Download Genital warts are highly contagious

Sexually Transmitted
Diseases
Presented by Felecia Briggs RN,
MS, APN-BC
June 4th, 2010
Student Objectives
The students will be able to: differentiate
between the common signs and symptoms of
Chlamydia, Gonorrhea, Herpes, Syphilis,
Hepatitis B, and HIV.
 List three alternatives to having unprotected sex
 Understand the possible consequences of not
using condoms, if sexually active
 Understand the importance of being more
proactive about their health (i.e., annual checkups, use of condoms, practicing monogamy,
avoiding drug and alcohol use during sex, or
being abstinent).

National Surveillance Rates
Sexually transmitted diseases (STDs) remain a
major public health challenge in the United
States.
 While tremendous progress has been made in
preventing, diagnosing, and treating certain
STD’s-the CDC estimates that 19 million new
infections occur each year (MMWR, 2005).
 More than half of the STD cases occur amongst
young people between the ages of 15-24.

Sexually Transmitted Diseases
STD’s fall into three categories, bacterial, viral,
or parasitic
 Bacterial infections can be completely cured
 Viral infections may clear up in 4-6 weeks, but
some may remain for the rest of your life
 Parasitic Infections- although annoying and
uncomfortable, they can usually be cured quite
easily

Bacterial Infections
Chlamydia- an STD
caused by intracellular
parasitic organism CTrachomatis, which
causes
1. Pelvic inflammatory
disease
2. Ocular infections
3. Lymphogranuloma
venereum- primarily
infects the lymphatics

5. Acute urethral
syndrome in females
6. Reiters syndrome- a
disorder that causes
three seemingly
unrelated symptoms:
arthritis, redness of
the eyes, and
urinary tract signs.
* Up to 85% of
women and 25%
of men are
asymptomatic
Chlamydia Defined?
Chlamydia is the most commonly transmitted
STD, and it’s caused by the bacterium called
“Chlamydia Trachomatis”-which can damage a
women’s reproductive organs.
 It’s transmitted during vaginal, anal or oral sex.
Also, passed from mother to baby during
childbirth.
 Known as the silent disease, because ¾ of
women and ½ infected men have no symptoms.
 Men may have d/c from their penis or burning
w/urination, some may have a burning/itching
feeling around the opening of the penis

Who does Chlamydia Affect?
 African
American women are
disproportionately affected by chlamydia.
 For instance, rates per 100,000 black
females was 1,729.0-seven times (7X)
that of White females (237.2) and more
than twice Hispanic females (733.2)
 The chlamydia case rate per 100,000
population for females in 2005 was three
times higher than for males (496.5 vs
161.1).
Signs and Symptoms
 Some
people may experience a
cloudy or yellowish discharge, painful
urination, and a dull pain in the
abdomen.
 If left untreated both men and
women can become sterile or it can
lead to pelvic inflammatory disease in
women ( a life threatening infection
that affects the lining of the uterus,
fallopian tubes, and ovaries).
Chlamydia con’t
The organisms are found in urethral, cervical,
and rectal epithelial cells, but not in exudate.
Also, found in throats of women & men having
oral sex.
 The DNA probe is used for both chlamydia and
gonorrhea. It can also be detected by urine
LCR.

Chlamydia & Gonorrhea
 Gonorrhea
is often diagnosed
simultaneously with chlamydia-so get
treated for both infections upon
diagnosis of either one.
 Partner diagnosis and treatment is
important to prevent reinfection and
complications. Treatment is the same
as for Gonorrhea.
 Protection against this is provided
through the use of condoms.
Gonorrhea
A
reportable disease caused by gramnegative diplococcus Neisseria
Gonorrhea. It primarily involves the
mucocutaneous surfaces of the GU
tract, pharynx, conjunctiva, and anus
 Purulent discharge can be noted in
men (called the drip or clap)
 Meanwhile, up to 80% of women are
asymptomatic.
Pathophysiology
 The
most common clinical presentation is
an infection of the lower genital tract;
which primarily manifests as male
urethritis (the drip) and female
endocervicitis (inflammation of the
mucous lining of the uterine cervix).
 Infection of the pharnyx, rectum, and
female urethra occur frequently but are
more likely to be asymptomatic or
minimally symptomatic.
Gonorrhea
This is a curable disease of the penis, butt hole,
lining of the eyelid, and the throat
 Even if your partner doesn’t ejaculate (cum),
the gonorrhea bacteria can still be present
 Although some men show no symptoms-others
may experience- yellow-white d/c from penis,
pain when defecating, increased voiding and
pain or swelling of their scrotal sac.
 Gonorrhea infections in the mouth & throat
usually present w/no symptoms or as
pharyngitis.

Who is at risk for Gonorrhea?
Young sexually active individuals
 Non-white urban poor
 Those engaged in high risk behaviors such as
drug use, prostitution, and/or multiple partners
 On the rise in gay and bisexual men
 Highest rates in females ages 15-19y/o and
males 20-24y/o
 **Up to 50% of those w/gonorrhea have a coexistent chlamydia infection

Untreated Gonorrhea

Untreated gonorrhea can also result in
disseminated gonococcal infections to the
ophthalmia neonatorium in newborns
(a form of conjunctivitis mostly contracted
during delivery by an infant whose mother is
infected with gonorrhea), and it can lead to
blindness unless promptly treated.
*Infections caused by gonorrhea are a major
cause of PID, ectopic pregnancy, and chronic
pelvic pain.
Epididymitis
This is a complication resulting
from the spread of a gonococcal
infections to the posterior urethra
that can lead to infertility if left
untreated.
Gonorrhea, Epididymitis
Syphilis
Syphilis is a complex sexually transmitted
disease (STD) caused by the bacterium
Treponema Pallidum. It has often been called
the great imitator because so many of the signs
and symptoms are indistinguishable from those
of other diseases.
 The syphilis bacterium is passed from person to
person through direct contact with a syphilis
sore. Sores mainly occur on the external
genitals, vagina, anus, or in the rectum. Sores
can also occur on the lips or in the mouth.
 Pregnant women can pass it to their babies

How syphilis is not spread?
 Syphilis
cannot be spread by:
 toilet seats
 door knobs
 swimming pools, hot tubs, or bath
tubs
 Sharing clothing, and/or eating
utensils.
Syphilis
The time from first exposure to the bacteria
and signs and symptoms can range from 10 to
90 days (average 21 days).
 The primary stage is marked by the appearance
of a single sore (called a chancre). The
chancre is usually firm, round, small, and
painless. It appears at the spot where the
bacterium entered the body.
 The chancre lasts 1-5 weeks and will heal on its
own, if adequate treatment is not administered,
it progresses to the secondary stage.

Primary stage of syphilis-picture
Syphilis 1st Stage
Secondary stage con’t
The 2nd stage starts when one or more areas of the
skin break into a rash that usually does not itch.
Rashes can appear as the chancre is fading or can be
delayed for weeks. The rash often appears as rough,
copper penny spots on both the palms of the hands
and soles of the feet.
 The rash may also appear as a prickly heat rash, small
blotches, or scales all over the body, as a bad case of
old acne, as moist warts in the groin area, as slimy
patches in the mouth, as sunken circles the size of a
nickel or dime, or as pus filled bumps that look like
chicken pox.

Secondary stage
The Third Stage (Latent)
 This
stage of syphilis begins when the
secondary symptoms disappear. If
the infected person has not received
treatment, he/she still has syphilis.
 The bacterium remains in the body
and begins to damage the brain,
internal organs, nerves, the eyes,
heart, blood vessels, liver, bones, and
joints.
rd
3
stage
Latent Stage Syphilis Con’t
Late stage signs and symptoms include not
being able to coordinate muscle movements,
paralysis, no longer feeling pain, gradual
blindness, dementia (madness), repeated
vomiting, or other personality changes.
 Men may also experience impotence, and
others may feel shooting pains, have blockage
or ballooning of the heart vessels, tumors on
the skin, bones, liver or other organs, damage
to knee joints, and deep sores.

Viral infections
 Herpes-
painful
open sores
 Genital wartscaused by Human
Papilloma Viruscauses painless
cauliflower like
warts
 Hepatitis
B- if it
does not clear
will develop into
a chronic
infection
 HIV- Human
Immunodeficiency Virus
Herpes (HSV)
 It’s
an infection caused by the Herpes
Simplex Virus
 Since it’s a virus, drugs like antibiotics
can’t be used to cure it.
 Oral herpes- is caused by herpes simplex
virus type 1- commonly causes cold sores
or fever blisters that appear on or around
the mouth
 Genital Herpes- caused by HSV type 2
Blisters appear on or around the sexual
organs exposed to the fluids or sores
Herpes Transmission
Oral herpes is transmitted by kissing someone
who has active sores around the mouth
 Genital herpes- is usually transmitted through
sex or genital contact with someone who has
active sores in the genital region, or it can be
transmitted at the skin surface when the virus
is active. (i.e., it can be transmitted without
active sores present, this is called-viral
shedding)

Herpes Symptoms
Sores appearing singly or in clusters are the
primary symptoms, and they can be painful or
painless
 Swollen glands around the groin or neck may
be present during the first outbreak
 Flu-like symptoms- such as fever, muscle aches,
and a sick feeling are common during the first
episode
 Pain in the genital area during urination and
intercourse is also sometimes noted

Genital Warts/HPV
 Genital
warts are caused by a group of
viruses called HPV ( or Human Papilloma
viruses)
 It’s spread by sexual contact during
vaginal, anal, or oral sex.
 The shape and location of the genital
warts may vary. In addition to the genital
area, they may occur in the anal or rectal
area and even the throat.
HPV Slide
HPV in the mouth
Genital Warts Con’t
 Genital
warts can be dangerous (i.e.,
certain types are linked to cervical cancer
as well as other types of cancers in
women and men).
 Genital warts are highly contagious- they
may appear single or in clusters, be pink,
or red flesh in color, be flat or raised, and
sometimes difficult to see with the naked
eye (detected with Pap/Colposcopy)
Treatment for HPV
Podophyllin- applied to the warts and can be
used for more than one application
 Freezing- Cryosurgery- uses cold liquid- like
liquid nitrogen
 Laser Surgery- high intensity light is used to
destroy both cervical and skin warts
 TCA- (Trichloracetic Acid)- this is a powerful acid
that can destroy stubborn warts
 Electrosurgery- an electric needle is used to
burn off warts under a local anesthetic

HPV Vaccine
As a means of combating the rise in cervical cancer
rates, a vaccine has been developed to reduce HPV
transmission.
 It can be administered to young girls bet. the ages of 926.
 The injections 0.5ml IM are given at 0, 2, and 4months
after 2nd dose (i.e., 6months). Free through the NJ
vaccine program for those under 18 or 18 and older with
first injection while in H.S.
 Merck has patient assistance program for those 26 &
under who have or have not contracted HPV, or those
with cervical dysplasia interested in taking the vaccine.

Hepatitis B
 HBV
virus is a DNA virus
 In North America & Europe, Hep B is most
common amongst adolescents and young
adults. Usually spread via sexual contact &
percutaneous (needle) exposure.
 Severity of infection ranges from
asymptomatic to fulminant w/fatal liver
failure. It can progress to chronic liver
disease w/cirrhosis or to the development
of hepatocellular carcinoma (cancer).
HBV- where’s it found? & How’s it
Transmitted
HBV can be found in blood, tears, cerebrospinal
fluid, breast milk, saliva, vaginal secretion and
seminal fluid
 HBV is transmitted parenterally, via sexual
contact, and perinatally
 Heterosexual contact is the most common
mode of transmission, followed by IV drug use,
homosexual activity, and transmission from
mother to child at time of birth.
 Not transmitted by fecal-oral route

HIV covered under separate
lecture
Some good news…
After increasing 23 percent between 1972 and 1990 (including 10 percent between 1987 and
1990), the teen pregnancy rate for girls aged 15-19 decreased 28 percent between 1990 and
2000 to a record low.
120
116.9
115
111.0
110
105
100
106.7
99.6
95
90
85
83.6
80
1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Henshaw, S. (2003). U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24. New York: The Alan Guttmacher
Institute.
Why Care about Subsequent
Births

Overall teen birth rates are down, but
additional births to teen mothers are still
disturbingly common.

In 2002, there were nearly 89,000 such
births, representing 21% of all teen births.

Nearly 1/4 of teen mothers have a second
birth before age 20.
Additional Births

Reasons for second births are less apparent
than first births.

Causes of first births (un-realistic view of
motherhood, lack of knowledge of
contraception, it can’t happen to me),
presumably do not apply to women who are
already teen mothers.
What Research Shows: Age
 Studies
 Some
differ on the importance of age.
non-nationally representative
studies suggest that having a child at a
younger age increases the chance of a
second birth during the teen years.
What Research Shows:
Race/Ethnicity

The difference in rates of second births
overall does not significantly vary by
race/ethnicity.

African-American and Hispanic/Latina teen
mothers were slightly more likely than
White teen mothers to have closely spaced
second births.
What Research Shows:
Education

Lower educational expectations are
associated with having additional births.

Dropping out of school before or after first
birth was associated with a greater risk of
having a second child as a teen and close
spacing between births.

Girls with low cognitive ability are almost
three times more likely to have a second
birth as a teen than those with high
cognitive ability.
Consequences: Teen Mothers

Medical: Teen mothers initiate pre-natal
care later with subsequent pregnancies.
 Education: Additional births make the teen
mother less likely to attend school or to
complete school.
 Work: Additional births make it less likely
that a teen mother will be working and more
likely that they will be on welfare.
Consequences: Children

Five years postpartum, children of teen
mothers who had avoided additional births
were:
 Better
prepared for school
 Better behaved
 More outgoing and happy

The spacing between births seems to be the
most important factor because of how it affects
time devoted to first child.
References
Centers for Disease Control and Prevention.
Sexually Transmitted Diseases Treatment
Guidelines 2005. MMWR 2002; 51(no. RR-6).
 http://www.cdc.gov/std/chlamydia/STDfactChlamydia.htm
 http://www.cdc.gov/std/syphilis/STDFactSyphilis.htm
