Download Unit 13: Sexually Transmitted Diseases

Unit 13: Sexually Transmitted
Infections (STI’s)
HIV/AIDS
Natural history of HIV/AIDS
 Probably originated in Africa
 AIDS (acquired immune deficiency syndrome) is caused by the HIV
virus (Human immunodeficiency virus)
 The HIV virus infects T-cells (white blood cells)
 makes copies of itself
 then destroy these T-cells
 Body make antibodies for virus (HIV test checks for their presence)
 Our body can’t get rid of HIV fully because
 HIV weakens the immune system to begin with
 HIV replicates too fast for our immune system to fight it
 HIV can mutate (therefore changing its antigen), to avoid elimination
 A ‘positive HIV’ test means you have HIV antibodies in your blood
 Sometimes takes weeks to months to show antibodies
 Concern = _______________________________________
Natural history of HIV/AIDS
• Early symptoms include fever, fatigue, swollen
lymph glands (often mistaken for flu/cold)
• Most people who get HIV will eventually develop
AIDS
• However, AIDS has a long latent period (≈10 years)
• People may infect others without even knowing because they
don’t show the signs/symptoms of infection
• Destroyed T cells leave a person very susceptible to
opportunistic infections
Transmission
• NOT highly contagious
• Transmission requires intimate contact between body
fluids (blood, semen, breast milk) often through:
– Unprotected sex
– Unsterile needles
– Mother to fetus or infant
– Blood transfusion
– Risk from highest to lowest:
Anal intercourse > vaginal intercourse >>>>oral sex
>>>>>>>>>> wet kissing , urine, sweat, tears
Transmission
• More likely to occur during anal intercourse
than vaginal intercourse because:
– Rectum lining is thin
– Rich blood supply in the rectum
– Rectum has a lot of white blood cells that have the
HIV receptor
– The skin is often damaged
– The vagina has better natural lubrication
HIV Stages after Transmission
• First Stage – primary HIV disease
– Early cold/flu like symptoms, may have a rash
– Not early enough to show a + HIV blood test
• Second Stage – chronic asymptomatic disease
–
of immune cells without disease symptoms –
cont. swollen glands
– vulnerability to opportunistic infections
• Third Stage – chronic symptomatic disease
– Thrush – yeast infection of the mouth
– Body weakness and discomfort, sustained fever,
night sweats, weight loss, and frequent diarrhea
HIV Infection
http://www.hivcenternyc.org/newsletter/preview/300pxSymptoms_of_acute_HIV_infection.png
High Risk Groups
Canada
• Female incidence is increasing
• It used to be that most cases (80%) were in
men who have sex with men (MSM) (1989),
now more heterosexuals are being diagnosed
• The decline in mortality is attributed to:
– Public education to use condoms
– Antiretroviral drugs (ART) reduce infectiousness
and transmission
HIV Prevalence
New HIV Cases
HIV/AIDS Epidemiology
Kilmarx 2009
Epidemiology of HIV/AIDS
• Higher risk groups include:
– Men who have sex with men
– Sex trade workers
– Injection drug users
– Aboriginals
Treatment/ prevention
 No effective vaccine exists
 Some recent progress (published in New England Journal
of Medicine):
 canarypox vector vaccine (ALVAC-HIV [vCP1521]) + boasters
administered to heterosexual healthy individuals in Thailand
 monitored for 3yrs at 6 mn intervals
 “community-based, randomized, multicenter, double-blind,
placebo-controlled efficacy trial”
 New infections=
 Vaccine group= 51 of the 8,197
 Placebo group= 74 of the 8,198
 statistically significant difference
 Still very far from eradication!!
Treatment/ prevention
 Prevention is the key:
 Practice safer sex!
 Wear a condom, avoid multiple sex partners, know your
partner’s sexual history/last STI test
•
•
•
•
Don’t combine drug use and sex
Avoid injection drugs
Avoid “sketchy” tattoos and body piercing
HIV testing (prevents transmission)
HERPES SIMPLEX
Herpes Simplex Overview
 Caused by the herpes virus
 Two types
 HSV1 typically affects the mouth/lips
 HSV2 typically affect the genitals
 Appears as recurrent temporary lesions (ex.
Cold sores) on the lips, mouth genitals etc)
 1/5 of sexually active people have had HSV
infection in Canada
Herpes “fever blisters”
If you think this slide is bad.... Be thankful I didn’t post any genital herpes pictures!
Wear a Condom!!!!
Herpes simplex overview
 There is no cure
 Antiviral drugs may shorten episodes
 Have it for life
 HSV2 is easier to protect against
 Don’t touch genitals as much
 Can use a condom
Secondary Prevention
• List of things one can try to decrease episodes
– Stress Management – Vit B
– Exercise – Decrease production of cortisol
– Amino Acid L-Lysine - seems to help with type 1
(Smirnova IP et al. 1998)
– Mutations can occur between Herpes Simples 1
and 2 - oral sex?
HEPATITIS
Hepatitis Overview
• Hepatitis = inflammation of the liver
• There are six variations of the virus that causes it
(A,B,C,D,E and G)
• Initial symptoms are similar to the flu, may
progress to nausea, vomiting, dark urine,
abdominal pain, jaundice (yellow skin)
• Chronic hepatitis can cause cirrhosis of the liver,
liver cancer and death
Hepatitis
Hepatitis Overview
• Hep A and Hep E transmitted through fecaloral contact, typically through contaminated
water
• Hep B, and C transmitted through the
exchange of bodily fluids
– Sexual intercourse (B, not C), contaminated
needles main route of transmission
• Hep D/G usually occur as co-infections, not on
their own
Prevention/Treatment
Prevention
• Vaccines are effective against HepA and B
• HepB vaccine also confers protection against HepD/G
• Safe sex (B, D, G)
• Clean drinking water (A, E)
Treatment
• There is no cure
• Antiviral drugs may help
• Liver transplants indicated in advanced cases
Genital Warts- HPV
• Genital warts are caused by the human
papilloma virus (HPV) and often show no
symptoms
• If left untreated, genital warts can lead to
cervical cancer and perhaps cancers of other
genitalia an association of 90%
• Warts can be surgically removed,
burned/frozen off
HPV
• There are more than 100 known strains (Mayo Clinic,
2010)
• Symptoms show up months or years after
exposure
– Color range from pink in moist areas, greyishwhite warts in dry area
– Can be painless, or cause itching and
inflammation
– Appear on penis, vulva, anal area, or urethra
– Risk increase of HPV leading to cervical cancer if
the woman is also infected with herpes (J.S. Smith,
2002, Kelly, 2006)
HPV
OTHER STI’S
Chlamydia
• Most commonly reported STI in Canada
• ≈63,000 cases (2004) highest number of cases
since 1990 (first reported)
• Chronic long-term consequences: infertility,
chronic pelvic pain and ectopic (out of
place)pregnancy (life-threatening)
Chlamydia
• Incubation Period 7-21 d from vaginal or anal
intercourse
• Symptoms
– Genital discharge
– Burning during urination( not specific to men)
– Lower abdominal pain or during intercourse
(women)
– ¾ of cases in women have no symptoms
(Kelly, 2006)
Chlamydia Treatment
• Treatment
– Weeklong regimen of azithromycin, doxycycline,
or erythromycin
• Who is the most at risk?
______________________________
(Kelly, 2006)
Gonorrhea
• Second most commonly reported STI in
Canada
• Rates have doubled from 14.9 per 100,000
(1997) to 28.9 per 100,000 (2004)
• > 60% of reported cases = males.
• Incubation period – 2-6 days up to 30 d
• Treatment – oral doses of ceftriaxone,
ciprofloxacin or ofloxacin
Symptoms of Gonorrhea/Chlamydia
Often occur together!
– Increased vaginal discharge
– Irregular bleeding
– Abdominal pain
– Pain while urinating
– Thick greenish-yellow penile discharge
– Pain in testicles
Syphilis
• Rates increasing in Canadian males and females.
– 0.4 per 100,000 (Males, 1997)
– 6.3 per 100,000 (Males, 2004)
• 15 times higher!
• 82% of all reported cases = men 30-59
• 1st symptom typically = sore
• 2nd symptom = body rash, flu-like symptoms
• Untreated can damage heart, brain, eyes, nervous
system, bones and joints
• Treatment: single injection of penicillin,
tetracycline, erythromycin, or doxycycline
Chlamydia, Gonorrhoea and
Syphilis
• Bacterial infections, all on the rise
• Treated with antibiotics
• Symptoms sometimes hard to identify
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•
•
•
Pubic Lice
Aka “crabs”
Live by feeding on blood in the pubic area
Sexual transmission – eggs hatch 5-10 days
Non-sexual contact
– Towels, bed sheets, mattresses
• Treated with creams, shampoos
TAKE HOME MESSAGE
WEAR A
CONDOM!!!!!!