chapter 16 health
Human papillomavirus
A group of more than 200 related viruses
Mother-to-child transmission of HIV
A pregnant woman infected with HIV can infect her unborn child in utero, during labor, and via breastfeeding. However, this risk is profoundly decreased if the mother receives anti-HIV treatment during pregnancy. Although HIV can be transmitted through breastfeeding, formula feeding reduces this risk. However, this solution can be problematic in developing countries in which there are problems obtaining adequate supplies of formula and clean water.
Gonorrhea
Bacterial infection that is sexually transmitted; also known as the clap, the drip, the whites, and morning drop
Chlamydia
Common sexually transmitted infection caused by the microorganism Chlamydia trachomatis, often asymptomatic, and therefore known as the silent disease
Intravenous drug use:
Drug users who are infected with HIV can transmit the virus to other drug users with whom they share needles, syringes, and other drug-related implements. This transmission method accounts for an increasing proportion of new HIV infections in Eastern Europe, South America, and Asia.
Blood transfusion:
HIV can be transmitted through HIV-infected blood or blood products. Currently, all blood donors are screened, and blood is not accepted from high-risk individuals. The US blood supply is considered among the world's safest supplies. Blood that is accepted from donors is tested for the presence of HIV. Testing began in 1985.
Sexual contact
HIV is found in several body fluids of infected individuals, including blood, semen, pre-seminal fluid (pre-cum), rectal fluids, and vaginal fluids. During sexual contact (anal, vaginal, or oral) with an infected individual, the virus may enter a person's bloodstream through broken skin or mucous membranes (wet, thin body tissue, as in the mouth, eyes, nose, vagina, rectum, and the opening of the penis). Worldwide, most new infections are transmitted heterosexually, although risk factors vary. In the United States, for example, gay and bisexual men are more severely affected by HIV than any other group. The incidence of new HIV infections in the United States continues to be greatest among MSM (Blackwell, 2018).
Level of arousal
High levels of sexual arousal are associated with greater impulsivity/sexual risks (Cramer & Sparling, 2014).
nongonococcal urethritis
Infection of the urethra, the tube that carries urine from the bladder
Vaginitis
Infection of the vagina
Sexually transmitted infection
Infections transmitted primarily through sexual activity; a more recent, more specific term sometimes used to avoid the negative connotations sometimes associated with sexually transmitted disease (STD)
Scabies
Infestation of the skin by microscopic mites that causes intense itching
Pelvic inflammatory disease
Inflammation of the pelvic organs often requiring hospitalization and surgery, associated with complications, such as infertility, ectopic pregnancy, and chronic abdominal pain
Hepatitis B
Inflammatory disease of the liver caused by a virus
Acquired immunodeficiency syndrome
Last stage of HIV infection in which the immune system of a person's body is so weakened that it becomes vulnerable to infection and disease (opportunistic infections)
Pubic lice
Parasitic insects found in coarse body hair of humans, causing itching; also known as crabs
Asymptomatic
Producing no symptoms or signs or, as with some STIs, yielding symptoms so mild that medical care is not sought
Organ or tissue transplants and donor semen:
Receiving transplant organs and tissues, as well as receiving semen for artificial insemination, could involve risk of contracting HIV if the donors have not been tested for it. Such testing is essential, and recipients should insist on knowing the HIV status of the organ, tissue, or semen donor.
Herpes simplex virus type 2
See genital herpes
Genital warts
See human papillomavirus
syphilis
Sexually transmitted (or congenital) infection caused by a spirochete (Treponema pallidum); if untreated, it can progress to a systemic infection through three stages and be fatal
Oral herpes
Sores of the lip and mouth, often caused by herpes simplex virus type I, but can also be caused by herpes simplex virus type II
Duration:
The length of time an infected person is contagious and able to spread the disease
transmission
The probability of an exposed person acquiring the infection
Exposure:
The rate of sexual contact between uninfected persons and infected individuals
Candidiasis
Vaginal yeast infection that tends to occur in women during pregnancy, when they are on oral contraceptives, or when they have poor resistance to infection
Genital herpes
Viral infection that may cause blistering, typically of the genitals, and may also infect the lips, mouth, and eyes
Herpes simplex virus type 1
Viral infection that may cause blistering, typically of the lips and mouth, and may also infect the genitals
Human immunodeficiency virus
Virus that attacks the immune system and may lead to AIDS
PrEP is effective only about 10% of the time.
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Rates of syphilis have been steadily decreasing over the last 5 years.
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STIs always produce noticeable symptoms.
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The primary reason people do not get tested for STIs is cost.
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Although many infected men are asymptomatic, when symptoms are present, they usually appear between 1 and 14 days after infection. Symptoms include dysuria (painful urination) or a white, yellow, or green urethral discharge.
gonorrhea symptons
high-risk group
implies that certain traits determine who will become infected with an STI; however, it is not the group that you belong to, but rather the behaviors that you practice that put you at risk for contracting an STI
Zika virus
is a vector-borne flavivirus primarily spread through the bite of an infected Aedes aegypti mosquito. Zika can also be transmitted through sexual contact, blood transfusion, and, rarely, from mother to child (Centers for Disease Control and Prevention, 2019g). Research by Oster and colleagues (2016) states that infection with Zika virus is asymptomatic in an estimated 80% of cases; when it does cause illness, symptoms are generally mild and self-limited. For this reason, many people may not realize they have been infected. The most common symptoms are similar to those of dengue and chikungunya and include headache, fever, rash, muscle and joint pain, or conjunctivitis (red eyes) lasting for several days to a week. According to the CDC, Zika virus remains in the blood of an infected person for about a week. Once infected, they are likely to be protected from future infections (Centers for Disease Control and Prevention, 2019g).
A herpes virus causes mononucleosis.
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A lice-killing lotion can be used to treat pubic lice and is available over-the-counter at a local drug store or pharmacy. These medications are safe and effective when used exactly according to the instructions. Prescription medications are also available but are restricted to patients who have failed treatment with or cannot tolerate other medications that pose less risk (Centers for Disease Control and Prevention, 2019k).
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According to American College Health Association's (ACHA's) Fall 2018 National College Health Assessment (NCHA), 39.8% of students reported not receiving any information regarding STIs and STI prevention (American College Health Association, 2018). Individuals in developing countries are often unaware that STIs exist or that they are vulnerable to infection. Throughout the world, most young adults have not been tested for HIV and other STIs. Thus, many people are infected and do not even kno
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According to American College Health Association's (ACHA) Spring 2015 National College Health Assessment (NCHA), 42.5% of students reported not receiving any information regarding STIs and STI prevention (American College Health Association, 2015).
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Also known as the clap, the whites, morning drop, and the drip, gonorrhea is caused by infection with the Neisseria gonorrhea bacterium, which infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women and the urethra in women and men. It can also infect the mucous membranes of the mouth, throat, eyes, and rectum. The 555,608 reported cases of gonorrhea to the CDC in 2017 were an 18.6% increase from 2016 (Centers for Disease Control and Prevention, 2018d). Individuals most often contract gonorrhea through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Gonococci cannot live long outside the human body. Even though these bacteria can be cultured from a toilet seat, there are no documented cases of gonorrhea being transmitted in any way other than intimate physical contact or perinatally, from mother to baby during childbirth. These bacteria thrive in warm, moist cavities, including the urinary tract, cervix, rectum, mouth, and throat.
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Anyone who engages in risky sexual behavior is susceptible to acquiring STIs
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As mentioned above, asymptomatic infected persons often assume they are STI free, with the mind-set of "I would know if I had something." As a result, they fail to seek medical care and continue to put themselves and their partner(s) at an increased health risk. Often, a long interval, sometimes years, occurs between acquiring an STI and recognizing a clinically significant health problem.
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Because individuals with NGU are often asymptomatic, they unknowingly transmit infection to their partners. In men, symptoms of NGU include penile discharge, burning during urination, and burning or itching around the opening of the penis. Some men experience no symptoms or have symptoms so mild that they go unnoticed. In women, symptoms of NGU may include vaginal discharge, burning during urination, abdominal pain, bleeding between periods, and fever. Many infected women show no symptoms.
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Before 1993, a diagnosis of AIDS was made only when an HIV-infected individual developed one of more than 20 serious illnesses—such as Pneumocystis carinii pneumonia, pulmonary tuberculosis, cervical cancer, or Kaposi sarcoma (a form of cancer)—as delineated by the CDC. Since 1993, the definition of AIDS has been expanded to include anyone with HIV whose immune system is severely impaired, as indicated by a T-cell (or CD4 cell) count of less than 200 cells per cubic millimeter of blood. T-cell counts in healthy people not infected with HIV range from 800-1,200 per cubic millimeter of blood.
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Chlamydia (clah-MID-ee-uh) is a commonly reported STI in the United States. It is caused by infection with the Chlamydia trachomatis bacterium. The 1,708,569 cases reported to CDC in 2017 were a 6.9% increase from 2016. Considering that a large number of cases are not reported because most people with chlamydia are asymptomatic and do not seek testing, the CDC indicates that diagnoses can increase, even as infection rates decrease (Centers for Disease Control and Prevention, 2018c).
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Chlamydia is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. The microorganisms are found most often in the urethra of men; the cervix, uterus, and fallopian tubes of women; and the rectum. Genital-to-eye transmission of the bacteria can also occur. If a person with a genital chlamydia infection rubs their eye (or touches the eye of a partner) after touching their infected genitals, the bacteria can be transferred to the eye. In addition, an infant can get chlamydia while passing through the cervix of its infected mother during delivery.
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Compared with older adults, sexually active adolescents ages 15-19 and young adults ages 20-24 are at higher risk of acquiring STIs for a combination of behavioral, biological, and cultural reasons. The CDC (2018b) estimates that 1 in 4 sexually active adolescent females has an STI, such as chlamydia or HPV. Higher rates may reflect multiple barriers to accessing quality STI prevention and management services, including inability to pay, lack of transportation, long waiting times, conflicts between clinic hours and work and school schedules, embarrassment attached to seeking STI services, method of specimen collection, and concerns about confidentiality.
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For example, about 5%-30% of women and 10% of men who are infected with chlamydia develop symptoms. They may not be aware of the infection until years later, when a significant health problem develops, such as infertility or ectopic pregnancy. It is estimated that untreated, chlamydia can cause 10%-15% of women to develop pelvic inflammatory disease (Centers for Disease Control and
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HIV attacks a person's white blood cells.
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Hepatitis B (HBV) is an inflammatory disease of the liver caused by a virus. Other forms of hepatitis viruses include types A, C, D, and E. HBV is most often transmitted through vaginal, oral, or anal sexual contact with an infected individual. Infection may also occur from transfusions of contaminated blood or from sharing contaminated personal items, such as razors or needles (used for steroid injections, drug use, body piercing, or tattoos). Pregnant women may also transmit hepatitis B to their newborns. The rate of new HBV infections has declined from 8,036 in 2000, to 3,218 in 2016, likely attributable to the routine vaccination of children introduced in 1991 (Centers for Disease Control and Prevention, 2019f).
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However, clinic survey data indicated that when respondents were faced with the hypothetical situation of being diagnosed with an STI, more than 90% would notify their partners in person; only 5% would use email or an online service (Rietmeijer et al., 2011).
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However, young people are not the only age group experiencing serious STI consequences. Many people aged 50 and older are sexually active, and have many of the same STI risk factors as younger people, including an unrealistic assumption of risk due to a lack of knowledge and how to prevent transmission, as well as multiple partners. Older people also face some unique issues, such as dating after a death or divorce, less use of barrier contraceptive methods due to no longer worrying about pregnancy, and being less likely to discuss their sexual habits or drug use with their doctors.
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In 2016, in the United States, gay and bisexual men accounted for 67% of the 40,324 new HIV diagnoses in the United States and 82% of males age 13 years and older (Centers for Disease Control and Prevention, 2018f). Their high-risk behaviors included unprotected anal intercourse, finding sex partners online, substance use, and failing to maintain prevention practices. High-risk behaviors among MSM may have increased due to optimism about the success of highly active antiretroviral therapy (HAART), the challenge of maintaining safer sex behaviors over time, and the younger MSM not having seen the toll of AIDS firsthand.
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In the United States, more than 110 million individuals are infected with an STI (Centers for Disease Control and Prevention, 2013), and more than 1 million STIs are acquired every day worldwide. Recent studies estimate that there are approximately 2.3 million diagnosed cases of STIs in the US in 2018, which breaks the 2016 record by nearly 200,000 (Howard, 2018). Additionally, HIV continues to be a major global public health issue. By the end of 2017, approximately 36.9 million people were living with HIV (with 2 million people becoming newly infected), resulting in 1.2 million deaths from HIV-related causes globally (World Health Organization, 2019b).
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Individuals who find out they have an STI often withdraw from social interaction.
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It is possible for HPV to remain inactive for months or years.
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Many people mistakenly assume an annual medical checkup includes STI testing.
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Many studies document the association of substance abuse with STIs. At the community level, the introduction of new drugs can have a drastic influence on sexual behavior in high-risk sexual networks
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Men who perform oral sex are four times more likely to contract HPV, which can morph into cancer.
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Most people infected with chlamydia lack abnormal physical examination findings.
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Older adults account for 17% of new HIV diagnoses in the US and are more likely to be diagnosed with HIV later in the course of the disease compared to younger people. However, an estimated 83.7% of sexually active older adults never tested for HIV (Oraka et al., 2018).
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Peers also influence STI exposure. Donenberg et al. (2018) noted that friends of young women are particularly influential in one's exposure to STIs because young women may engage in sexual activities in order to get approval from their friends.
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Pregnant women can pass STIs on to their babies.
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Pubic lice (pediculosis pubis), also called crab lice or crabs, are parasitic insects.
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Regardless of the severity of symptoms, untreated gonorrhea can cause permanent health problems.
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STI testing is available at most local public health centers, STI clinics, family planning clinics, private health-care providers, hospitals, and university health centers. You can also get tested for STIs and HIV in the privacy of your home. Getting tested for STIs requires an investment of time, effort, and, potentially, money. It also requires you to overcome any embarrassment and fear associated with discussing your sexual behavior with health-care providers, having your genitals examined, and coping with the possibility of being told you have an STI.
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STIs are also associated with health problems for pregnant women and infants. Various STIs may be transmitted to the fetus, newborn, or infant through the placenta (congenital infection), during passage through the birth canal (perinatal infection), or after birth through breastfeeding or close contact. Health consequences include spontaneous abortion, stillbirth, and premature delivery. The health consequences of HIV and AIDS can often be life-threatening—AIDS causes more deaths than any other STI. Untreated syphilis can cause serious damage to the cardiovascular and nervous systems and may also cause blindness and death.
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STIs caused by bacteria and protozoa can generally be cured through treatment with antibiotics
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STIs have a profound impact on sexual and reproductive health worldwide. Each year, there are an estimated 376 million new infections with 1 of 4 STIs: chlamydia (127 million), gonorrhea (87 million), syphilis (6.3 million), and trichomoniasis (156 million). More than 500 million people are living with genital herpes simplex virus infection. And at any point in time, around 300 million women have an HPV infection, one of the most common STIs (World Health Organization, 2019c).
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Sexual transmission of Zika virus is possible and is of particular concern for pregnant women, considering recent evidence that suggests a possible association between Zika virus and adverse fetal outcomes, such as congenital microcephaly, as well as a possible association with Guillain-Barré syndrome. However, as of June 2019 there have been reportedly zero cases of Zika being transmitted sexually in the United States (Centers for Disease Control and Prevention, 2019c). At this point, whether infected men who never develop symptoms can transmit Zika to their sex partners is unknown (Oster et al., 2016).
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Surveillance data show higher rates of reported STIs among some racial or ethnic minority groups when compared with rates among whites. For example, African Americans are most affected by HIV. In 2017, the most recent year this information was available, African Americans made up only 13% of the US population but had 43% of all new HIV infections. Hispanics/Latinos are also strongly affected, as they made up 17% of the US population but had 21% of all new HIV infections (Centers for Disease Control and Prevention, 2019j). In 2017, reported cases of chlamydia, gonorrhea, and syphilis in the United States were highest among African Americans, followed by American Indians/Alaska Natives, Native Hawaiians/other Pacific Islanders, and Hispanics (Centers for Disease Control and Prevention, 2018e).
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The 30,644 cases of primary and secondary syphilis reported to the CDC in 2017 were a 10.5% increase from 2016. While rates have increased among both men and women, men account for more than 90% of all primary and secondary cases, with MSM accounting for 83% of male cases (Centers for Disease Control and Prevention, 2017c). Syphilis is transmitted from person to person by direct contact with a syphilitic sore, known as a chancre, during vaginal, anal, or oral sex. Additionally, infected pregnant women can transmit it to their unborn child.
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The CDC conservatively estimates that the lifetime cost of treating the eight most common STIs contracted in just one year is $15.6 billion. Since viral STIs such as HIV are incurable and require lifelong treatment and care, they are by far the costliest. HPV is particularly costly due to the expense of treating HPV-related cancers. However, the annual cost of curable STIs is also significant at $742 million, especially considering that bacterial STIs have the potential to infect an individual more than once during their lifetime.
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The CDC now recommends dual therapy (using two drugs) for the treatment of gonorrhea. Although medication will cure the infection, it will not repair any permanent damage that has been done. Antimicrobial resistance in gonorrhea is of increasing concern, and successful treatment is becoming more difficult to achieve. If symptoms continue for more than a few days after receiving treatment, patients should return to a health-care provider to be reevaluated (Centers for Disease Control and Prevention, 2019i).
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The HIV epidemic not only affects the health of individuals; it also impacts households, communities, and national development and economic growth. Many of the countries hardest hit by HIV also suffer from other infectious diseases, food insecurity, and other serious problems (The Henry J. Kaiser Family Foundation, 2015). Fortunately, in the United States, government and private programs can help pay for medications for eligible individuals. Some of these programs include the Ryan White AIDS Drug Assistance Program, Medicare Prescription Drug Coverage Plans, and Private Prescription Assistance Programs (Centers for Disease Control and Prevention, 2019b). By mid-2015, 15.8 million people living with HIV were receiving antiretroviral therapy (ART) globally. By the end of 2014, 40% of all people living with HIV were on ART (World Health Organization, 2016d).
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The best way to prevent HBV is by getting vaccinated.
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The following biological, social, economic, and behavioral factors affect the spread of STIs.
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The more involved the couple, the lower the condom use.
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The more sexual partners an individual has, the higher the risk of being exposed to an STI. According to the 2017 U.S. Youth Risk Behavior Surveillance System (YRBSS) report, which surveys high school students, of the 39.5% of students who had ever had sexual intercourse, 28.7% had had sexual intercourse during the 3 months before the survey (currently sexually active), and 9.7% had had sexual intercourse with four or more people during their life. Among currently sexually active students, only 53.8% had used a condom during their last sexual intercourse (Centers for Disease Control and Prevention, 2017a).
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The most common cause of vulvitis (irritation of the vulva) is candidiasis, also known as monilia or yeast infection. Candidiasis tends to occur in women during pregnancy, when they are on oral contraceptives, or when they have poor resistance to disease. Symptoms of candidiasis include vaginal irritation, itching, thick cottage cheese-like discharge, and pain during intercourse. Treatment involves inserting antifungal suppositories or creams into the vagina. Though commonly discussed with vaginitis, candida is caused by a fungus not bacteria. For this reason, antibiotics are not effective. This type of infection can spread to a partner, so it is important for both the identified patient and the sexual partner to be treated.
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The most well publicized STI is HIV/AIDS. The CDC (2019k) estimates that about 1.1 million people in the United States were living with HIV at the end of 2016, the most recent year this information was available. Of those people, about 14% do not know they are infected.
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The percent of high school teens reporting first intercourse has dropped to 30%.
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The transmission of an STI (likelihood of acquiring the infection once exposed) is influenced by your sex. Women are biologically more susceptible than men to becoming infected if exposed to STIs. This is due to the larger mucosal surface area exposed to the virus in women, the greater amount of virus present in semen as compared with vaginal secretions, and the shortness and location of the female urethra (shorter distance for infectious organisms to travel). Table 16-1 reviews the different effects of STIs on women and men.
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They attach themselves to the base of coarse pubic hair but may also be found on other coarse hair of the body, such as hair on the legs, armpits, mustache, beard, eyebrows, or eyelashes. (Lice found on the head are head lice, not pubic lice.) They bite the skin to feed on blood; the bite causes severe itching. Crawling lice may be observed, although it is hard to see them because they move away quickly from light. Nits (lice eggs) may be visible. An infected person transmits pubic lice most often through sexual contact. Clothing, towels, and bedding may harbor the creatures, but infestation is rarely spread this way. Sitting on a toilet seat does not spread lice, as they are unable to hold onto smooth surfaces
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Three types of vaginitis, or vaginal infection, are trichomoniasis, bacterial vaginosis (Gardnerella), and candidiasis. Most women get vaginitis at some time in their lives, and many do not develop it from sexual contact. It can be caused by anything that upsets the balance of vaginal microflora, including illness, antibiotics, or overgrowth of one organism. It may also be the result of bacteria from the rectum being transferred to the vagina, which can result from improper hygiene or anal intercourse and manipulation combined with vaginal intercourse. Vaginal infection may also result from foreign objects, such as tampons and diaphragms, being left in the vagina too long.
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When disclosing an STI to a partner, a person might want to anticipate the partner feeling shock and fear.
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Women are biologically more susceptible than men to becoming infected if exposed to STIs.
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Women who have sexual relations only with women have a lower risk of acquiring STIs than heterosexual women.
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Young people ages 15 to 24 account for half of all new STIs, although they represent just 25% of the sexually experienced population. In 2014, increases were seen in all three nationally reported STIs (chlamydia, gonorrhea, and syphilis).
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Young people ages 15-24 account for half of all new STIs, although they represent just 25% of the sexually experienced population. In 2014, increases were seen in all three nationally reported STIs—chlamydia, gonorrhea, and syphilis—across all groups. The 1.7 million cases of chlamydia represent the highest number of annual cases of any condition ever reported to the CDC. Substantial increases were also seen among reported cases of gonorrhea (555,608) and syphilis (30,644). Many cases continue to go undiagnosed and unreported, and data on several additional STIs—such as human papillomavirus (HPV), herpes simplex virus, and trichomoniasis—are not routinely reported to the CDC. As a result, the annual surveillance report captures only a fraction of the true number of STIs in America. While young people and women are most severely affected by STIs, increasing rates among men (particularly gay and bisexual men) contributed to the overall increase in 2017 across all infections (Centers for Disease Control and Prevention, 2018g).
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Zika can be transmitted through a blood transfusion.
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although lesbians are not immune to HIV and other STIs, women who have sexual relations only with women (and whose partners do likewise) have a substantially lower risk of acquiring STIs than heterosexual women. The risk associated with the most common female-to-female sexual practices (oral sex and manual stimulation) is less than with heterosexual sexual intercourse. Hence, the main source of HIV infection among lesbians is related to injection drug use and sex with HIV-infected men.
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arly detection of HIV is especially important because it enables the infected individual to begin interventions that slow the growth of the virus and prevent opportunistic diseases. Early detection of other STIs can prevent or minimize the negative health effects they might otherwise produce. Because of the ulcerations caused by genital herpes, syphilis, and chancroid and the inflammation caused by gonorrhea, chlamydia, and trichomoniasis, these infections facilitate transmission of HIV. Therefore, rapid diagnosis and treatment of these STIs may help prevent sexual transmission of HIV.
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he herpes virus is spread by direct skin-to-skin contact, such as kissing or oral, vaginal, or anal sex, with an infected individual. Pregnant women can transmit the herpes virus to their newborn infants, most often during delivery. Fortunately, this type of transmission is rare in the United States. Herpes may also be spread from one part of the body to another by touching the infected area and then touching another area of the body. For example, touching a herpes infection can allow the virus to spread to a finger that has a cut or abrasion. This most often occurs during an initial outbreak. Although this type of transmission is not common, it is a good idea to avoid touching HSV lesions and avoid biting your nails if you have oral-facial herpes. Some people believe that herpes can be spread only when there are obvious signs or symptoms of the infection. However, it may be active without causing signs or symptoms. Herpes is often transmitted by people who are unaware that they are infected and by people who do not realize that their herpes infection is in its active phase. Wagoner (2018) followed 144 discordant couples over a median of 334 days and found that 14 of 144 partners were infected (9.7%). In 70% of the cases, the transmission occurred when the person was asymptomatic.
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k abnormal physical examination findings. Given the relatively slow replication cycle of the bacteria, symptoms may not appear until several weeks after exposure in those people who develop symptoms. When men have symptoms, they usually have urethritis (inflammation of the urethra), with urethral discharge and painful urination. If left untreated, a minority of men develop epididymitis (inflammation of the epididymis) and have testicular pain and swelling.
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pelvic inflammatory disease (PID). PID can lead to internal abscesses, chronic pelvic pain, infertility, and ectopic pregnancy. The major complication for men is epididymitis, which may be signaled by severe scrotal pain. This could result in abdominal pain, infertility, and erectile problems. Untreated gonorrhea can eventually spread to the blood, causing disseminated gonococcal infection (DGI). DGI results in bone and joint disease and can be life-threatening. Untreated gonorrhea also increases a person's risk of acquiring or transmitting HIV (Centers for Disease Control and Prevention, 2019i).
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scabies results from a microscopic mite, Sarcoptes scabiei, that penetrates the skin and lays eggs. The larvae of these eggs burrow tunnels under the skin and cause intense itching. They may cause skin rash, burrows, or pimple-like irritations between the fingers and in skin folds of the wrist, elbow, knee, penis, breast, or shoulder blades. Because the itching is intense, especially at night, scabies sufferers tend to scratch the affected area, which may result in sores on the body that may become infected. Scabies is spread by direct, prolonged skin-to-skin contact with an infested person (not a quick handshake or hug). In addition, it is easily spread to sexual partners and household members through clothing, towels, and bedding. Institutions such as nursing homes, extended-care facilities, and prisons are often sites of scabies outbreaks since it can spread rapidly under crowded conditions where skin-to-skin contact is frequent. Several prescription lotions are available to treat scabies, but no over-the-counter products have been proven to be effective. Household members and/or sexual partners should also be treated to prevent re-infestation. Machine-washing in hot water and drying on the hottest temperature of all bedding, clothing, and towels is advised (Centers for Disease Control and Prevention, 2010a; Workowski & Bolan, 2015).
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untreated chlamydia can spread into the uterus and fallopian tubes and cause PID. Only 10%-15% of PID is symptomatic (Centers for Disease Control and Prevention, 2016e).
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yphilis typically follows a progression of stages that can last for weeks, months, or even years. The average time between infection with syphilis and the start of the first symptom is 21 days, though this can range from 10 to 90 days. The appearance of a single chancre marks the primary stage, but there may be multiple sores. The chancre is usually firm, round, and painless. It appears at the location where syphilis entered the body (the vagina, penis, or anus), lasts 3-6 weeks, and heals regardless of whether the individual is treated. This is one of the tricky aspects of syphilis, because the chancre's disappearance leads infected people to believe they are cured. In reality, the disease is still present and doing great harm, even though there are no visible symptoms. Because the chancre is painless and often occurs internally in women, it is far more likely to remain undetected in women than in men. If untreated, the infection progresses to the secondary stage.
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