HIV/AIDS epidemic.

Communicable diseases (CDs):

A disease that is transmitted from a human to another human, from a human to an animal, or from an animal to a human.

Hemophilia:

A genetic disease in which the blood fails to clot quickly enough, causing uncontrollable bleeding from even the smallest cut.

Noncommunicable diseases (NCDs):

A noninfectious disease; one that is nontransmissible (not passed from person to person); often a chronic disease, such as cardiovascular disease, cancer, or diabetes.

Epidemiological transition:

A shift in the disease pattern of a population as mortality falls: acute, infectious diseases are reduced, while chronic, noncommunicable diseases increase in prevalence. "the CDs of childhood are gradually overtaken by the chronic NCDs typical of adulthood"

HIV is classified as a retrovirus:

A virus that copies its genetic information onto the DNA of a host cell (T cell).

Human immunodeficiency virus (HIC):

A virus that infects cells of the immune system, destroying or impairing their function.

The initial spread of the HIV virus among injection drug users and gay men in the United States and other Western countries is believed to have occurred why?

Because these are relatively small, closed populations in which an individual is more likely to be exposed to the virus repeatedly.

Trichomoniasis

Caused by infection with protozoan parasite, Trichomonas vaginalist -Most people cannot tell they are infected

___________ measures are the primary control measure for diarrheal diseases.

Cleaner water, better hygiene, and healthier sanitation

AIDS optimism:

HIV-negative men who have sex with men are less concerned about contracting HIV; HIV-positive men who have sex with men are less concerned about transmitting it; and both groups are more likely to engage in unsafe sex—resulting in more HIV infection

Chronic illnesses such as _______ are the leading cause of disability throughout the world, including in the United States where they cause 7 of every 10 deaths and account for most of the nation's annual health care expenditures

HIV/AIDS

_____ of all Americans have at least one chronic illness, and one _____ have multiple chronic conditions.

Half, third

A critical factor in tailored interventions that are delivered via smartphones, tablets, and other digital devices is eHealth literacy:

How well a person navigates, understands, and uses electronic health information.

Syphilis Primary stage

Infected person has a sore (usually painless, round, and hard) called a chancre at the site of infection, usually the penis, vagina or vulva, anus, or mouth

Sexually transmitted infection:

Infections that are spread primarily through person-to-person sexual contact.

________ have proved to be the best way to educate people about STIs such as HIV and to change social norms that influence high-risk behaviors.

Intensive, coordinated, community-wide interventions

Hepatitis B (HBV), hepatitis C (HCV), and hepatitis D (HDV) viruses

Most commonly spread through contact with the blood, semen, or other body fluids of an infected person, or by sharing needles and even toiletries such as toothbrushes and razors (since they can come in contact with blood and open sores)

_______ transmission of HIV through vaginal intercourse is far more common than is _______ transmission.

Male-to-female, female-to-male

Syphilis Secondary stage

May develop a skin rash on the palms of the hands and soles of feet, swollen lymph nodes, and fever.

HIV progresses through four stages of infection, which vary in length from person to person 2nd stage:

Months to years Period of latency Person has no obvious symptoms except perhaps for swollen lymph nodes, which may go unnoticed; nevertheless, the HIV infection is far from inactive. T cell concentration falls, HIV is constantly replicating.

TB is caused by the bacterium ______ and spreads through aerosolized droplets that people inhale from others who are already infected with the disease.

Mycobacterium tuberculosis

Experts once believed that, as countries develop, ____ replaced ______ disease as the main source of ill health.

NCD, communicable

Psychological adjustment:

Refers to a person's cognitive, emotional, and behavioral responses to these stressors, which can be beneficial and contribute to improved health, or detrimental and contribute to worsening health

For some germs, such as the bacterium ______, the primary factor in increased resistance is that antibiotics are being fed to animals that are raised for food.

Salmonella

Syphilis Tertiary stage

Severe problems, including dementia and other brain conditions, and damage to the nerves, eyes, heart, blood vessels, liver, bones, and/or joints

HIV invades and destroys a type of lymphocyte called the ______, which is a crucial player in the immune response because it recognizes harmful microbes and triggers the production of antibodies. It also coordinates the release of ________.

T cell, natural killer (NK) cells

HIV progresses through four stages of infection, which vary in length from person to person 3rd stage:

T cells are further reduced, immune function is impaired, and opportunistic infections occur. Among the most common are Kaposi's sarcoma (a cancer of blood vessels that causes purplish spots in the skin, mouth, and lungs); lymphoma; parasitic gastrointestinal infections; and pneumocystis carinii pneumonia (PCP), a bacterial disease that caused 60% of all AIDS deaths prior to the development of the effective treatments available today.

Antimicrobial Resistance:

The ability of bacteria, viruses, and other microbes to resist the effect of drugs as a result of mutation or exchange of genetic material among different strains

Dynamic tailoring;

The delivery of individualized and targeted health messages over multiple periods of time.

The microbes that contaminate food can also become resistant due to the use of _____.

antibiotics

Finally, ________ (such as consistent condom use) is a primary control measure for sexually transmitted infections, Ebola virus, and HIV.

behavioral change

Unlike hepatitis A and E, which are acute, short-term illnesses, hepatitis B, C, and D are more likely to become ______ conditions and can lead to scarring of the liver (fibrosis, and in its later stages, cirrhosis) and liver cancer. These _____ forms of hepatitis develop slowly, so their signs and symptoms often go unnoticed.

chronic

Today's optimum HIV treatment regimen is ________, which involves several antiretroviral drugs that attack different parts of HIV or stop the virus from entering cells.

combination antiretroviral therapy (cART)

Among the conditions that increase susceptibility to TB are living in _______ and having a ________.

crowded circumstances, weakened immune system

An important motivational factor in many models of health behavior is ________, as a person balances the pros and cons of a specific action, such as using a condom.

outcome expectancy

The infected DNA may remain ________ in the chromosome of the host lymphocyte for a period of time. Eventually, however, the infected lymphocyte is certain to become activated against another virus or some other foreign substance. At that point, it divides, replicating HIV along with itself. As infected cells continue to divide, vast numbers of HIV particles emerge from the infected host and invade other ______.

dormant, lymphocytes

The global burden of communicable disease is generally about the same for females as it is for males. Two exceptions are tuberculosis, which affects more males than ____, and HIV/AIDS, which globally now ranks higher as a cause of death for _____ than for ___

females, women, men

Most people with TB are cured by a strictly followed, six-month treatment regimen with ______ such as isoniazid and rifampicin.

first-line antimicrobial drugs

The ______ model, which is based on the idea that beliefs predict behavior, has achieved modest success with a variety of high-risk groups in predicting condom use, the number of sexual partners, and knowledge of partners' past sexual history.

health belief

A less common route of HIV infection involves a transfusion of infected blood. In the early years of the AIDS epidemic, HIV spread rapidly through transfusions of infected blood to victims of ______

hemophilia

Preventive vaccines exist for some STIs, including _______

hepatitis A, hepatitis B, and HPV.

NCDs account for the most prevalent combinations of chronic conditions:

hypertension and diabetes, hypertension and heart disease, and hypertension and cancer.

Many people with AIDS who are now in their twenties undoubtedly were ______ while still in their teens. Nearly one in _____ HIV+ individuals in the United States (14.3%) are unaware of their infection

infected, seven

If untreated, chlamydia infection may cause _______ in both women and men. In women, the infection may also cause pelvic pain, pelvic inflammatory disease, and ectopic pregnancy.

infertility and arthritis

In poor countries, the three leading causes of death are communicable diseases:

lower respiratory infections, HIV/AIDs, and diarrheal diseases.

After intercourse, the infected _____ in semen may remain in the vagina and cervix for many days, thus giving the virus more time to infect the woman. By contrast, secretions from an HIV-positive (HIV1) vagina and cervix are washed from the penis easily.

lymphocytes

HIV infects mostly lymph tissues, where _______ develop and are stored.

lymphocytes

However, in recent decades _________—tuberculosis that does not respond to first-line anti-TB drugs—has developed.

multidrug-resistant TB (MDR-TB)

HIV is increasingly affecting _____ adults

older

AIDS increases its victims' vulnerability to ________, such as pneumonia and certain cancers, which prey on the weakened immune system.

opportunisitic infections

The theory of___________, which links beliefs and behavior, has achieved greater success, probably due to the influence of social norms on the sexual activity of many at-risk populations, including teenagers

planned behavior

Patients who report recent exposure to HIV (within the past 72 hours) are sometimes advised to take _______, a related pharmacological treatment designed to reduce the risk of infection.

post-exposure prophylaxsis, or PEP

Individuals at high risk for HIV exposure are advised to take ________, a pharmacological treatment that can reduce the risk of becoming infected with the virus.

pre-exposure prophylaxis, or PrEP

Research indicates that there is a profound need for ________ that target substance use and risky sex behaviors in reducing HIV risk, particularly among young Black adults, for whom the incidence of HIV/AIDS is 14 times higher than it is for other racial groups in the United States

preventive interventions

Until the late 1990s, HIV infection was almost always a ______

progressive, fatal disease.

Several researchers have reported that low self-esteem, a pessimistic outlook, chronic depression, and other negative emotions may influence the production of ________ and ________

proinflammatory cytokines, decline in T cells

An example of a cognitive response leading to good health is ______ (confidence in one's ability to perform activities such as adherence to medical treatment), while ______ is a thought process that is less likely to be effective.

self-efficacy, wishful thinking

The period from diagnosis of full-blown AIDS until death is notoriously unpredictable—as short as _______

several months or as long as five years.

Diseases that are spread through sexual contact are often called _______.

sexually transmitted diseases, or STDs

In recent years, public health experts have suggested replacing STD with the term __________ Why?

sexually transmitted infection (STI) 1. Concept of disease suggests a major medical problem 2. Several common STDs have no symptoms

Of particular interest in the investigation into the origins of AIDS is the ________, which affects monkeys. This virus is believed to be at least 32,000 years old and closely resembles HIV1 and HIV2, the two types of HIV

simian immunodeficiency virus (SIV)

In high-income countries, the three leading causes of death are NCDs:

stroke, ischemic heart disease, and lung cancer.

HIV progresses much more slowly among patients whose immune systems mount _________ activity in the acute stage of HIV sickness (stage 2). This strong defense apparently helps preserve the body's later ability to produce the T cells that target HIV.

strong lymphocyte

Transmission of communicable diseases can occur directly, such as through respiration, or indirectly through a ______, such as a mosquito in the case of malaria or the Zika virus.

vector

AIDS appears to have originated in ________, spreading quickly through neighboring countries.

west-central Africa

More of the virus is found in ejaculate than in vaginal and cervical secretions, so unprotected vaginal sex is much riskier for HIV for ______, and unprotected anal sex is even riskier for ____ than unprotected vaginal sex

women

According to the Centers for Disease Control and Prevention, _______ (ages 15-24) account for half of all new cases of STIs, even though they make up only _____ of the sexually experienced population

young people, 25%