Lesson 7 Chapter 15 Sexually Transmitted Infections

STI Transmission

-Centers for Disease Control and Prevention (CDC) notes two primary ways STIs are transmitted: -Discharge diseases: transmitted via body fluids HIV, gonorrhea, chlamydia, trichomonaisis -Genital ulcer diseases: transmitted via infected skin Herpes, syphilis, human papillomavirus virus The Centers for Disease Control and Prevention (CDC) note that there are two primary ways in which STIs are transmitted. There are discharge diseases and genital ulcer diseases. Discharge diseases are STIs that are transmitted via body fluids such as blood, semen, vaginal secretions, etc. Examples of discharge diseases are HIV, gonorrhea, chlamydia, and trichomonaisis. Genital ulcer diseases are STIs that are transmitted through contact with infected skin. Examples of genital ulcer diseases are herpes, syphilis, and human papillomavirus virus.

Age disparities

-Compared to older adults, sexually active young adolescents and young adults are at higher risk for acquiring an STI -½ of new STI cases are among 15-24 year olds, yet, only represent ¼ of sexual active population (CDC, 2011) -Greater risk Multiple sex partners Engage in high risk behavior Select high risk partners Barriers to prevention products and services There are also age disparities that exist with STIs. Compared to older adults, sexual active young adolescents and young adults are at a higher risk for acquiring an STI. Approximately 50 percent of new STIs are among those 15 to 24 years of age. Yet this age group only comprises about a quarter of the total sexually active population. They have greater risk due to four primary reasons. They are more likely to have multiple sex partners, they engage in risky behaviors, they select high risk partners, and face barriers to accessing quality STI prevention products and services

principal bacterial STIs

-Four principle bacterial STIs Chlamydia Gonorrhea Urinary Tract Infections Syphilis -Caused by bacteria Often curable

Gender Disparities

-Gender Disparities Biological sexism - Women more susceptible to infection than men when exposed to an STI organism Fluid dynamics of coitus Environment of women's reproductive organs -Suffer greater damage to their health and reproductive functioning -Increased likelihood of asymptomatic infection Symptoms masked by female reproductive physiology Delay in diagnosis and treatment -Lesbian and bisexual women are also at risk for STIs Anyone can get an STI. However, some population groups are disproportionately affected by STIs; this disparity reflects gender, age, and racial and ethnic differences. Women are more vulnerable to STI transmission due to a phenomenon known as biological sexism. In essence, women are biologically more susceptible when exposed to STIs. The fluid dynamics of vaginal intercourse make STI transmission more likely. Furthermore, the makeup of the female anatomy increases susceptibility. Because of the warm, moist interior of the vagina and uterus, it is ideal for many organisms to grow. There is also thin, sensitive skin inside the labia and mucus membranes lining the vagina that may be more receptive to infectious organisms. Women also suffer greater damage to their health and reproductive functioning, and there is an increased likelihood of an asymptomatic infection which delays diagnosis and treatment. The symptoms that women experience from an STI are often mild or absent. Due to a women's reproductive physiology, mainly monthly menstruation, this can make it more difficult to diagnose STI symptoms and delay diagnosis and treatment. Studies have also shown that lesbian and bisexual women as well as men who have sex with men are also an increasingly at risk for STIs. Lesbian and bisexual women often underestimate their risk, have limited knowledge of potential STI transmission, and reported little use of preventive behaviors with female partners including washing hands, using rubber gloves, and cleaning sex toys.

viral hepatitis

-Hepatitis A - Vaccine 21,000 new infections in 2009 Oral contact w/ food or water contaminated by feces Sexual contact, especially oral-anal sex -Hepatitis B - Vaccine 700,000 -1.4 million estimated cases Sexual contact: blood, semen, saliva, vaginal secretions, and urine -Symptoms: Fatigue, diarrhea, nausea, abdominal pain, jaundice, darkened urine, and an enlarged liver -Diagnosis: Blood tests Hepatitis is a viral disease affecting the liver. It has three types: A, B, and C. Hepatitis A and hepatitis B can be sexually transmitted while hepatitis C is a common virus passed on primarily through contact with infected blood. We will examine hepatitis A & B since they are primarily transmitted sexually. Your text includes information on hepatitis C. There were 21,000 new infections of Hepatitis A in 2009. It is transmitted via oral contact through food or water contaminated by feces. It can also be transmitted via sexual contact, especially oral-anal sex. Although there is a vaccine, the virus can last from a few weeks to several months and does not lead to chronic infection. Vaccination is recommended for all children starting at one years old, travelers to certain countries, and other risks. There are an estimated 700,000 to 1.4 million cases of Hepatitis B. It is transmitted via sexual contact through blood, semen, saliva, vaginal secretions, and urine. It can be prevented by a simple, widely available vaccine. Symptoms range in severity from a mild illness and last a few weeks being acute to a serious long-term chronic illness that can lead to liver disease or liver cancer. The symptoms of all forms of hepatitis include fatigue, diarrhea, nausea, abdominal pain, jaundice, darkened urine, and an enlarged liver. Viral hepatitis is detected through a blood test.

Urinary Tract Infections

-Inflammation of the urethra Can result from sexual exposure and noninfectious conditions Caused by several different bacteria, including chlamydia -Transmission: Vaginal, anal, & oral sex, perinatal -Symptoms: burning sensation when urinating, burning or itching, white or yellowish discharge -Diagnosis: Urethritis (men) or chlamydia culture -Treatment: Antibiotics Urinary Tract infection (UTI) is the inflammation of the urethra. It can result from sexual exposure and noninfectious conditions. An inadequate cleansing after urination and bowel movements can cause of UTIs. It is caused by several different bacteria including chlamydia, which is the most common and serious. It is transmitted through vaginal, anal, and oral sex, and perinatally. Symptoms of a UTI include burning sensation when urinating, burning or itching, white or yellow discharge. UTIs are usually diagnosis through urethritis or a chlamydia culture. The lab test looks for unusual discharge from the penis or the vagina. Treatment includes antibiotics. If left untreated, urinary tract infections results in permanent damage to the reproductive organs for men and women and problems with pregnancy.

Genital candidiasis

-Many factors contribute to the infection -men and women can carry the organism Genital candidiasis is also known as a yeast infection. It is the overgrowth of fungus. Many factors contribute to the infection, and men and women can carry the organism, however men are not treated. Symptoms include itching, burning with or without a cottage cheese-like vaginal discharge and males may have an itchy rash on their penis. It is treated with antifungal drugs taken orally or applied directly to the affected area or used vaginally. Over-the-counter treatments are becoming more available due to self-diagnosis, but two-thirds of women using over-the-counter drugs are without the disease, and this may lead to resistant infections

STI Epidemic

-Most common infectious diseases reported in U.S. -2 Types Bacterial STDs are often curable Viral STDs are not curable, but treatable -More than 25 STDs can be passed from person to person through sexual activities -Other routes of transmission Infected blood in injecting drug equipment From infected mother to her child, known as perinatal transmission. The Institute of Medicine characterizes STIs as the hidden epidemics of tremendous health and economic consequences in the US. Their hidden nature makes it challenging to identify exactly how many cases there are. There are also sociocultural taboos related to sexuality that act as barriers to STI prevention, screening, and treatment. STIs are asymptomatic infections meaning that they usual do not show symptoms. Because of this, infections are often undiagnosed because there are no early symptoms. When symptoms are present, they are mild and often ignored and left untreated. However, they can be diagnosed through testing, but routine screening is not widespread and reporting regulations vary or are nonexistent or inconsistent. This leads to the underreporting of various STIs. For example, gonorrhea, syphilis, chlamydia, and hepatitis A and B must be reported by healthcare providers to health departments in each state and to the federal Centers of Disease Control and Prevention. However, no reporting is required for major STIs like genital herpes, human papilloma virus, and trichomoniasis. In addition, some private physicians don't report STI cases to their state health departments. This inconsistency does not enable us to have a reasonable idea of what the STI epidemic is like in the US.

Syphilis more

-Symptoms: may not have symptoms for years Red pea sized bump (chancre) where bacterium originally entered the body -Diagnosis Material from chancre Blood Test - antibodies -Treatment: Antibiotics Easy to cure in early stages The characteristic symptom of syphilis is the red pea sized bump, chancre, where the bacterium entered the body. A blood test is the most common way to determine is someone has syphilis. After the infections, the body will produce antibodies to the infection are detected. Also, the material from the chancre can be examined to test for syphilis. Syphilis is treated with antibiotics and is easy to cure in early stages. After treatment, one must abstain from sexual contact until syphilis sores are completely healed. However, someone infected with syphilis is also susceptible to reinfection.

Syphilis

->45,000 cases in U.S. in 2010 -Transmission Direct person to person contact w/ syphilis sore Skin to skin contact Vaginal, anal, & oral sex, and perinatal -Infection has stages that indicate progression of infection Stage 1: Primary syphilis Stage 2: Secondary syphilis Stage 3: Late & Latency (Hidden) In the U.S. more than 45,000 cases of syphilis were reported in 2010. Syphilis is a genital ulcerative disease. It is spread by direct contact with a syphilis sore during vaginal, anal, and oral sexual behavior. The syphilis bacterium of an infected mother can infect the baby during the pregnancy. Many of its signs and symptoms of syphilis are indistinguishable from those of other diseases. Yet, many infected people stay asymptomatic for years but they remain at risk for complications if not treated. Further, they may unknowingly infect others. Syphilis progresses through three discrete stages: During the primary stage symptoms appear from 10 to 90 days after exposure with an average of 21 days in appearance. This is marked by the appearance of a single sore or multiple sores. The sore will be firm, round, small, and a painless chancre on the labia, the shaft of the penis, testicles or rectum, within the vagina, mouth, or lips. Without treatment it will heal in three to six weeks, but bacterium remains in the body and the person is still highly contagious. Infection also progresses to the secondary stage. The secondary stage develops six weeks after this appearance of the chancre. Its symptoms include a skin rash and mucus membrane lesions that do not itch or hurt on the palms of the hands, sole of the feet, or other areas of the body. They are often rough, red, and a reddish brown in color. A person can also experience a fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. Symptoms may be mild or unnoticeable but still contagious. This will resolve with or without treatment but will progress to the next stage. The latency stage develops two to six weeks after the disappearance of the symptoms for untreated secondary syphilis. An infected person can experience no further symptoms or can appear 10 to 20 years after initial infection, and the stage can last for years. After one year, bacterium can no longer be transmitted to sex partners, but women can still transmit the disease to their fetus. Damage can also occur later in the internal organs including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Also, this includes difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, dementia, and even death.

Biological factor STI

-Asymptomatic nature Most STDs either do not produce any symptoms or cause symptoms so mild that they go unnoticed or disregarded Time lag unknowingly infecting others -Resistance to treatment or lack of a cure -Other: immature cervix, douching, uncircumcised penis There are also biological factors that contribute to STI transmission. They are naturally asymptomatic in nature. Thus most STIs either do not produce any symptoms or cause symptoms so mild that they go unnoticed or disregarded. As a result, there is a time lag of unknowingly infecting others. Long-time lags, sometimes years, exist between contracting an STI and an onset of significant health problems. During the asymptomatic period individuals can unknowingly infect others, and individuals may not seek treatment, allowing the STI to do damage to their reproductive system. STIs can also become resistant to treatment or lack a cure. Resistant strands of viruses, bacteria, and other pathogens are continuing developing. Antibiotics that have worked may no longer effective. Infected people may continue to transmit STIs because they believe they are cured or currently show no symptoms. As previously discussed, women are also more susceptible, and those biological factors increase their risk for STI acquisition. Adolescent women are highly susceptible to acquiring chlamydia and gonorrhea because of an immature cervix. Women who practice vaginal douching are also at great risk for pelvic inflammatory disease, bacterial vaginosis, and other STIs. Douching disturbs the vaginal protective systems including the chemical and microbial balance, decreasing the good bacteria in the vagina. It also distorts the pH balance and permits the overgrowth of anaerobic and aerobic bacteria. Men with an uncircumcised penis have also been linked to an increase risk for STIs including HPV, gonorrhea, HIV, and syphilis. So as we see, various biological, behavioral, and social factors contribute to STI transmission.

Bacterial vaginosis

-Caused by overabundance of Gardnerella bacteria -Discharge, odor, pain, itching, or burning -Treat with antibiotics Bacterial vaginosis is caused by an overabundance of Gardnerella bacteria. It is a disruption of the normal balance of vaginal bacteria. It is sometimes accompanied by discharge, odor, pain, itching, or burning and is most common among women of childbearing age. The risk factors include new sex partners or multiple sex partners, and douching. It can be spread between female sex partners. It can be diagnosed in a lab test done on vaginal fluid, and it sometimes can clear without treatment. Male partners do not need treatment for bacterial vaginosis, and it is treated with antibiotics.

genital herpes

-Caused by the herpes simplex virus (HSV) type 1 (HSV-1) and type 2 (HSV-2) HSV-1 is an infection of mouth and lips e.g. cold sores or fever blisters HSV-2 is acquired during sexual contact with someone with a genital HSV-2 infection HSV-2 more common than HSV-1 1 in 6 persons aged 14-49 have HSV-2 -Transmission: can occur from an infected partner who does not have a visible sore and may not know of infection Vaginal, anal, & oral sex, and perinatal HSV-1: Oral-genital & Genital-genital HSV-2: Sexual contact w/ HSV-2 infected Genital herpes is an STI caused by the herpes simplex virus. There are two types: type 1 (HSV-1) and type 2 (HSV-2). The HSV-1 is more often the infection of the mouth and lips including cold sores or fever blisters. The HSV-2 is acquired during sexual contact with someone who had genital HSV-2 infection. HSV-2 is more common than HSV-1. Approximately 16% or 1 in 6 persons aged 14-49 have HSV-2. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected. HSV-1 can cause genital herpes, but it more often causes infections of the mouth and lips, so-called fever blisters. HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person infected with HSV-1. Genital HSV-1 outbreaks occur less regularly than genital HSV-2 outbreaks.

Vaginal Infections: Vaginitis

-Experienced by 3 of 4 women at least once in lifetime -Often, but not always sexually transmitted -Also induced by Stress Birth control pills Antibiotics Nylon panty hose Douching They may also be induced by an upset in the normal balance of vaginal organisms by such things as stress, birth control pills, antibiotics, nylon panty hose, and douching.

viral STIs

-Four principal viral STIs Human immunodeficiency virus (HIV) Discussed as an individual lecture Genital human papillomavirus (HPV) Genital herpes (HSV) Hepatitis -Caused by viruses Are treatable but not curable

HPV Vaccine

-Gardisil -Approved by the FDA For females 9-26 years (approved in 2006) For males 9-26 years (approved in 2009) -Prevents infection from 4 strains of HPV 2 low-risk (Types 6 & 11) that cause 90% of genital warts 2 high-risk (Types 16 & 18) that cause 70% of cervical cancer -The vaccine does not protect against those already infected with these types Two HPV vaccines, Gardasil and Cervarix, have been developed. The U.S. Department of Health and Human Services highly recommends their use. Gardasil was the first approved HPV vaccine and is the one we will focus our examination on since there is more data on it. It is approved for the administration to both males and females aged 9-26 years. Gardasil protects against HPV types 6 and 11 (the cause of 90% of genital warts) and types 16 and 18 (the cause of 70% of cervical cancer). Gardasil also prevents HPV associated with anal, vulvar and vaginal cancers. The vaccine does not protect against those already infected with these types Failure in completing the vaccine series in a six-month period and lack of parental acceptance has significantly affected the effort to vaccinate all young people in the United States. Cultural taboos have influenced the receptiveness to this vaccine. Most people who have sex will have HPV at some time in their lives, and they may have HPV for a very long time before it is detected. There should be no shame or blame involved with having genital HPV; the virus is very common.

Racial and ethnic disparities

-Higher rates for racial/ ethnic minorities -Markers that correlate w/ basic determinants of health status Poverty Access to & quality of health care (Lack of) Health-care-seeking behavior Illegal drug use Communities w/ high prevalence of STIs There are also racial and ethnic disparities when it comes to STI infections. STIs are higher among racial and ethnic minorities and markers that correlate with basic determinants of health and social factors are correlated with STI infections. For example, they are more likely to be in poverty and lack access to healthcare and/or quality healthcare. They also have less healthcare seeking behaviors, and illegal drug use can also be an influence.

STI Epidemic-more

-Incidence is the number of new cases while -prevalence is the total number of cases Incidence represents the occurrence of an STI. On the other hand, prevalence is the wide extent of an STI. STIs are common in the United States, but identifying exactly how many cases there are is impossible, and even estimating the total number is difficult. How common are STIs? STIs represent four of five most frequently reported infectious diseases. The US has the highest STI rate among industrialized nations. More pragmatic approaches to sexuality issues, more comprehensive school and public sexuality education, and easier access to healthcare in other countries contribute to lower STI rates in Canada, Japan, Australia, and countries of the western and northern Europe. It is estimated that there are 19 million new STI cases occur each year in the US. By age 25, one in two persons will get an STI, and half of all people will be infected at some point in their lifetime. In discussing disease statistics, or epidemiology, it is important to be able to distinguish between incidence and prevalence. Incidence is the number of new cases while prevalence is the total number of cases. Incidence represents the occurrence of an STI. On the other hand, prevalence is the wide extent of an STI.

Genital Human Papillomavirus(HPV)

-Most common STI among young, sexually active people, particularly women 20 million currently infected 6 million new cases each year By age 50, at least 80% of women will have acquired an HPV infection (CDC, 2011) -Group of viruses that includes more than 100 different strains Over 40 transmitted sexually -Can infect throat & genital areas — the vulva, vagina, cervix, rectum, anus, penis, or scrotum -Types Low Risk: cause genital warts High Risk: cause cancers cervical, vulvar, vaginal, anal, penile, & oropharynx -Transmission: vaginal, anal, & oral sex Primarily through direct skin to skin contact Symptoms: 6 weeks to 8 months appearance after exposure Usually none Genital warts -No cure - 90% go away on their own w/in 2 yrs. Most people with genital HPV do not know they are infected and most are temporary Cannot see or feel cell changes Body fights off HPV naturally & infected cells go back to normal -Diagnosis: No general test for men or women Pap SmearHPV DNA test -Treatment Genital warts - patient applied medication; treatments by health care provider Cancer - surgery, radiation therapy, chemotherapy It lives in the skin or mucus membranes and most have no harmful effects. Certain types of HPV can cause genital warts in men and women and are referred to as "low risk". Other HPV types can cause cancer and are referred to as "high risk". These HPV types can cause cervical, vulvar, vaginal, anal, penile, and oropharynx cancers. Transmission occurs primarily through direct skin to skin contact during vaginal, anal, or oral sex. It is easily transmitted through genital contact. Symptoms usually appear 6 weeks to 8 months after exposure. Most infected people are asymptomatic, and most infections are temporary. Genital warts usually appear as soft, moist, pink, or flesh-colored swellings. They can appear on the penis or scrotum, in or around the vagina or anus, on the cervix, or on the groin or thigh. In 90% of the cases, the body's immune system clears the HPV naturally within 2 years. This includes both high-risk and low-risk types. If a high-risk HPV infection is not cleared by the immune system, it can linger for many years and turn abnormal cells into cancer over time. The Pap test can identify abnormal or precancerous tissue in the cervix so that it can be removed before cancer develops. An HPV DNA test, which can find high-risk HPV on a women's cervix, may also be used with a Pap test in certain cases. Visible genital warts can be removed by the patient him- or herself with prescribed medications or treated by a health-care provider. Some people choose not to treat warts but see if they disappear on their own. Removal of the warts does not eliminate HPV from the person's system. The extent to which a person can still transmit HPV after the visible warts have been removed is unknown. Those that develop cancer from HPV can undergo surgery, radiation therapy, and/or chemotherapy.

Chlamydia

-Most common bacterial STI in U.S. Most commonly reported infectious disease 2.8 million infected annually -Transmission: vaginal, anal, & oral sex, perinatal -Symptoms: appear 1-3 weeks after exposure ¾ women, ½ men experience no symptoms Unusual discharge, burning sensation when urinating or frequent urination, & low grade fever -Diagnosis: Urine or specimens from penis or cervix -Treatment: Antibiotics Chlamydia is the most common STI in the US and affects more than 2.8 million Americans each year. It is transmitted through vaginal, anal, or oral sex, and perinatally. It can infect the penis, vagina, cervix, rectum, urethra, throat, and eyes, as well as respiratory tracts of infants. Chlamydia, aka the silent disease, is referred to that because three-fourths of women and half of men infected have no symptoms. Symptoms for chlamydia appear in one to three weeks after exposure. Unusual discharge, burning sensation when urinating or frequent urination as well as a low grade fever are common symptoms of chlamydia. The CDC recommends yearly chlamydia testing for all sexually active women aged 25 and younger, older women with risk factors such as new sex partner or multiple sex partners, and all pregnant women. There are two lab tests to diagnose chlamydia, a urine sample or fluid from the man's penis or the woman's cervix. Chlamydia can be treated with antibiotics. Untreated chlamydia for women can lead to pelvic inflammatory disease can also lead to ectopic pregnancy and sterility. Receptive anal intercourse may lead to chlamydial infection in the rectum, which can cause rectal pain, discharge, or bleeding. Oral sex with an infected partner can lead to chlamydia in the throats of women and men.

general symptoms of sti

-Multiple symptoms unique to each STI -However, there are general symptoms of all STIs Genital or rectal discharge Abdominal pain Painful urination Skin changes Genital itching Flulike conditions -In lecture, will only examine characteristic symptoms for each STI Text lists all symptoms for each STI **Please note: Pictures of STIs in lecture and text are advanced cases Most at first do not produce any symptoms or are so mild, they can go unnoticed or disregarded Each of the principle STIs that we will review have symptoms unique to the infection which aid in detection and diagnosis. However, there are general symptoms of all STIs. These general symptoms are: genital or rectal discharge, abdominal pain, painful urination, skin changes, genital itching, and flulike conditions. In this lecture, we will only discuss the characteristic symptoms for each STI. However, your text goes into more detail regarding all the symptoms associated with each STI. Also, please note, the pictures of the STIs used in this lecture and in your text usually represent more advanced cases. Most STIs do not produce any symptoms or very mild symptoms.

Pelvic inflammatory disease (PID)

-Occurs when bacteria move upward from a woman's vagina or cervix into her uterus, fallopian tubes, and other reproductive organs -Leading cause of infertility -Many cases are associated with gonorrhea and chlamydia -Symptoms vary from none, to subtle and mild, to severe Pelvic inflammatory disease (PID) is one of the leading causes of female infertility. PID occurs when bacteria move upward from a woman's vagina or cervix into her uterus, fallopian tubes, and other reproductive organs. Several organisms can cause PID, but many cases are associated with gonorrhea and chlamydia. Sexually active women in their childbearing years are at most risk, and those under age 25 are more likely to develop PID than those older than 25. Because the cervix of teenage girls and young women is not fully mature, their susceptibility to the STIs that are linked to PID are increased. Women with repeated episodes of PID are more likely to suffer infertility, ectopic pregnancy, or chronic pelvic pain than those who have had just one episode. Symptoms of PID vary from none, to subtle and mild, to severe. PID is difficult to diagnose because of the absent or mild symptoms, and many episodes go undetected. Because there is no precise test for PID, a diagnosis is usually based on clinical findings. Symptoms of PID include lower abdominal pain, fever, unusual vaginal discharge that may have a foul order, painful intercourse, painful urination, irregular menstrual bleeding, and, rarely, pain in the upper right abdomen. PID can be cured with several types of antibiotics.

social factors STI

-Poverty and marginalization Disenfranchised individuals Social networks in which high risk behaviors are common -Access to health care Limited in many low-income areas Funds for P.H. programs are scarce -Secrecy and moral conflict about sexuality Cultural stigma associated w/ STIs Moralistic, judgmental stance Social factors also contribute to STI transmission. Individuals in lower socioeconomic groups and in social networks with high-risk behaviors are common which influence STI rate. Sex workers, adolescence, migrant workers, incarcerated individuals are considered as disenfranchised populations. There is also the consideration of access to care. There is limited healthcare in many low-income areas, and funds for public health programs are scarce. Without these programs, many people in high-risk social networks have no access to STI care. Socially, there is secrecy and moral conflict about sexuality. There are cultural stigmas associated with STIs and moralistic, judgmental stances that prevent people from seeking treatment or care for STI infections. Significant funding for AIDS research did not begin until it was clear that heterosexual individuals as well as gay men were threatened. In addition, in the past, the federal government has funded school and community adolescence abstinence-only education programs, which lack pertinent information about the prevention of STIs. This demonstrates the many social factors that influence STI transmission.

Ectoparasitic Infestations

-Scabies - Red, intensely itchy rash caused by the barely visible mite Appears on the genitals, buttocks, feet, wrists, knuckles, abdomen, armpits, or scalp -Pubic lice - Found in the genital area on pubic hair Can be transmitted during sexual contact with a person who has pubic lice Prescription and over the counter treatments available though they are not infections per se, parasites such as scabies and pubic lice can be spread by sexual contact. Scabies and pubic lice are considered ectoparasitic parasites or infestations since they live on the outer surfaces of the skin.These can be spread by both sexual and nonsexual contact. Scabies is a red intensely itchy rash caused by barely visible mites. It appears on the genitals, buttocks, feet, wrists, knuckles, abdomen, armpits, or scalp. It is the result of mites tunneling beneath the skin to lay their eggs and baby mites making their way back to the surface. It is highly contagious and can spread quickly through close contact including sexual and nonsexual contact, such as linens, furniture, and clothing. Treatment is prescribed lotion applied at bedtime and washed off in the morning. You must also disinfect your clothing, towels, and bedding and washing in hot water and drying in high heat or by dry cleaning to kill the scabies. Pubic lice, AKA crabs, move easily from pubic hair of one to the other. The female produces eggs, which she attaches to the hairs at the rate of three eggs a day for seven to ten days. The nits or the babies hatch within five to ten days and reproduce in two weeks creating a very ticklish or itchy situation. It is transmitted during sexual contact or nonsexual contact through underwear, sheets, towels, where they can live up to a day and lay eggs that hatch in about a week. Symptoms include intense itching, tiny pale crablike louse, or its miniscule pearly nits that are attached at the base of the pubic hair. Treatment includes prescriptions and over-the-counter drugs. You do not have to shave off your pubic hair to get rid of crabs, but disinfecting includes washing all infected linen and clothing in hot water and drying it in high heat or the crabs may be able to survive.

Gonorrhea

-Second most common notifiable disease 700,000 infected annually in U.S. -Transmission: Vaginal, anal, & oral sex -Symptoms: 2-30 after exposure Watery discharge ('drip') from penis, increased vaginal discharge, burning during urination 80% of women show no symptoms -Diagnosis: Urine or sample from infected body parts -Treatment: Antibiotics Gonorrhea is the second most commonly reported notifiable disease in the United States and 700,000 people are infected annually. Gonorrhea is transmitted during vaginal, anal, or oral sex with an infected person. The organism thrives in the warm, moist environment provided by the mucous membranes lining the mouth, throat, vagina, cervix, urethra, and rectum. Though some infected men may be asymptomatic, men tend to experience the symptoms of gonorrhea more readily than women. It is popularly referred to as "the clap" or "the drip," because early symptoms include a watery discharge from the penis or increased vaginal discharge. Other symptoms include burning and pain during urination. If untreated, the disease soon produces other symptoms, such as thick yellow or greenish discharge, increasing discomfort or pain with urination, and painful or swollen testicles. Up to 80% of women with gonorrhea show no symptoms or very mild symptoms, which they tend to ignore. Untreated gonorrhea can cause sterility in both sexes, ectopic pregnancy, prostate damage, epididymitis, scarring of the urethra in men, and testicular pain. It is diagnosed using a urine or sample from the infected body part. Gonorrhea is curable with several antibiotics. However, emergence of drug-resistant strains of gonorrhea is making successful treatment more difficult.

genital herpes more

-Symptoms: HSV-2 symptoms appear 2 weeks after exposure Blisters 4-5 outbreaks w/in a yr. (less severe and shorter than initial outbreak) Overtime recurrences decrease in frequency -Diagnosis: Visual inspection & sample from sores Blood test - antibodies -Treatment: Antiviral, oral meds No cure, but medications manage virus Sores heal w/in 2-4 weeks Most infected people have no or minimal signs or symptoms from HSV-1 and HSV-2 infection. When signs appear, they typically occur within 2 weeks after the virus is transmitted and appear as one or more blisters on or around the genitals or rectum. After a first episode of genital herpes, about four to five more outbreaks can occur within a year. Subsequent outbreaks are less severe than the first one and the number of outbreaks decreases with time even though the infection can stay in the body indefinitely. It is diagnosed usually by visual inspection and samples from sores. It can also be diagnosed with a blood test looking for antibodies. There is no cure for herpes. Treatment includes antiviral medications and oral daily suppressive medications. Antiviral medications relieve pain, shorten the duration of sores, prevent bacterial infections at open sores, and prevent outbreaks while on the medication. HSV often responds better to oral daily suppressive therapy than topical medications. Other treatment includes rest, a balanced diet, avoiding tight clothes, keeping genital areas cool and dry, taking aspirin or other pain killers, and reducing stress.

Sexually Transmitted Infections

-The STI epidemic -Principal STIs Incidence, transmission, symptoms, diagnosis, and treatment -STIs and women -Preventing STIs Sexually transmitted infections, or STIs, are an epidemic and are linked to behavior and other factors. The sociocultural taboos associated with STIs are a major barrier to prevention and treatment. These infections are a serious public health issue that requires greater personal and public attention and resources. In this lecture we will cover the STI epidemic, principle STI including incidence, transmission, symptoms, diagnosis and treatment, STIs among women, and how to prevent STIs.

Consequence of STI

-Women, men, and infants affected -Presence of STIs increases HIV risk -Untreated STIs have serious consequences Infertility/ sterility Untreated Pelvic Inflammatory Disease (PID) causes 10-15% of women's infertility Ectopic pregnancy, miscarriage Blindness Cancer, heart disease Death STI infection has its share of consequences for women, men, and infants. STI infection and the presence of other STIs increase the likelihood of transmission and acquiring HIV. Someone infected with another STI has two to five times more likelihood to be infected with HIV. In addition, susceptibility to HIV is increased with the presence of other STIs. The likelihood of a dually infected person, someone with HIV and an STI, infecting other people with HIV is also increased. Untreated STIs have serious consequences. It can result in infertility and sterility. For example, untreated pelvic inflammatory disease causes 10-15 percent of women's infertility. It also can cause ectopic pregnancy and miscarriages for women. Untreated STIs can also lead to blindness, cancer, and heart disease, and death. There is also an astronomical cost to STIs. The direct cost for STIs is over 16 billion dollars annually and that number does not include indirect nonmedical costs, such as lost wages and productivity due to illness, out-of-pocket expenses, and the costs related to STI transmission to infants.

Avoiding STIs

Abstinence Practice sexual exclusivity Reduce risk during sexual intimacy Select partners carefully Avoid numerous partners Avoid injection and other drugs Get vaccinated Protect babies Be a good communicator It seems that STIs should be easy to prevent, at least in theory. But in reality, STI prevention involves a subtle interplay of knowledge, psychological factors, couple dynamics, and behaviors. Here is how to avoid STIs: Practice abstinence. The closest thing to a foolproof method of STI prevention is abstaining from intimate sexual contact. Practice sexual exclusivity. Uninfected partners who practice sexual exclusivity in a long-term relationship or marriage will not contract an STI through sexual contact unless one partner had an STI when he or she started having sexual contact. Reduce risk during sexual intimacy. Unless you are certain that your partner is not infected, you should not allow his or her blood, semen, or vaginal fluids to touch your genitals, mouth, or anus by using a condom or latex barrier. Select partners carefully. Knowing whether a partner might be infected with an STI can be tricky and this strategy alone is often not reliable. Avoid numerous partners. Having numerous sexual partners increases the risk for STIs. Avoid injection and other drugs since some STIs are transmitted through blood. Get vaccinated. Unfortunately, only HPV and hepatitis A and hepatitis B have vaccines. Protect babies. Most STIs can be transmitted from mother to child during pregnancy or childbirth. A woman who has an STI and becomes pregnant should inform her doctor, and all pregnant women should be checked for STIs. Be a good communicator. Avoiding an STI frequently means having to talk. Good communicators are less likely to do things against their values or beliefs. And you should never have sex with someone who will not talk about STI prevention.

Summary

STIs are an epidemic linked to behavioral, social, and biological factors that contribute to the transmission STI disparities exists among women, youth, certain racial groups Preventing STIs requires protective health behaviors, safer sex practices, and communication skills

Cervicitis

Cervicitis - Inflammation of the cervix, the lower end of the uterus -Might be a sign of upper genital infection -High-risk sexual behavior increases risk Cervicitis is an inflammation of the cervix, the lower end of the uterus. Cervicitis might be a sign of upper genital infection, most often caused by a sexually transmitted infection such as gonorrhea or chlamydia. Frequently there are no signs of cervicitis, but some women complain of abnormal vaginal discharge, painful urination, and vaginal bleeding between menstrual periods, such as after sexual intercourse. A woman may not need treatment for cervicitis if it is not caused by an STI. If it is caused by an STI, both the woman and her partner are likely to need treatment. Prescription medications often are effective in clearing up the inflammation of cervicitis. A bladder infection that affects mainly women,

Cystitis

Cystitis - Bladder infection that affects mainly women Related to sexual activity but not transmitted Characterized by painful, burning urination and a nearly constant need to urinate Bacterium is introduced into the urinary tract Delayed treatment can result in damage to kidneys cystitis is often related to sexual activity, although it is not transmitted from one partner to another.Cystitis is characterized by painful, burning urination and a nearly constant need to urinate. Cystitis occurs when a bacterium normally present in the lower intestine and in fecal material, is introduced into the urinary tract. This can occur from continuous friction from intercourse or manual stimulation. If cystitis is not treated promptly with antibiotics, more serious symptoms such as lower abdominal pain, fever, kidney pain, and kidney damage will occur.

behavior factors STI

Early initiation of intimate sexual activity Sequential sexual relationships (serial monogamy) Concurrent sexual relationships High-risk sexual partners High-risk sexual behaviors Inconsistent and incorrect condom use Substance abuse Sexual coercion Lack of knowledge of and concern about STIs Erroneous perception of partner's STI status There are numerous behavioral factors. The first is early initiation of intimate sexual activity. Individuals that are sexually active at an early age increase the risk because it increases the total time that they are sexually active. They are also more likely to have non-voluntary intercourse and a greater number of partners as well as use condoms less consistently. The more exclusive sexual partners an individual has over a period of time, known as serial monogamy, the greater the chance of acquiring an STI. Those in committed relationships often transition from condoms to hormonal birth control without establishing STI status first. Furthermore, having concurrent sexual relationships, that is, overlapping sexual partnerships, facilitates the spread of STIs. Research has shown that sexual concurrency is associated with individual STI risk. We must also consider the factor of high-risk sex partners. Sex with a person who has had many partners increases your risk of acquiring an STI. There is also high-risk sexual behavior. Certain behaviors put individuals at higher risk for STI including anal intercourse, having paid sex, and one night stands. Another behavioral factor is inconsistent and incorrect condom use. Correct and consistent condom use is associated with lower rates of STIs for both men and women. Substance abuse is also a factor. Alcohol and drugs affect cognitive and negotiating skills before and during sex, lowering the likelihood that partners will protect themselves from STIs and pregnancy. There is also sexual coercion. Not all people enter sexual relationships as willing partners, particularly women. Persons experiencing violence are less able to protect themselves. In addition, a lack of knowledge of and concern about STIs is also a behavioral factor that influences STI transmission. Lastly, erroneous perceptions of our partner's risk also leave us vulnerable to STIs. Individuals with an inadequate perception of their partner's risk and who rely on visual and verbal cues to judge whether their partners are disease-free instead of discussing partner's sexual history leave themselves vulnerable for STI transmission.

Screening and treating STIs

Get Tested! Talk to your health care provider to determine which STIs you should be test for Recognized STI symptoms Seek treatment Get partners to treatment in order to treat STIs you need to get tested, recognize STI symptoms, seek treatment, and get partners to treatment. If you have no symptoms and are entering a new relationship and are interested in general testing, talk to your health care provider about which STIs you should be tested for. Know that not all doctors perform the same tests for STIs. Learn which tests you need and which you might have to ask for. To help avoid STIs, you should know what symptoms to look for, in yourself and others. In general, the symptoms of STIs are genital or rectal discharge, abdominal pain, painful urination, skin changes, genital itching, and flulike conditions. However, some STIs do not have any symptoms until the disease is well advanced. If you suspect that you might have an STI, you should seek medical care immediately. People who get treatment for an STI are doing the right thing, but they also need to encourage sexual partners and injection-drug-use partners to seek professional care immediately.

STI and women

The female anatomy increases a woman's susceptibility to STIs. STIs threaten the fertility of women related to biological factors that increase their vulnerability