Worldwide HIV/AIDS statistics: Acquired immunodeficiency syndrome (AIDS) is a leading cause of death in many parts of the world. More than 36 million people around the world are infected with the human immunodeficiency virus (HIV, the virus that causes AIDS) and most of them will die within the next 10 years. Worldwide, it is estimated that more than 57 million (almost 1% of the world’s current population) people have been infected since the epidemic began (late 1970’s - early 1980’s) and more than 21 million people have died as a result of the infection. About 10 people are infected every minute and half of these new infections are people age 15-24. U.S. HIV/AIDS statistics: Although the death rate from AIDS in the U.S. began to decline in 1996, more than 430,000 of the 750,000 Americans who had been diagnosed with AIDS by the year 2000 had died from the disease. By 2000, an estimated 650,000-1 million Americans were believed to be living with HIV – about 1 in 160 males and 1 in 800 females over the age of 12. Although the death rate from AIDS among Americans has declined, new infections are holding steady at about 40,000 people per year. STD information – STDs are a particularly insidious group of diseases because a person can be infected and be able to transmit the disease to others, yet not look or feel sick. It is important that everyone have a clear understanding of what STDs are, how they are transmitted, and – most importantly – how they are able to be prevented . However, if STDs are not prevented, many can be cured if they are detected and treated early and properly.
In general, seven different STDs pose major health threats: HIV/AIDS, hepatitis, syphilis, chlamydia, gonorrhea, herpes, and genital. These diseases are considered major because they are serious in themselves, cause serious complications if left untreated, and/or pose risks to a fetus or newborn baby. In addition, pelvic inflammatory disease (PID) is a common complication of gonorrhea and chlamydia and merits discussion as a separate disease. Chlamydia, gonorrhea, and syphilis are the bacterial STDs and are curable with antibiotics. Unfortunately, previous infection does not confer immunity, so a person can be re-infected despite treatment. HIV infection, herpes, hepatitis, and genital warts are viral STDs and are not curable with current therapies. Although antiviral drugs and other medications can help target the effects of these STDs, the virus remains in the body and may cause chronic or recurrent infection. A further risk of all STDs is that they can substantially contribute to the spread of HIV. The sores and inflammation caused by STDs allow HIV to pass more easily from one person to another.
HIV is a relatively new disease for humans. Experts believe that the virus initially spread from chimpanzees to people during the 1930’s as a result of the trapping, butchering, or eating of infected chimps. In the middle part of the 20 th century, HIV infection was relatively rare, but the disease began to spread rapidly in the 1970’s and 1980’s. Despite the best efforts of health professionals all around the world, HIV infection continues to spread, and a cure is yet to be found. What is HIV infection? HIV is the virus that causes AIDS. It affects the immune system, making an otherwise healthy person less able to resist a variety of infections. HIV infection is a chronic disease that progressively damages the body’s immune system, making an otherwise healthy person less able to resist a variety of infections and disorders. Under normal conditions, when a virus or another pathogen enters the body, it is targeted and destroyed by the immune system. But the HIV attacks the immune system itself (especially the T-cells), invading and taking over the CD4 T-cells, monocytes, and macrophages, which are essential elements of the body’s defense system (see chapter 17). When the HIV takes over the CD4 T-cell , it causes the cell to produce new copies of the HIV and the HIV makes the CD4 cell incapable of performing its immune functions. Immediately following infection, billions of HIVs are produced every day. For a time, the immune system keeps pace, also producing billions of new cells and antibodies. But unlike the virus, the immune system cannot make new cells indefinitely; and as long as the virus keeps replicating, it wins in the end. As the number of CD4 cells declines, an infected person may begin to experience mild to moderately severe symptoms. A person is diagnosed with full-blown AIDS when his or her CD4 cells in the blood drop below a certain level (200 / μl) or develop a condition defined as a marker for AIDS. People with AIDS are vulnerable to a number of serious, often fatal secondary, opportunistic infections . The infections that most often prove deadly for people with HIV are seldom serious in people with a healthy immune system. An asymptomatic period of HIV infection can last from about 2 to 20 years, with an average of 11 years in untreated adults. During this time the virus is progressively infecting and destroying the cells of the immune system. People infected with HIV can pass the virus to others – even when they have no symptoms and even if they do not know they have been infected. These asymptomatic individuals, unaware that they are infected but with high viral levels, are responsible for much of the spread of HIV. Transmitting the virus –HIV is carried in blood and blood products, semen, vaginal and cervical secretions, and breast milk. HIV is transmitted through the exchange of these fluids. Populations of special concern for HIV – Among American with AIDS, the most common means of exposure to HIV has been sexual activity between men. The next most common are injection drug use (IDU) and heterosexual contact. The screen of all donated blood has drastically slowed the rate of this type of HIV transmission. HIV in the U.S. is increasingly becoming a disease that disproportionately affects minorities, women, children, and the poor. The rate of HIV infection is 8 times higher in African Americans than it is in whites, and the rate of HIV infection among Hispanics is twice that of whites. African American and Hispanic women account for nearly 80% of new HIV cases among women in the U.S. In 2000, 85% of children reported with AIDS were African American or Hispanic. Most HIV infection among whites in the U.S. is due to sexual contact between men. About half of all HIV infection among minorities in the U.S. is due to IDU. Of young women with AIDS, more than half were infected through heterosexual contact, often with an injection drug user. Symptoms of HIV infection – Symptoms of acute HIV infection are similar to those with a viral infection. Months or even years later, a variety of symptoms signal a weakened immune system which can lead to other infections. Diagnosing HIV infection – Early diagnosis of HIV infection is important to minimize the impact of the disease. The most common tests for HIV check for the presence of antibodies to the virus. Diagnosing AIDS – AIDS is the most severe form of HIV infection. Specific criteria are used to diagnose AIDS. Reporting – All diagnosed cases of AIDS must be reported to public health authorities. With the development of more effective treatments, the length of time that it takes HIV to turn into AIDS has increased for many patients; therefore, making predictions and tracking more difficult. For this reason, the CDC recommended in 1999 that states require reporting of both HIV infection and AIDS. Despite efforts to safeguard confidentiality and prohibit discrimination, mandatory reporting of HIV infection remains controversial. If people believe they are risking their jobs, friends, etc, they may be less willing to be tested. Treatment – Drugs have been developed to slow the course of the disease and to prevent or treat certain secondary infections. What about a vaccine? There is currently no cure or vaccine for HIV infection. Prevention – HIV infection can be prevented by making careful choices about sexual activity, not sharing drug needles, and learning about how to protect oneself form contracting HIV.
HIV only lives within the cells and body fluids, not outside the body. It cannot live in air, in water, or on objects or surfaces such as toilet seats, eating utensils, or telephones. The three main routes of HIV transmission are: Sexual contact – HIV is more likely to be transmitted by unprotected anal or vaginal intercourse than by other sexual activities. Being the receptive partner during unprotected anal intercourse is the riskiest of all sexual activities. Oral sex is responsible for a small, but significant number of cases of HIV transmission. HIV can be transmitted through tiny tears in the fragile lining of the vagina, cervix, penis, anus, and mouth and through direct infections of cells in some of these areas. The presence of lesions, blisters, or inflammation from other STDs in the genital, anal, or oral areas makes it 2-9 times easier for the virus to be passed. In addition, any trauma or irritation of tissues, such as might occur from rough or unwanted intercourse, increase the risk. Spermicides may also cause irritation and increase the risk of HIV transmission. During vaginal intercourse, male-to-female transmission is more likely to occur than female-to-male. HIV has been found in pre-ejaculatory fluid, so transmission can occur before ejaculation. Direct contact with infected blood – Needles used to inject drugs (including heroin, cocaine, and anabolic steroids) are routinely contaminated by the blood of the user. If needles are shared, small amounts of one person’s blood are directly injected into another person’s bloodstream. HIV may be transmitted through subcutaneous and intramuscular injection, as well as from needles or blades used in acupuncture, tattooing, ritual scarring, and piercing of all parts of the body. Nearly half of all new cases of HIV in the U.S. are caused, directly or indirectly, by sharing drug injection equipment contaminated with HIV. Although HIV has been transmitted in blood and blood products used for medical treatment, the blood supply in all licensed blood banks and plasma centers in the U.S. is now required to be screened for HIV. The odds are less than 1 in 650,000 that a unit of HIV-infected donated blood will fail to be detected with today’s testing methods, and new genetic tests may further reduce the risk. Unfortunately, the blood supply in the rest of the world is much less safe. A small number of healthcare workers have acquired HIV on the job, most of which were acquired through an accidental needle stick. The likelihood of a patient acquiring HIV infection from a healthcare worker is almost negligible. Trace amounts of HIV have been found in the saliva and tears of some infected people. However, researchers believe that these fluids do not carry enough of the virus to infect another person. HIV has been linked to deep kissing or biting, but oral sores (and traces of blood) were also present, so it is unlikely that saliva transmitted the virus. HIV has been found in urine and feces of an infected person and contact may carry risk. Contact with an infected person’s sweat is not believed to carry any risk. There is absolutely no evidence that HIV can be spread by insects such as mosquitoes. Mother-to-child transmission – This is also called vertical or perinatal transmission. It can occur during pregnancy, childbirth, or breastfeeding. About 25-30% of infants born to untreated HIV-infected mothers are also infected with the virus. Primarily because of voluntary HIV testing and treatment of pregnant women, the number of new cases of AIDS diagnosed each year among U.S. children has declined more than 80% since 1992. Not through casual contact – A person is not at risk of getting HIV infection by being in the same classroom, dining room, or even household with someone who is infected.
Symptoms of HIV Infection - Within a few days or weeks of HIV infection, about half the people develop symptoms of acute HIV infection. These symptoms are almost flu-like (or viral) and include: fever, fatigue, rashes, headaches, swollen lymph nodes, body aches, night sweats, sore throat, nausea, and diarrhea. Many times the condition goes undiagnosed at its early stages. Other than the flu-like symptoms, most people in the first months or years have few if any symptoms. As the immune system weakens, a variety of symptoms can develop – persistent swollen lymph nodes; lumps, rashes, sores, or other growths on or under the skin or on the mucous membranes of the eyes, mouth, anus or nasal passages; persistent yeast infections; unexplained weight loss; fever and drenching night sweats; dry cough and shortness of breath; persistent diarrhea; easy bruising and unexplained bleeding; profound fatigue; memory loss; difficulty with balance; tremors or seizures; changes in vision, hearing, or smell; difficulty in swallowing; and persistent or recurrent pain. Because the immune system is weakened, people with HIV infection are highly susceptible to infections. The infection most often seen among people with HIV is Pneumocystis carinii pneumonia, a protozoal infection. Kaposi’s sarcoma, a rare form of cancer, is common in HIV-infected men. Cases of tuberculosis (TB) are increasingly being reported in people with HIV. Diagnosing HIV Infection - Diagnosis in a very early stage, although uncommon, is extremely beneficial. Immediate treatment may help preserve immune function, slow the progress of the disease, and reduce transmission of HIV to others. Therefore, those people who have engaged in behavior that puts them at risk for HIV and experiences symptoms of acute HIV infection, should see a physician immediately. An HIV RNA assay, a specialized test which measures the amount of the virus, must be used to diagnose HIV in the very early stages of infection. Typically diagnosis occurs using tests that check (screen) the blood for the presence of antibodies to the virus. (Unfortunately, these antibodies do not protect against the spread of the disease or indicate protective immunity. In the case of HIV, the presence of antibodies indicate an active case of the disease). HIV antibody tests are used for screening because they are accurate and relatively inexpensive. An initial test, called an ELISA, is performed; if it is positive, a second test called a Western blot is done to confirm the results. Not everyone with HIV infection will test positive on antibody tests, however. Antibodies may not appear in the blood for weeks or month after infection, so people who are newly infected are likely to have a negative antibody test. If a person is diagnosed HIV-positive, the next step is to determine the current severity of the disease in order to plan appropriate treatment. The status of the immune system can be gauged by taking CD4 T-cell measurements every few months. The infection itself can be monitored by tracking the amount of virus in the body through HIV RNA assay. Although rates vary from state to state, surveys indicate that about 40% of adults in the U.S. have been tested for AIDS. The majority of those were tested to obtain insurance, enter the military, or for employment reasons, about 20% were for personal or health reasons.
Diagnosing AIDS – The CDC’s criteria for a diagnosis of AIDS reflect the stage of HIV infections at which a person’s immune system becomes dangerously compromised. Since January 1993, a diagnosis of AIDS has been made if a person is HIV-positive and either has developed an infection defined as an AIDS indicator or has a severely damaged immune system (as measured by CD4 T-cell counts).
Although AIDS is currently incurable, it is preventable. You can protect yourself by avoiding behaviors that may bring you into contact with HIV. It means making careful choices about sexual activity and not sharing needles for injection drug users. Make careful choices about sexual activity – In a sexual relationship, the current and past behaviors of you and your partner determine the amount of risk involved. If you are uninfected and in a mutually monogamous relationship with another uninfected person, you are not at risk for HIV. Having a series of monogamous relationships is not a safe prevention strategy. Other than a single long-term monogamous relationship, abstinence from any sexual activity that involves the exchange of body fluid is the only sure way to prevent HIV infection. Safer sex practices are those activities that carry virtually no risk of HIV infection such as hugging, rubbing, closed lip kissing, etc. Anal and vaginal intercourse are the sexual activities associated with the highest risk of HIV infection. If you have intercourse, always use a latex condom. Condoms are not perfect, and they do not provide risk-free sex, but when used properly, a latex condom provides a high level of protection against HIV. Condoms should also be worn during oral sex. Limiting the number of partners you have lowers your risk of exposure to HIV. Talking about sex may seem embarrassing and uncomfortable, but good communication is critical for your health. Asking a partner about past sexual experiences can be helpful, but you cannot always depend on that information because people lie. Removing alcohol and other drugs from sexual activity is another crucial component of safer sex. Alcohol and other drugs affect judgment and lower inhibitions, making one more likely to engage in unsafe sex. Don’t forget, you can’t tell if someone is infected by looking at him or her. Be proactive and assertive. Consider in advance what you will say and do in particular situation. Unfortunately, surveys of college students indicate that the majority of students engaging in sexual activity are not practicing safer sex. Unhealthy attitudes and behaviors put college students at continued high risk for contracting HIV. If you put yourself at risk, get tested for HIV and other STDs as often as appropriate. Remember, if you are sexually active take responsibility. Don’t share drug needles – People who inject drugs should avoid sharing needles, syringes, or anything that might have blood on it. Cleaning methods are unreliable and HIV can survive in a syringe for a month or longer. If you are an injection drug user, your best protection against HIV is to obtain treatment and refrain from using drugs. Participate in an HIV education program –The attitude of “It won’t happen to me” is prevalent among high school and college students and is a major stumbling block to HIV/AIDS prevention. Accurate information, healthy attitudes and skills, practiced and exhibited as safe behaviors are the foundations of effective educational programs. Peer influence and role playing have been shown to be effective in the behavior change process. Together, individual responsibility and education can lead to controlling this devastating epidemic.
Chlamydia is the most prevalent bacterial STD in the U.S. About 3 million new cases occur each year, down from a high of about 4 million. The drop is likely due to increased screening and treatment. An estimated 5-10% of all sexually active American women and men are infected with chlamydia. The highest rates of infection occur in single people between the ages of 18-24. Both men and women are susceptible to chlamydia, but as with most STDs, women bear the greater negative potential health effects. In most women, chlamydia produces no early symptoms. If left untreated, it can lead to pelvic inflammatory disease (PID), which in turn can cause infertility because of scarring. Chlamydia greatly increases a woman’s chance of ectopic pregnancy. Sexually active women should have routine pelvic exams. Chlamydia may also lead to infertility in men, but not as often as women. In men under age 35, chlamydia is the most common of epididymitis and is involved with up to half of the cases of urethritis. Symptoms – In men, the symptoms include painful urination, a slight watery discharge from the penis, and sometimes pain around the testicles. However, many men have no symptoms. Most women are asymptomatic, but some notice increase vaginal discharge, burning with urination, pain or bleeding with intercourse, and lower abdominal pain. Less common symptoms in both men and women include arthritis, conjunctivitis, and rectal inflammation and pain. Symptoms in both men and women can begin within 5 days. Unfortunately, most people experience few or no symptoms, increasing the likelihood that they will not be treated and inadvertently spread the infections to others.
Diagnosis – Chlamydia is typically diagnosed through laboratory tests. Specimens are usually obtained by collecting a urine sample or a small amount of fluid from the urethra or cervix with a swab. Treatment – Once diagnosed, the infected person and his or her partner(s) are given antibiotics. Treatment of partners is important because people who have been treated for chlamydia are susceptible to getting the disease again if they have sexual contact with an infected person.
An estimated 700,000 new cases of gonorrhea are diagnosed every year in the U.S. The highest incidence is among 15-24 year olds. Like chlamydia, untreated gonorrhea can cause PID in women (up to 40%) and urethritis and epididymitis in men. It can also cause arthritis, rashes, and eye infections and it occasionally involves internal organs. A woman who is infected during pregnancy is at risk for preterm delivery and for having a baby with life-threatening gonorrheal infection of the blood or joints. An infant passing through the birth canal of an infected mother may contract gonococcal conjunctivitis, an infection in the eyes that can cause blindness if not treated. In most states, all newborn babies are routinely treated with antimicrobial eye-drops to prevent eye infection. Gonorrhea is caused by a bacteria which flourishes in mucous membranes, such as the mouth, throat, vagina, cervix, urethra and anus. It cannot survive outside the warm, moist environment of the human body and dies within moments of being exposed to air or light. Consequently, it cannot be contracted from toilet seats, towels, or other objects. Symptoms – In males, the incubation period is brief, generally 2-7 days. The first symptoms are due to urethritis, which causes urinary discomfort and thick, yellowish-white or yellowish-green discharge from the penis. The urethral opening may become swollen. Up to half of all males have very minor symptoms or no symptoms at all. Most infected females are also asymptomatic. Those who do have symptoms often experience urinary pain, increased vaginal discharges, and severe menstrual cramps. Gonorrhea can also infect the throat or rectum of people who engage in oral or anal sex.
Diagnosis – Several test – gram stain, detection of bacterial genes or DNA, or culture – may be performed. Depending on the test, samples of urine or cervical, urethral, throat, or rectal fluids may be collected. Treatment – A variety of new and relatively expensive antibiotics are usually effective in curing gonorrhea. Older, less expensive antibiotics, such as penicillin and tetracycline are not currently recommended for treating gonorrhea because of widespread drug resistance. People with gonorrhea often also have chlamydia, so additional antibiotics are typically given to treat chlamydia.
PID is a major complication in 10-40% of women who have been infected with either gonorrhea or chlamydia and have not received adequate treatment. PID occurs when bacterium travel beyond the cervix into the uterus, oviducts, ovaries and pelvic cavity. PID is often serious enough to require hospitalization and sometimes surgery. Even if the disease is treated successfully, about 25% of affected women will have long-term problems such as a continuing susceptibility to infection, ectopic pregnancy, infertility, and chronic pelvic pain. It is the leading cause of infertility in young women, often undetected until later, when the inability to become pregnant leads to further evaluation. Young women under age 25 are much more likely to develop PID. As with all STDs, the more sex partners a woman has had, the greater her risk of PID. Smokers have twice the risk of PID as nonsmokers. Using IUDs for contraception and vaginal douching also increase the risk of PID. Symptoms – Symptoms vary greatly. Some women, especially those with PID from chlamydia, may be asymptomatic. Others may feel very ill with abdominal pain, fever, chills, nausea, and vomiting. Early symptoms are essentially same as described for chlamydia and gonorrhea. Symptoms often begin or worsen during or soon after a woman’s menstrual period. Many women have abnormal vaginal bleeding – either bleeding between periods or heavy and painful menstrual bleeding.
Diagnosis – Diagnosis of PID is made on the basis of symptoms, physical exams, ultrasound, and laboratory test. Laparoscopy may be used to confirm the diagnosis and obtain material for cultures. Careful diagnosis is made because symptoms of PID, ectopic pregnancy, and appendicitis can be quite similar. Treatment – Starting treatment of PID as quickly as possible is important in order to minimize damage to the reproductive organs. Antibiotics are usually started immediately. In severe cases, the woman may be hospitalized and antibiotics given intravenously. It is especially important that an infected woman’s partner(s) be treated. As many as 60% of the male contacts of women with PID are infected with an STD, but asymptomatic.
Genital warts are also known as condyloma and are caused by infection with the human papillomavirus (HPV). The CDC estimates that more than 20 million people in the the U.S. have this persistent viral infection, and another 5.5 million people are infected each year. Approximately, 15% of Americans age 15-49 have HPV infection and are contagious. The vast majority of these people have no visible warts and have no idea that they are infected with HPV. Rates are even higher among college students. Condyloma is the most common STD for which diagnosis and treatment are sought in student health services. The disease appears to be most prevalent in young people age 16-25. HPV infection presents a challenge to the medical community because of its known relationship to cervical cancer. A precancerous condition known as cervical dysplasia often occurs among women with genital HPV infection. If untreated, women with this condition sometimes develop cervical cancer. Recent evidence also suggests that HPV infection also speeds the progression of HIV/AIDS. HPV causes many types of human warts. There are more than 100 different strains of HPV, and different strains infect specific locations. More than 20 types are likely to cause genital infections, and five of these are are often linked to cervical cancer. Genital HPV is very contagious. Condoms and other barrier methods can help prevent the transmission of HPV, but HPV infections frequently occurs in areas where condoms are not fully protective. These areas are the labia in women, the base of the penis and the scrotum in men and around the anus in both men and women. Symptoms – Genital warts can look like warts that are seen on other parts of the body. Untreated warts can grow together to form a cauliflower-like mass. In males, they appear on the penis and often involve the urethra, appearing first at the opening and then spreading inside. In women, warts may appear on the labia or vulva, and may spread to the perineum, the area between the vagina and the rectum. The incubation period ranges from 1 month to 2 years from the time of contact. People can be infected with the virus and be capable of transmitting it to their sex partners without having any symptoms at all. The vast majority of people with HPV infection have no visible warts or symptoms of any kind. Diagnosis – Genital warts are usually diagnosed based on the appearance of the lesions. Sometimes examination with a special magnifying instrument or biopsy is done to evaluate suspicious lesions. Frequently, HPV infection of the cervix is detected on routine Pap tests. Special tests are now available to detect the presence of HPV infection including the strains of HPV that cause most cases of cervical cancer. These tests are not yet widely used. Treatment – Treatment of genital warts focuses on reducing the number and size of warts. The currently available treatments do not eradicate HPV infection. Warts may be removed by cryosurgery (freezing), electrocautery (burning), or laser surgery. Direct applications of podophyllin or other cytotoxic acids may be used. Two treatments are also available for patients to use at home. Even after treatment and the disappearance of visible warts, the individual may continue to carry HPV in healthy-looking tissue and can probably still infect others. Anyone who has ever had HPV should inform all partners
Genital herpes affects about 45 million people in the U.S. and is also very common worldwide. It plays a significant role in HIV infection because the sores associated with genital herpes facilitate the transmission of HIV. Two types of herpes simplex, HSV-1 and HSV-2, cause genital herpes and oral-labial herpes (cold sores). Genital herpes is usually caused by HSV-2, and oral-labia herpes is usually caused the HSV-1, although both virus types can cause either genital or oral-labia lesions. HSV-1 infection is so common that 50-80% of U.S. adults have antibodies to HSB-1 (indicating previous exposure to the virus). Most adults were probably exposed to HSV-1 during childhood. HSV-2 infection usually occurs during adolescence and early adulthood, often between ages 18 and 25. Approximately 22% of adults – nearly 1 in 4 have antibodies to HSV-2 and about a million are infected each year. HSV-2 is almost always sexually transmitted. The infection is more easily transmitted when people have active sores, buy HSV-2 can be transmitted to a sex partner even when no lesions are present. Because HSV is asymptomatic in 80-90% of people, the infection is often acquired from a person who has no awareness that he or she is infected. The risk of mother-to-child HSV transmission is low (less than 1%), but can have very serious effects. Symptoms – Up to 90% of people who are infected with HSV have no symptoms. Those that do develop symptoms often first notice them with 2-20 days after having sex with an infected partner (although it could be month or years later). The first episode of genital herpes frequently cause flu-like symptoms in addition to genital lesions. The lesions usually heal within 3 weeks, the the virus remains alive in an inactive state (latent) within nerve cells. A new outbreak of herpes can occur at any time. On average, newly diagnosed people will experience 5-8 outbreaks per year, with a decrease in the frequency of outbreaks over time. Diagnosis – Genital herpes is often diagnosed on the basis of symptoms. A sample of fluid from the lesions may also be sent a lab for evaluation. A new blood test that can determine if a person in infected with HSV-1 or HSV-2 is now available and may potentially alert many asymptomatic people to the fact that they are infected. Treatment – There is no cure for herpes. Once infected, a person carries the virus for life. Medications are available to shorten the severity and duration of outbreaks, and in some cases suppress the frequency of outbreaks. Support groups are available to help people learn to cope with herpes.
Hepatitis is inflammation of the liver. It can cause serious and sometimes permanent damage to the liver, which can result in death in severe cases. One of the many types of hepatitis is caused by hepatitis B virus (HBV). HBV is somewhat similar to HIV. It is found in most body fluids, and it can be transmitted sexually, by injection drug use (IDU), and during pregnancy and delivery. However, HPV is much more contagious than HIV and it can be spread through nonsexual close contact. Health care workers who are exposed to blood are frequently infected, as are people who live in close contact with each other, such as prisoners and residents of mental health care facilities. In the Far East and in developing countries, hepatitis B is extremely common, and the virus is primarily transmitted from the mother to child during pregnancy or delivery. HBV is a potentially fatal disease with no cure, but fortunately there is an effective vaccination. The number of cases of acute HBV in the U.S. has dropped by more than 50% in the past decade, primarily as a result of the vaccine. Vaccination is recommended for everyone under age 19 and for all adults at increased risk for hepatitis B. Transmission – HBV is found in all body fluids, including blood and blood products, semen, saliva, urine, and vaginal secretions. It is easily transmitted through any sexual activity that involves the exchange of body fluids, the use of contaminated needles, and any blood to blood contact, including the use of contaminated razor blades, toothbrushes, and eating utensils. The primary risk factors for acquiring HBV are sexual exposure and IDU. Symptoms – Many people infected with HBV never develop symptoms and are known as “silent infections.” The normal incubation period is about 30-180 days. Mild cases of hepatitis cause flu-like symptoms. As the illness progresses, there may be nausea, vomiting, dark-colored urine, abdominal pain, and jaundice. Some people also develop a skin rash and joint pain or arthritis. People with HBV sometimes recover completely, but they can also become chronic carriers of the the virus, capable of infecting others for the rest of their lives. Some develop chronic liver disease which can cause cirrhosis, liver failure and a deadly form of liver cancer. Hepatitis kills about 6000 Americans each year and worldwide over 1 million. Diagnosis – Blood tests can be used to diagnose hepatitis through analysis of liver function and detection of the specific organism causing the infection.
Treatment – There is no cure for HBV and no specific treatment for acute infection. Prevention – Preventive measures for HBV are similar to those for HIV infection. Avoid sexual contact that involves sharing body fluids and don’t share needles. If you choose to have tattooing or body piercing done, make sure all needles and equipment are sterile. The vaccine for hepatitis B is safe and highly effective.
Syphilis is a disease that once caused death and disability for millions, but now can be effectively treated with antibiotics. Each year, there are about 7000-10,000 new cases of early syphilis in the U.S. and about 70,000 people are diagnosed at all stages of the disease. The number of new cases hit an all-time low in 1999, and most were clustered in a few countries in the south and northeast. Syphilis is unfortunately still very common in developing countries and a major cofactor in the transmission of HIV. Syphilis is caused by a spirochete, a thin, corkscrew-shaped bacterium. The disease is usually transmitted through sexual contact, although infected pregnant women can transmit it to the fetus causing various complications. The pathogen passes through any break or opening in the skin or mucous membranes and can be transmitted by kissing, vaginal or anal intercourse, or oral-genital contact. Although easy to treat, syphilis can be difficult to recognize; and if left untreated, the disease can cause devastating damage to almost any system in the body. Symptoms – Syphilis progresses through multiple stages. Primary syphilis is characterized by an ulcer called a chancre that appears within about 10-90 days after exposure. The chancre is usually found at the site where the organism entered the body, such as the genital area, but it may also appear in other sites such as the mouth, breast, or fingers. Chancres contain large numbers of bacteria and make the disease highly contagious when present. They are often painless and typically heal on their own within a few weeks. If the disease is not treated during the primary stage, about a third of infected individuals progress to chronic stages of infections. Secondary syphilis is usually marked by mild, flu-like symptoms and a skin rash that appears 3-6 weeks after the chancre. The rash may cover the entire body or only a few areas, but the palms of the hands and soles of the feet are usually involved. Areas of skin affected by the rash are highly contagious but usually heal within several weeks or months. If the disease remains untreated, the symptoms of secondary syphilis may recur over a period of several years. Affected individuals may then lapse into an asymptomatic latent stage in which they experience no further consequences of infection. However, in about a third of cases of untreated secondary syphilis, the individual develops late or tertiary syphilis . Late syphilis can damage many organs of the body, possibly causing severe dementia, cardiovascular damage, blindness, and death. Diagnosis – Syphilis is diagnosed by the examination of infected tissues and with blood tests. Treatment – All stages can be treated with antibiotics, but damage from late syphilis is permanent.
Trichomoniasis – This is often called “trich.” It is a common protozoal STD, with about 5 million cases per year. The single-celled organism thrives in warm, moist conditions, making women particularly susceptible to infections in the vagina. The pathogen can remain alive on external objects for as long as 60-90 minutes, in urine for 3 hours, and in seminal fluid for 6 hours. Thus it is possible, although rare, to contract trich by nonsexual means. Women who become symptomatic develop a greenish, foul-smelling vaginal discharge 5-28 days after transmission. The discharge can cause sever itching and irritation of the vagina and vulva, causing redness and pain. Although most males do not have any symptoms, some may experience slight itching, clear discharge, and sometimes painful urination. Diagnosis is done with analysis of the discharge. Drugs are available to treat the infection. Partners also need to be treated to prevent the “ping-pong” effect. Treatment is also important because in may increase the risk of HIV transmission and a pregnant woman’s chances for premature delivery. Bacterial vaginosis (BV) – is the most common cause of abnormal vaginal discharge in women of reproductive age. BV involves a shift of the bacteria that normally inhabit the vagina. BV is clearly associate with sexual activity, often occurring after a change in partners. Research is ongoing regarding the cause, the long-term effects ,transmission of BV, and its relationship to other more serious STDs. Topical and oral antibiotics are used to treat BV, but it often reoccurs after treatment. Symptoms included a vaginal discharge with a fishlike odor and in some cases, vaginal irritation. Many women have no symptoms. Chancroid – In the U.S., this is a relatively uncommon bacterial STD, although there are periodic outbreaks. It is characterized by painful open sores in the genital area that may resemble herpes or syphilis. Other symptoms may include painful urination and vaginal discharge. Chanchroid is treated with antibiotics. It also increases the risk of HIV transmission. Pubic lice (crabs) – These are highly contagious, both sexually and nonsexually. Crabs are often difficult to see, but are the color and size of small freckles until they have fed, and then they become dark brown in color. Like mosquitoes, lice feed on human blood. Pubic lice are usually attached to pubic hair, but have been know to attach themselves to hair on the head, eyelashes, underarms, and even mustaches and beards (head lice is a different species than pubic lice). Separated from their human hosts, lice can survive for about 24 hours. Crabs are easily passed from person to person, but can also be transmitted from bedding, clothing, toilet seats, etc. Intense itching is the usual symptom, and with careful examination, both the parasite and its eggs, or nits, can be seen. Treatment is generally easy, although the infestation can require repeated application of nonprescription medications. These preparations are in lotion or shampoo form and include a fine comb for removing any remaining lice or nits. Carefully washing clothing and linen is also essential for preventing reinfestation. Scabies – This is a burrowing parasite that is also fairly common. The scabies mite deposits eggs beneath the skin, especially in the creases of the body. The eggs hatch in a few days, and the new mites congregate around hair follicles. The burrowing parasite produces intense itching, especially at night. The usual sites of infestation are between the fingers, on wrists, in armpits, underneath the breasts, along the inner surfaces of the thighs, penis and scrotum and occasionally the female genitals. They are easily transmitted directly or indirectly. Diagnosis is made by identification of the mites or eggs by scrapings taken from the infested areas. Scabies are treated with medicated cream and clothing and bedding must be washed to prevent reinfestation.
Remember, approaches to STD prevention that do not work include urinating or douching after intercourse, engaging in oral sex, or genital play without penetration. Many forms of contraception may prevent pregnancy, but do not prevent the transmission of STDs. The decision to have a sexual relationship is accompanied by many uncertainties and risks, both physical and psychological. It also carries with it many responsibilities. Being mature enough to communicate and to accept the consequences associated with sexual behavior are critical to your well-being and the well-being of others. Prevention – All STDs are preventable. The key to prevention is practicing responsible sexual behaviors. Those who are sexually active are safest with one mutually monogamous uninfected partner. Using a condom properly with every act of sexual intercourse helps protect against STDs (see the next slide).
You can take responsibility for your health and contribute to a general reduction of the incidence of STDs in the three following areas: Education – Since the AIDS epidemic began, public and private agencies have grown more serious about educating the public and increasing their awareness of all STDs. This campaign may already be paying off in changing attitudes and sexual behaviors, at least among certain segments of the population. Education efforts have been multifaceted. Although information about STDs is widely disseminated, learning about STDs is still up to every person individually. You must assume responsibility for learning about the causes and nature of STDs and their potential effects on you, the children you may have, and others with whom you have relationships. Once you know about STDs, you are in a position to educate others. Providing information to your friends and partners, whether in casual conversation or in more serious decision-making discussions, is an import way that you can make a difference in your own wellness and that of others.
Diagnosis and Treatment – This involves: being alert for symptoms in yourself (perform self-exams) and your partner; getting tested (just because you don’t have any symptoms, doesn’t mean you shouldn’t be tested), informing partners (this isn’t easy and help is available, but it’s the responsible thing to do), and following treatment instructions carefully (With the exception of HIV, treatments are safe and generally inexpensive. Don’t stop taking the medication just because you’re feeling better or the symptoms have disappeared).
Sexually Transmitted Diseases Chapter 18
Acquired ImmunodeficencySyndrome (AIDS) Leading cause of death in many parts of the world. 36 Million people around the world are infected with Human Immunodeficency Virus (HIV). HIV is the virus which causes AIDS. 2
Sexually Transmitted Diseases (STD’s) Gonorrhea, genital warts, chlamydia, herpes, and syphilis have a high incidence among Americans. United States has the highest rate of STD’s among any developed nations. 6
HIV Infection and AIDS By 2000, an estimated 650,000 – 1,000,000 Americans were believed to be living with HIV. 1 in 600 males and 1 in 800 females over the age of 12. What is HIV Infections? HIV attacks and invades CD4 T-cells. AIDS opens the possibility for a opportunistic infections. Once initial symptoms resolve, the asymptomatic period may last from 2 to 20 years. 7
Transmitting the Virus HIV lives only within cells and body fluids. Transmitted by blood, blood products, semen, vaginal and cervical secretions, and breast milk. Sexual contact. Direct contact with infected blood. Mother-to-Child transmission. Not through casual contact. 8
Symptoms of HIV Infection HIV RNA assay. Flu like symptoms. Pneumocystis Carinii pneumonia. Kaposis sarcoma. 9
Diagnosing AIDS Infection defined as an AIDS indicator. Severely damaged immune system (CD4 T-cell counts). Reporting. Treatment. Antiviral drugs. Reverse transcriptase inhibitors. Zidovudine (AZT). Protease inhibitors. Highly active antiretrovial therapy (HAART). Structured intermittent therapy. Post-Exposure prophylaxis. Treatment for opportunistic infections. 10
Common Sexually TransmittedInfections in College It is estimated that 20-25% of college students are or have been infected with an STD. Most common: Chlamydia. Genital warts (HPV). Herpes. 14
Signs and SymptomsIf You or Your Partner Show Any of These Signs See a Physician Bleeding Warts Boils Blisters Burning sensation Cervicitis Irritations Growths Odors Itches Pains Painful intercourse Pus Rashes Sores Swellings Tenderness Ulcers Urine changes Vaginal yeast infections 15
Chlamydia Trachomatis Bacterial infection - Can cause sterility in men and women WOMEN infects the cervix and to urethra, fallopian tubes & ovaries, PID, bladder infections. MEN- Epididymitis, urethra to testes, bladder infections, watery discharge. Symptoms –ASYMPTOMATIC : Discharge, pain and burning while urinating, vaginal bleeding, painful intercourse, abdominal pain, nausea, fever, inflammation of rectum or cervix, swelling and pain in the testes. 16
Chlamydia Trachomatis Spread - vaginal and anal intercourse, from the birth canal to the fetus Diagnosis - Examination of tissue samples or urine Treatment - Both partners treated fully with antibiotics Protection - Condoms and safe sex 17
Gonorrhea Bacterial infection - Can cause sterility, arthritis and heart problems PID, can cause ectopic pregnancy, premature labor and still birth, arthritis, rashes Symptoms –Asymptomatic - Frequent burning urination, menstrual irregularities, pelvic pain, discharge Males – thick yellow-white discharge, painful urination, 19
Gonorrhea Spread - Vaginal, anal and oral sex. Diagnosis - Microscopic exam of discharge. Treatment - Oral antibiotics - People often have chlamydia at same time. Protection - Condoms and safe sex. 20
Pelvic Inflammatory DiseasePID Progressive infection that harms a women’s reproductive system. Can lead to sterility, ectopic pregnancy and chronic pain - treated or not. Caused by chlamydia and gonorrhea. Symptoms - long and painful periods, discharge, spotting, low abdominal pain, fever, chills, nausea, vomiting, pain during intercourse. 23
Pelvic Inflammatory Disease PID Treatment - Antibiotics, bed rest, sexual abstinence and maybe surgery to remove scarring Diagnosis - Pelvic Exam, cultures, laparoscopy Protection - Condoms and safe sex 24
Human Papilloma VirusGenital Warts 20 million men and women are infected Symptoms How is it spread Diagnosis Treatment Protection 25
Genital Herpes Herpes-1 cold sores and fever blisters Both can cause miscarriages or still births along with serious health issues of newborns Symptoms How it is spread Common symptoms Diagnosis Treatment Protections 28
Herpes Two forms - Herpes simples virus-1 and -2. Type 1 is associated with cold sores and fever blisters. Both are sexually transmitted. 45 million have been diagnosed - 1 million per year. Remains in the body for life. Symptoms - Recurring rash, pain ulcerations. Primary outbreak - pain and discomfort around infected area, itching, burning during urination. 2-20 days after infection - may years before outbreak. 29
Herpes Spread - Touching, sexual intimacy - including kissing, vaginal, oral and anal sex Diagnosis - Examination of sores and culturing of fluid taken from sores Treatment - No cure - symptoms are relieved by drugs Protection - Refrain for sex during out break 30
Hepatitis B Virus (HBV) Can cause liver disease and death -Preventable with vaccination. 750,000 total acquired sexually Symptoms - Extreme fatigue, headache, fever, hives, lack of appetite, nausea, vomiting, tenderness in lower abdomen Spread - Semen, saliva, blood and urine Diagnosis - Blood Test 33
Hepatitis B Virus (HBV) Treatment - None, clears up within 4-8 weeks. Some remain contagious for the rest of their lives. Protection - No contact during infection. Children and adults who do not have HBV can get permanent protection with a series of HBV vaccinations. 34
Syphilis Syphilis organism remains in the body for life and leads to disfigurement, neurological disorders, or death. Effective antibiotics and condom use. Symptoms - Primary phase- 3 weeks - 90 days - painless sores and wet ulcers, swollen glands. Secondary Phase - 3-6 weeks - up to 2 years body rash, mild fever, fatigue, sore throat, hair loss. Late phase - Damage to organs and nervous system. 35