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Download STI Overview - HIVAIDSUkraine
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2.22 Lesson Plan I. Title: Sexually Transmitted Infections (STIs) II. Objectives: Students will know about the various STIs, their means of transmission, and actions necessary to prevent them. They will understand the risk factors for sexually transmitted infections. Students will also be able to explain the transmission, symptoms, treatment, and prevention of HIV/AIDS III. Materials: 1. Attitude and Belief Scale 2. HIV/AIDS "What Do You Know" Survey (handouts follow lesson plan) 3. Vocabulary: Host: an unprotected living organism receptive to agents. Susceptible: an immune system is in a weakened condition due to any number of factors. Agent: a strong pathogen that is able to transmit a disease. Environment: an area of the living organism (you?) where an agent may enter the body and be able to live and thrive in darkness, moisture, warm temperature, nourishment, etc. Pathogen: a disease-causing agent (fluid, cells, parasite, bacteria, virus, protozoan, fungus, etc.) IV. Procedures: 1. Warm up/Discussion: Ask class “How many Sexually Transmitted Infections are there?” Possible answers: Chlamydia, gonorrhea, syphilis, genital herpes, genital warts, HIV/AIDS, hepatitis (virus), trichomoniasis (protozoan), candidiasis (fungus includes vaginitis, and thrush), general urinary tract infection (UTI), Pubic Lice ("crabs", parasite), pelvic inflammatory disease (PID, may be caused by multiple STI infections of woman's reproductive tract), conjunctivitis (eye infection, possible blindness, may be caused by chlamydia), etc. There are more than 20 different types of sexually transmitted infections (STIs). Each has a separate test for diagnosis: most often -blood, urine, and/or visual. The early symptoms of any STI are usually not serious - a mild discomfort, an annoying itch, or a fluid discharge. If left untreated, some infections can cause sterility (no ability to have children), blindness, central nervous system destruction, disfigurement, or even death. Mothers carrying the pathogens of an STI at the time of delivery are at risk of giving it to their newborn baby. STIs affect males and females, from all social and income levels, all ages, all ethnic groups, and all countries of the world. The more sexual partners a person has while practicing unprotected sexual activities, the greater the risk for contracting an STI. Note: Bacterial pathogen infections are curable through using an appropriately prescribed antibiotic. Viral pathogens are often controllable, yet not curable. 2. Exercise: Hand out “Attitudes and Beliefs Scale” Quiz for students to complete. 3. Lecture/Discuss: Ask class WHY sexually transmitted infection rates are high. Possible answers include: Shame and embarrassment keep infected people from seeking treatment. Infected persons have unprotected sex with unsuspecting partners. Many infected persons are uncomfortable discussing sexual issues and may be less likely to ask their partner to use protection (condom) as a means of protection from pregnancy or STIs. There is a casual attitude about sex. The media (television, movies, songs, etc.) glamorize it and many people are sexually active - without using protection or considering the consequences. Many people are pressured into having sex and either do not use protection, or are too inebriated to think about using it. 4. Modes of transmission: Most STI pathogens are spread through some form of intimate sexual contact with an infected person: Broken skin, mucous membranes, urethra, etc. Some may be spread through infected fabric, utensils, toilet seats, etc. Infection can occur through unprotected sexual intercourse - vaginal, oral, or anal - hand, mouth, or genital contacts with an infected person. Infection may be spread through sharing drug injection needles with an infected person. All pathogens prefer dark, moist, warm mucous membranes, especially those covering the linings of reproductive organs. Some pathogens are susceptible to light, excess heat, cold, dryness, and may die quickly when exposed to air. 5. Types of Common STIs: Chlamydia: Bacteria caused infection of uro-genital tract. This is the most common STI in USA. From Greek word "chlamys" meaning "to cloak". Bacteria can only live and grow inside other cells. More women than men have this disease. It is called the "Silent Epidemic" because it often has NO SYMPTOMS. Over 70% of infected women do not realize they have it until secondary damage occurs, such as blocked reproductive tubes. Women: damage to cervix, fallopian tubes, sterility, and/or pelvic inflammatory disease. Men: damage to prostate, seminal vesicles, possible blood vessels and heart. Symptoms: Women: may be yellowish discharge from vagina, spotting between menstrual periods, and occasional spotting after intercourse. Infected mothers: conjunctivitis or blindness to newborn infants during delivery. Men: painful and difficult urination, frequent urination, and a watery pus-like discharge from penis. Gonorrhea: Bacteria caused infection. There are two million new cases each year in USA. From Latin words "Neisseria Gonoffhoeae". It infects the lining of the pharynx, urethra, genital tract, and rectum. May spread to the eyes and other areas of body due to infected fluids via the hands or sexual activity. Most victims are between 20-24 years old in USA. Sexually active women between 15-20 years of age, practicing unprotected sexual intercourse, are at high risk for infection. Women: damage to reproductive organs and sterility. Men: damage scar tissue in reproductive tubes, causing sterility. Symptoms: Women: 20% have symptoms. Bacteria may stay in vagina, cervix, uterus, and fallopian tubes for a long time and show no symptoms. Men: 80% have symptoms of painful and burning urination 2-9 days after contact with an infected partner. Syphilis: Bacteria caused infection - spirochete. From Latin words: "Treponema Pullidam". It is delicate and dies on exposure to air, dryness, or cold. It is transferred from infected person through direct sexual contact. This disease is unique because it affects males and females in a similar way. Stage I - Primary Syphilis - there is a development of a sore "chancre" 3-4 weeks after contact with an infected person. The sore is located at the site of the initial infection (outside for men, inside for women). It is the size of a dime, painless, and it oozes bacteria ready to infect an unsuspecting partner. The sore disappears from sight (not the bacteria from the body) within 3-6 weeks. Stage II - Secondary Syphilis - develops 1 month to 1 year after untreated contact. A fine rash with white patches appears on skin and mucous membranes of mouth, throat, and genitals. It disappears after some days-1 week. Stage III - latent Syphilis - the syphilis spirochetes invade body organs as they travels up the spinal column. This happens 2-4 years after the secondary infection (rash) if still untreated. It is also transmitted during pregnancy. Newborn could have several physical problems, including blindness. Stage IV - Late Syphilis - this occurs years after untreated contact. Symptoms include heart damage, central nervous system damage, blindness, deafness, paralysis, premature senility, and ultimate insanity. TREATMENT: Simple antibiotics after first infected contact and positive diagnosis. Genital Warts: Virus caused infection - NO CURE. Condyloma-Human Papilloma Virus (HPV) enters the genitals or anus through unprotected sexual contact with an infected partner. It is relatively easy to catch. There is a 6-8 week’s incubation period (time the virus grows and spreads throughout the body) after contact with an infected person. Symptoms: Many people have no apparent symptoms. Others have small tolarge, hard, itchy, white/yellow-gray colored, cauliflower-like growths on genitals, in vagina, or in urinary tract. Scar tissue can stop reproduction capability in men and women. HPV could lead to dysplasia - a pre-cancerous condition. The only treatments available are drugs to control the symptoms, and possibly surgery if growths are too large. Herpes: Herpes Simplex Virus I cold sores and fever blisters (mouth) Herpes Simplex Virus 11 small burning blisters on genitals It is one of the most widespread STIs in the world. There is NO CURE. It is a virus caused infection. Symptoms: Burning and redness at site of the infection. Small blisters form and they are filled with clear, viral fluid. Viral fluid on hands can make infection spread to other parts of the body including the eyes, causing blindness. Over days, the blisters dry, crust, and disappear. The virus seeks out nerve cells, enter them, and lie dormant (quiet, no action) until activated again through: an inadequate diet, high stress, an overworked immune system, or excessive sunlight. These may re-activate the blister process and create a highly contagious environment for an unsuspecting, unprotected partner. Pregnant Mothers can give the virus to their newborn infants during the delivery process. This is why many doctors will recommend a cesarean delivery (surgery to remove the infant before a natural birth through the vagina can occur). HIV/AIDS: Virus caused infection. It is extremely virulent STI that eventually makes the body's immune system unable to function at all. Every continent has been affected by the HIV/AIDS pandemic. The HIV/AIDS virus has affected all ages, races, ethnic origins, social and income levels, and sexual orientations of people all over the world. HIV = Human Immunodeficiency Virus. A person is considered HIV+ if they have been tested with a blood test and HIV antibodies have been found in the blood. May not have any signs or symptoms yet. AIDS = Acquired Immune Deficiency Syndrome. Signs and symptoms appear. Diagnosis: A person is considered to have AIDS if HIV antibodies have been detected (in a blood test), and pulmonary tuberculosis, recurrent pneumonia (PCP- Pneumocystic Carinii Pneumonia), Kaposi Sarcoma, a low number of Helper T cells is found, or invasive cervical cancer is also diagnosed. Most importantly, AIDS will be diagnosed if there are <200 (less than 200) CD4 Master Immunity cells per cubic milliliter of blood found in the person's blood test. A healthy person would have at least 1000 CD4 cells per cubic milliliter of blood. AIDS is the leading killer among Americans 25-44 years of age in cities larger than 100,000 people in the USA. Every continent has been affected by the HIV/AIDS pandemic. WHO? There is NO ONE GROUP receiving or spreading the disease. It is an "Equal Opportunity Pathogen". ANYONE WHO ENGAGES IN HIGH HIV/AIDS RISK BEHAVIORS IS SUSCEPTIBLE TO THIS DISEASE. Highest Risk Behaviors: Sharing needles and syringes with an HIV/AIDS infected person. Unprotected vaginal, oral, anal intercourse with an HIV/AIDS infected person. No or Low Risk Behaviors: Abstinence - no sexual contact ever. Celibacy - was sexually active, is not now. No infections. Both partners have tested negative, and they are in a monogamous and committed relationship with each other and DO NOT have sexual contacts with anyone else, AND neither uses illegal injected drugs. Transmission: HIV/AIDS typically enters the body when the infected fluids (semen, vaginal fluids, blood, and breast milk) of an HIV/AIDS infected person, gains entry through mucous membranes of genital organs (an anus is the easiest route), direct blood to blood contact through infected blood entering into open sores/cuts, or by sharing infected needles or syringes when injecting legal or illegal drugs. HIV infected breast milk is under further study at this time. It is suspected that bloody nipples and infected breast milk, and/or infection through fluids in the birth process infect newborn babies with HIV. Also, HIV babies originally carry their HIV/AIDS infected mother's antibodies after birth, yet they may not be really infected. After approximately 18 months the baby would develop his/her own antibodies, and a blood test would reveal if the baby were truly HIV/AIDS infected or not. Within the illegal drug abusing culture, there is a possibility for other infectious diseases to be spread. Hepatitis and tuberculosis are diseases that are easily spread through coughing and saliva contact. They are easily contracted due to a low functioning immunity system of an HIV/AIDS infected person. Those who tend to use illegal drugs, also tend to have poor health in general. They may also have a low functioning immune system due to poor nutrition, lack of sleep, and perhaps other acquired diseases. *** Tuberculosis is the major killer of HIV infected persons in Ukraine. How does HIV infect immune system? The HIV viruses enter the body, find white blood cells (WBQ, and invade them. Each small virus multiplies within the cell and finally breaks the cell open, thereby destroying it. Then the HIV viruses enter new WBC and continue doing the same thing again and again. Over time, this is the cause of the reduced count of Master Immunity cells that control the immune system. HIV antibodies are detected in the blood within 6 weeks to 3 months of original, infected contact. Detection time depends upon strength of the HIV/AIDS viruses. HIV/AIDS Testing: No one can tell if someone is HIV/AIDS infected just by looking at him or her. A specific blood or saliva test is needed. A small amount of blood is taken and an ELISA (Enzyme Linked Immuno-Suppressed Assay) test or a more involved Western Blot test is necessary for the analysis. A few hospitals in Ukraine are also pilot-testing a saliva swabbing test where a piece of cotton is wiped along the inside cheek of one's mouth and the fluid is analyzed for HIV/AIDS. This is only done for women who are about to deliver and HIV may be suspected. So far, the saliva test has been accurate in diagnosis. Common Symptoms: Excessive amounts of colds, sore throats, fever, severe fatigue/tiredness, nausea, night sweats, swollen lymph glands (throat, armpits, groin), PCP, KS, and of course, the many positive laboratory tests. Note: In Ukraine, as in many areas of the world, one must register in order to receive treatment. Of course, registration also may bring discrimination by employers, friends, and families along with the HIV/AlDS treatment. This may be why there is suspicion there are many more HIV/AIDS cases than actually diagnosed in Ukraine. Treatment: Nucleoside Analogues - AZT, ddl, ddC, d4T, 3TC are drug "cocktails" that inhibit the “enzyme reverse transcriptase" of the virus before it enters a new WBC cell. “Protease inhibitor” also act to prevent the production of the virus in new cells. There are many uncomfortable side effects and therefore, it is critical to have the correct dose of these drugs. This is why a hospital stay is often necessary to make sure the correct dosage is being used and tolerated. Summary and Review: HIV/AIDS is preventable. Question your partner(s) about his or her sexual history BEFORE protected sexual activity occurs. Both partners should stay in a monogamous, committed relationship with each other and not use illegal injected drugs. Being sexually active with many partners, and/or without using protection are high-risk behaviors for contracting HIV/AIIDS and other sexually transmitted diseases. Sharing drugs, needles, and syringes with anyone, who may or may not be infected, is a high-risk behavior for possibly contracting HIV/AIDS and other highly infectious diseases (Ex. Hepatitis, Tuberculosis). There is no cure for HIV/AIDS.