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Reproductive Health Module: Sexually Transmitted Diseases 1: HIV/AIDS Sexually Transmitted Disease: Definition A sexually transmitted disease (STD) is a disease acquired through sexual contact with an infected person STD: Classification Chlamydia Human Immunodeficiency Virus Herpes simplex Human Papillovirus (HPV) Cytomegalovirus (CMV) Gonorrhoea Syphilis Hepatitis B (HBV) Hepatitis C (HCV) STD: Transmission Portals of entry of STD micro-organisms are the skin and mucosal linings of: Urethra Cervix Vagina Rectum Oropharynx STD: Modes of Transmission Sexual Perinatal (vertical transmission from mother to foetus/ newborn in utero, at birth, through breastfeeding): HBV, HCV, chlamydia, gonorrhoea, syphilis, HIV Percutaneous in addition to sexual: HBV, HCV, HIV STD: Risk Factors High risk behaviours: Sexual relations with infected persons Multiple sexual partners Relations with prostitutes Oral or anal sex Using IV injections/ drug abuse (high risk associated behaviour) STD: Prevention Health education about risk factors/ high risk behaviour Use of a condom as a protective barrier: reduces but does not eliminate risk of transmission: “Safer sex” rather than “safe sex” STD: Public Health Challenge Sexually transmitted diseases may progress without symptoms Those persons with symptoms often reluctant to disclose and seek help: Through embarrassment (stigma) Fear of losing partner Often more than one STD co-infect Delay in diagnosis/ treatment risks health complications and transmission to others Human Immunodeficiency Virus (HIV) Human Immunodeficiency Virus: Description HIV is the causative agent of AIDS An RNA retrovirus (which transcripts DNA) Targets CD4-positive (CD4+) T lymphocytes reducing count and function May progress to severe immune dysfunction: Acquired Immune Deficiency Syndrome (AIDS) Immunosuppression leads to: Opportunistic infections Neoplasms Lymphadenopathy HIV: Transmission Transmitted in body fluids of an infected person: Blood Seminal fluid Vaginal secretions Amniotic fluid Breastmilk Blood transfusion (screening → now rare) HIV/AIDS: Pathophysiology HIV RNA retroviruses attach to CD4 cell surface receptor/ fuse with cell membrane Uncoating: viral contents empty into cell HIV enzyme reverse transcriptase copies viral genetic material to DNA: Blueprint for replication of viral RNA and repeat process Dormant infected cells reactivated against any new infection: further replicate virus HIV/AIDS: Clinical Manifestations Persistent enlargement of lymph nodes Fatigue (lack of energy) Weight loss Frequent fevers and night sweats Persistent oral or genital candida (thrush) Persistent skin rash/ flaky skin Short-term memory loss HIV/AIDS: Complications Disease progress may involve: Opportunistic Candidiasis of the bronchial tract, oesophagus Pneumocystis carinii pneumonia HIV encephalopathy Kaposi sarcoma Invasive cervical cancer/ other neoplasms Lymphoma TB Multiple associated infections Wasting HIV/AIDS: Diagnosis Patient history and clinical picture CD4 positive T cell count: (HIV destroys CD4 T cells) CD4/ CD8 ratio EIA (ELISA) enzyme immunoassay ( HIV antibodies detected) Western blot (antibodies confirm EIA) Viral load (measures HIV RNA in plasma) HIV Test Result: Patient Education Positive result: HIV antibodies are present Patient infected: HIV active in body Despite HIV infection may not have AIDS Does NOT indicate immunity to AIDS Negative result: No antibodies present at test time Not infected, or infected but no antibodies as yet (3 weeks to 6 months to develop): take precautions HIV: Anti-retroviral Agents Anti-HIV drugs attempt to block viral replication within the cells Inhibit reverse transcriptase (interfere and confuse HIV in converting RNA to DNA) Inhibit HIV protease (enzyme which cuts and disperses viral particles to new CD4+) Multiple drug protocols used AIDS: Treatment/ Prophylaxis Anti-retrovirals (HIV) Antibiotics Antiviral agents: Amphotericin B (meningitis), Alpha- interferon (Kaposi), Acyclovir, Gancyclovir Anti-fungal agents: TMP-SMZ (Pneumocystis carinii pneumonia) Anti-TB medication Anti-depressants Anti-diarrhoea medications Nutrition therapy (wasting) AIDS: Prophylactic Measures in Pregnancy Anti-retrovirals to pregnant women have reduced risk to the newborn A caesarian section may be recommended Breastfeeding should be discouraged HIV: Vaccines Uniquely difficult to produce HIV vaccine Usually vaccines activate the humoral immune response: B lymphocytes and production of antibodies (long-term memory IgG) HIV affects T lymphocytes (and also a retrovirus) Trials of HIV vaccine were discontinued as detrimental to health of participants No vaccine available at present time HIV/AIDS: Nursing Considerations Patient education related to risk factors related to infection and spread of virus Importance of complying with medication protocol Importance of maintaining healthy lifestyle, good nutrition, adequate sleep Psychological support to patient/ family Management of symptoms/ total care