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Sexually Transmitted Diseases Stavropol state medical academy Department of asu Sexually Transmitted Diseases transmitted during coitus or genital contact 1 in 4 will contract STD between 15-55 yrs of age require moist environments (“transitional zones”) STDs common areas of infection: – – – vulva, vagina urethra in females penis, urethra in males mouth, oral cavity, eyes, anus in both sexes if untreated, can pass from transitional zone to other tissues person usually has >1 STD as a time Causes BACTERIA : – single-celled, microscopic organisms – cause disease by producing toxins – can be prevented by vaccines; killed by antibiotics Examples of bacterial STDs: chlamydia, gonorrhea, syphilis Causes VIRUSES: – tiny, noncellular particle – has DNA or RNA core and a protein coat – parasitic (reproduces in host cell) – some can be prevented by vaccine Examples of viral STDs: – Herpes genitalis, HPV, HIV OTHERS: FUNGI, PROTOZOA, INVERTEBRATES Chlamydia (most prevalent bacterial STD) caused by bacterium-like microorganism that lives inside cells symptoms: – urinary tract infection in both males and females – yellowish vaginal discharge – Infected tissues become red, irritated – some may be asymptomatic (30% of males, 5070% of females) Chlamydia Life Cycle Chlamydia Cervicitis Chlamydia if left untreated, PID can result in females untreated males can develop infertility (due to scarring of sex accessory tubes) can be passed from pregnant woman to child during delivery > lung and eye infections in newborn detected by tissue culture treated with antibiotics (note: penicillin is ineffective) association exists between chlamydia and cervical cancer Gonorrhea Bacterial STD Symptoms similar to those of chlamydia Syphilis STD caused by bacterium 1st epidemic: 15th century, W. Europe bacterium thrives in moist regions 9/10 cases due to transmission during coitus Stages of Syphilis: Primary stage involves single sore (chancre) where bacteria 1st entered the body appears 10-90 days after entry heals in 1-5 weeks afterwards, travels in blood, lymph to other parts of body Sores Primary Syphilis Chancre 12 Secondary stage of syphilis occurs 2 weeks - 6 months after primary stage characterized by rash on upper body, arms, hands, spreads to other skin larger bumps develop, burst (release lots of bacteria!) doesn’t itch; painless can also cause hair loss, sore throat, headache, loss of appetite, nausea, muscle / joint pain, low fever sometimes symptoms are overlooked goes away in 2-6 weeks enters latent stage Secondary Syphilis Rash Latent stage of syphilis can last for years has few or no symptoms after 1 yr, bacteria can no longer be transmitted (except to fetus) 1/2 never leave latent stage 1/2 enter tertiary stage if not already treated with antibiotics Tertiary stage of syphilis bacteria has invaded tissues throughout the body causes large, tumor-like sores on skin, muscle, internal organs greatly damages heart, valves ultimately affects central nervous system > paralysis, blindness, psychotic behavior 4000 die per year in U.S. due to advanced syphilis Congenital Syphilis can be passed from mother to fetus at any stage of syphilis placenta protects baby up to 6 mo. then, bacteria enters fetal bloodstream: – – 30% miscarry 70% born with congenital syphilis and go through normal progression of disease can severely damage developing tissues of newborn; many die Diagnosis / treatment of syphilis Cultures; blood test for antibodies several antibiotics are effective curable, like gonorrhea may cause permanent damage if tertiary stage is reached Herpes genitalis most common viral STD (1 million in U.S. contract / year) incurable caused by herpes simplex type 2 virus other herpes viruses exist (cause fever blisters, cold sores, chicken pox, infectious mononucleosis) type 2 invades areas below the waist; type 1 invades above the waist 20% of infections in genital region are due to type 1 Genital Herpes Simplex Genital Herpes Simplex in Females Herpes likewise, type 2 is sometimes found in mouth sores condoms not 100% effective in preventing transmission type 2 can be transmitted by nonsexual contact Herpes: Symptoms Burning sensation followed by appearance of blisters Blisters rupture in 1-2 days; become painful ulcers Possible flu-like symptoms in males > sores occur on penis in females > on labia, clitoris, cervix, vagina, urethra, perineum Herpes Symptoms in both sexes: painful urination and coitus; sometimes fever and enlargement of lymph nodes sores heal between 1-6 weeks if virus comes into contact with eye, can cause blindness Herpes: Transmission even with no sores, virus is harbored within body in nerve cells near spinal cord a person is most infectious when sores are present; transmission at other times? sores can reappear throughout a persons lifetime Herpes: Transmission triggers for recurrence: – – – – sunlight stress menstruation sex sometimes, antibodies are developed that alleviate or stop recurrences Herpes: Treatment no cure for herpes drugs can disrupt viral reproduction some forms resistant proper hygiene helps reduce spread vaccine is currently being developed that decreases frequency of sore recurrence Herpes vaginal deliveries can result in infection of newborn: – – 25% can develop blindness, brain damage 25% develop skin lesions rarely, virus can cross placenta Human papilloma virus Over 70 strains Some cause “venereal warts” -moist, soft, cauliflower-like bumps (within 3 weeks - 8 months) appear on cervix, labia, vulva, perineum in females on penis in males, urethra, scrotum treated topically with dry ice, liquid nitrogen > warts dry up and fall off in a few days warts may recur Perianal Wart HPV Penile Warts Possible HPV on the Tongue Human papilloma virus major cause of cervical cancer (95% of cases associated with HPV) also associated with cancer of the penis, vagina, anus AIDS AIDS = acquired immune deficiency syndrome: – – – condition is caught, not inherited virus attacks immune system certain infections, cancers occur in infected persons caused by human immunodeficiency viruses (HIV) live and reproduce in helper T cells host cells die as viruses depart to infect other cells consequence: decrease in helper T cells, which are necessary for stimulating antibody production by B cells and activity of killer T cells AIDS between 4.2 and 15 years, HIV infection leads to fullblown AIDs stages: – “window period” (incubation period): – can be as long as six months virus replicates slowly; no antibodies detected “acute phase of HIV disease” (after seroconversion): lasts 2-4 weeks accompanied by flu-like illness (fever, swollen glands, muscle aches, weight loss) AIDS – – “asymptomatic phase”: little or no symptoms virus continues to replicate, destroy T cells “symptomatic phase”: opportunistic infections begin examples: bacterial skin infections, diarrhea, fever, tuberculosis AIDS T cell count less than 200 cells per microliter of blood (normal is 900-1200 cells) accompanied by one or more opportunistic infections: pneumonia neurological problems (meningitis, seizures) cancers of skin, cervix, lymph nodes death follows in about 2 years AIDS: Transmission of HIV virus is present in bodily fluids: blood, semen, cervical and vaginal secretions low levels also present in urine, saliva, tears (no evidence that virus can be transmitted by these fluids) transmitted when contaminated fluid enters another’s body risk of contraction is greatest in receptive partner during anal or vaginal intercourse common modes of transmission: use of contaminated needles, sexual contact, during pregnancy AIDS: Transmission of HIV virus does not live long outside of the body cannot be contracted from classroom activities, bathrooms, swimming pools, kissing, sharing food, coughing, sneezing, sweating, sharing utensils, giving blood Pregnancy and HIV Use of protease inhibitors during pregnancy can reduce risk of infecting fetus (25% to 8%) HIV-positive women are advised not to breastfeed