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Chapter Eleven
Protecting Against Sexually Transmitted Diseases and AIDS
Learning Objectives
1. Describe the impact of sexually transmitted diseases (STDs) on society.
2. List the risk factors for contracting an STD.
3. Identify the causative agent, symptoms, and treatment for the following diseases: trichomonas,
chlamydia, gonorrhea, syphilis, genital herpes, genital warts, pubic lice, scabies, and HIV-AIDS.
4. Describe the importance of testing for HIV infection and the proper testing procedures
5. Identify several safer sex practices.
6. Describe the importance of effective communication in reducing the risk of STDs including
HIV.
Key Terms
Anogenital Warts (245)
Bacterial vaginosis (BV) (243)
Chancre (244)
Chlamydia (243)
Epididymitis (243)
Gonorrhea (243)
Hemophilia (249)
Herpes (244)
Human immunodeficiency virus (HIV) (246)
Human papillomavirus (HPV) (245)
Pubic lice (246)
Scabies (246)
Sexually transmitted diseases (STDs) (240)
Syphilis (244)
Chapter Summary
Sexually transmitted diseases, or STDs (formerly called venereal diseases, or VD) are infectious
and passed from person to person, most often by sexual contact. Some common STDs are
gonorrhea, syphilis, genital herpes, human immunodeficiency virus (HIV), vaginal infections,
chlamydia, and pubic lice. Although most STDs can be treated successfully, the best way to deal
with the high incidence of these diseases is for sexually active people to take care not to acquire
them or pass them to their sexual partners.
The human and social costs of STDs are enormous. The human suffering and economic costs
wrought by AIDS are well-known. Although today HIV and AIDS awareness seems to be more
widespread than before, prevention practices must increase worldwide.
Lecture Outline
What is an STD?
• An STD is an infection that is transmitted by sexual behavior.
• STD agents can enter the body by:
—Breaks in the skin
—Mucous membranes
—Transfer of blood or semen
• There are 25 different infectious diseases that can be passed from person to person.
• Eleven are common in North America.
STD Risk Factors
• Multiple sexual partners: 20% of unmarried sexually active people reported having more than
one sexual partner in the previous three months.
• False sense of security: Oral contraceptive pills tend to decrease the use of condoms and
spermicides.
• Absence of signs and symptoms: Some STDs have very mild or no symptoms, which makes
unintentional transmission to others possible.
• Impaired judgment: use of drugs and alcohol.
• Lack of immunity: Organisms can escape the body’s immune defenses, individuals can remain
infected and transmit the infection.
• Body piercing: Wound gives organisms direct access to the bloodstream. Pierced genitals may
impede proper use of condoms. Nipple, tongue, and lip jewelry may increase risk of infection via
oral sex.
• Value judgments: STDs have been associated with sinfulness, dirtiness, condemnation, shame,
guilt, and disgust.
• These negative attitudes discourage people from getting physical examinations and talking
with their partners.
• Denial: Typical thoughts are “It won’t happen to me,” “He (or she) is too nice to have an
STD,” or “She (or he) isn’t the type of person to have an STD.”
• The only way to prevent STDs is to take responsibility, and the only way this can happen is if
you know when you are at risk.
Trichomonas and Gardnerella
• Trichomonas and gardnerella are vaginal infections caused by the protozoan Trichomonas
vaginalis and the bacterium Gardnerella vaginalis, respectively.
• Symptoms occur primarily in women and include vaginal itching and a cheesy, odorous
discharge from the vagina.
• Men also can carry the organisms in the urethra of the penis and under the penile foreskin.
• Bacterial vaginosis
—Overgrowth of certain types of bacteria
—Can be sexually transmissible
—Symptoms include vaginal discharge, may have fishy smell, or may show no symptoms
Chlamydia
• Chlamydia is caused by the bacterium Chlamydia trachomatis, which infects certain cells that
line:
—The mucous membranes of the genitals, mouth, anus, and rectum
—The conjunctiva of the eyes
• The lungs are occasionally infected.
• This infection often occurs in conjunction with gonorrhea.
• Newborns can contract it from their mothers during birth.
• Symptoms are often mild or do not appear at all, which allows the infected individual to
unknowingly transmit the infection.
• Up to 75% of infected women and 50% of infected men have extremely mild or no symptoms.
• Symptoms generally appear within 7 to 21 days after infection and include:
—Painful urination in both men and women
—A whitish discharge from the penis or vagina
• Chlamydia can be treated with antibiotics.
• There is no immunity to chlamydia, which means reinfection may occur many times.
Gonorrhea
• Caused by the bacterium Neisseria gonorrheae.
• A person can be infected in the genitals, anus, mouth, or eyes.
• Can be transmitted by oral or anal sex.
• Can be passed to newborns as they move through the vagina.
• Can be asymptomatic.
• When symptoms do appear they include:
—Painful urination in both men and women.
—A yellowish discharge from the penis or vagina.
• First symptoms appear 7 to 10 days after exposure.
• Can be treated with antibiotics.
Syphilis
• Caused by a spiral-shaped bacterium called Treponema pallidum.
• Transmitted through genital, oral, and anal contact and through blood.
• First sign is a painless ulcer (chancre), which occurs between the first week and the third
month after infection.
• Secondary stage (if untreated) appears in about 6 months. Marked by:
—Skin rash
—Loss of hair
—Growths on moist areas of the body
• If left untreated, infection enters the latent stage.
• There are years of no obvious symptoms, during which the organisms invade body organs.
• Infection can seriously damage vital organs.
• Treatment at any stage is with antibiotics.
Genital Herpes
• Herpes is caused by the virus Herpes simplex (HSV).
• Various strains of herpes can cause:
—Cold sores on the mouth (fever blisters)
—Skin rashes
—Mononucleosis
—Lesions of the penis, vagina, or rectum.
• Can infect newborn babies; two-thirds of untreated babies die.
• Genital herpes is caused most frequently by the viral strain herpes simplex virus type 2 (HSV2).
• Often asymptomatic; 90% of people infected with HSV-2 do not know it.
• Both HSV-1 and HSV-2 can cause genital and oral infections with identical symptoms.
• Symptoms are blisters and painful sores, and sometimes fever and abdominal pain.
• Virus remains in the body and occasionally flares up in response to stress.
• There is no cure, but the drug acyclovir can minimize symptoms.
• Highly contagious when a sore is present.
Human Papillomavirus (HPV)
• The majority of HPV infections are symptomless and go away on their own.
• Sexually transmitted warts, or Condylomata acuminata, are caused by some types of human
papillomavirus (HPV).
• Anogenital warts are growths in the genital and anal regions.
• Some types of HPV cause cervical dysplasia, which can lead to cancer of the cervix.
• Warts sometimes can be removed with self-applied medication, such as a liquid containing
podophyllin or by freezing the wart with liquid nitrogen.
• Generally diagnosed by visual examination.
Hepatitis B
• Disease of the liver is caused by hepatitis B virus (HBV) infection.
• HBV is sexually transmitted 100 times more effectively than HIV.
• Transmitted sexually and through blood.
• Vaccine is available.
• Symptoms include:
—Low-grade fever
—Tiredness
—Headaches
—Loss of appetite
—Nausea
—Dark urine and jaundice (signs of liver disease appear later)
Molluscum Contagiosum
• Caused by molluscum contagiosum virus.
• Characterized by the appearance of freckle-sized, smooth, rounded, shiny, whitish growths on
the skin of the trunk and anogenital region.
• No associated symptoms.
• Should be removed by a health care provider.
Pubic Lice
• Pubic lice (Phthirus pubis) are also known as crabs.
• Transfer of lice occurs via physical, usually sexual, contact.
• Can be eliminated by washing pubic hair with liquids containing agents that specifically kill
lice.
• All of the infected person’s clothes, towels, and bed sheets should be washed with cleaning
agents made specifically to kill lice.
Scabies
• Scabies is a skin infestation of tiny mites, Sarcoptes scabiei.
• Causes intense itching.
• Can be treated with topical agents.
Acquired Immune Deficiency Syndrome (AIDS)
• Acquired immune deficiency syndrome (AIDS) is caused by human immunodeficiency virus
(HIV) infection.
• HIV infection causes disease by destroying immune system cells, leaving patient vulnerable to
bacterial, viral, and fungal infections.
• HIV transmitted via blood, semen, breast milk, and vaginal fluids of infected individuals.
• HIV is a retrovirus, which means that once it gains entry to a cell, it incorporates itself into the
host cell’s DNA.
• First symptoms are often flu-like and experienced within a few weeks of exposure; generally,
the person recovers from these symptoms.
• An HIV-infected person may not manifest symptoms of AIDS for 15 to 20 years but can still
spread the infection.
• Most tests for HIV infection detect antibodies to HIV; a positive result (“seropositive”)
indicates that a person has been exposed to sufficient quantities of HIV to trigger an immune
response.
• HIV infections are lifelong.
• To date there is no cure for AIDS.
• Treatments attempt to slow the replication of the virus.
• Medications help treat the symptoms.
Reducing the Risk of HIV
• Can infect anyone.
• Measures to reduce the risk of being infected with HIV include:
—Having sex only in a monogamous, long-term relationship
—Avoiding drug use with needles, or, if needles are used, using clean needles and not
sharing needles
—Using condoms when having sex
Testing for HIV
• Testing begins with a counseling session.
• Actual testing involves taking a small amount of blood from the arm, which is tested in a
special laboratory.
• Regardless of the test results, another counseling session is necessary.
• HIV testing can be anonymous and confidential.
Practicing Safer Sex
• Surest method of prevention is abstinence.
• There are a number of ways to reduce your risk of contracting an STD.
• Practice abstinence.
• Know your partner’s sexual history, including all high-risk activities.
• Use a male or female condom and spermicides.
Effective Communication Skills
• Talk to your partner before having sexual intercourse or engaging in activities that involve
contact with your partner’s bodily fluids.
• Think ahead of time what you will say if your partner wants to have sex.
—What if the person is offended that you want to know their sexual history?
Study Guide and Self-Assessment Workbook
11.1 AIDS and Me
Additional Resources
American Social Health Association is dedicated to stopping sexually transmitted diseases and
their harmful consequences to individuals, families, and communities.
www.ashastd.org/
HIVInsite provides information about HIV/AIDS, including medical issues, prevention, statistics,
and policy analysis; from the University of California, San Francisco Medical Center.
http://hivinsite.ucsf.edu
Joint United Nations Programme on HIV/AIDS provides international views of the AIDS
epidemic.
http://www.unaids.org
U.S. Centers for Disease Control, Division of STDs provides up-to-date information on all
aspects of STDs.
http://www.cdc.gov/std/