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2.std's
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2.std's

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  • 1. COMMUNICABLE DISEASES STDs
  • 2. Sexually transmitted infection  Sexually transmitted infection (STI) are Infections that may be transmitted through intimate contact with the genitals, mouth, or rectum of another individual  May spread by other routes such as blood or body fluids 
  • 3. Important ways to help those with STDs  Be kind  Polite  Nonjudgmental  Sensitive to the patient’s communication  Maintain an open posture and eye contact
  • 4. List psychological & physical complications STD may produce  Tremendous suffering through pain  Scarring of genitourinary structures  Damage to other body organs  Infertility  Birth defects  Nervous system damage  Throat and mouth cancers
  • 5. List psychological & physical complications STD may produce  Development of cancer  Death of infected patients and sometimes their children  Guilt about passing on an incurable disease to a loved one  Feelings of betrayal because of being infected as a result of someone else’s choice
  • 6. DEFINE THE FOLLOWING:           Vulvovaginitis Urethritis Mucopurulent cervicitis Proctitis and enteritis Genital ulcers Condylomatous Pelvic inflammatory disease Cervicitis Endometritis Salpingitis
  • 7. Vulvovaginitis  Inflammation of the vulva and vagina  Can be asymptomatic or involve redness, itching, burning, excoriation, pain, swelling of the vagina and labia, and discharge
  • 8. Vulvovaginitis  CAUSE:  Variety of sexually transmitted and nonsexual transmitted infectious agents  SYMPTOMS:  Odor and discharge  Bartholin’s gland may develop an abscess as a result of infection with non-sexually transmitted microbes  STDs such as gonorrhea and Chlamydia
  • 9. Urethritis  Inflammation of urethra caused by infection  CAUSE:      STDs and non-sexually transmitted microorganisms Neisseria gonorrhoeae Chlamydia trachomatis Herpes simplex Trichomonas vaginalis
  • 10. Urethritis  SYMPTOMS: In men, inflammation of urethra, prostate, and epididymis  Can result in difficult, painful, and frequent urination and a urethral discharge  In women, same symptoms, but they may also develop mucopurulent cervicitis (MCP) 
  • 11. Mucopurulent cervicitis (MCP)  Inflammation of the cervix that can produce a mucopurulent yellow exudate of the cervix  CAUSE:  Organism such as Chlamydia, gonorrhoeae, candida albicans, and herpes simplex  SYMPTOMS:  Mucopurulent yellow discharge  May have no symptoms at all
  • 12. Proctitis  Proctitis is inflammation of the rectum and anus  CAUSES:  Non-sexually transmitted microbes or to STDs  SYMPTOMS:  Pain and swelling
  • 13. Enteritis  Enteritis is inflammation of the lining of the intestine  CAUSES:  May occur as result of contamination during anal intercourse
  • 14. Genital ulcers  Sexually transmitted disease characterized by genital sores and swollen glands  CAUSE:   Not all are caused by STDs as injury, some non-STD viruses, some types of drug reactions, radiation, and some forms of cancer can product genital ulcers STDs that produce genital ulcers are syphilis, herpes, and HIV
  • 15. Genital ulcers  SYMPTOMS: Papules or Macules  Painful raw, pitted, or excoriated areas on or around the genitals 
  • 16. Condylomatous  Genital warts  Wart on the skin or adjoining mucous membrane on or near the genital organs or the anus and caused by any of several human papilloma viruses  CAUSE:   Viral skin disease Virus responsible is human papilloma virus (HPV)
  • 17. HPV
  • 18. Condylomatous  SYMPTOMS:  Anal itching  Dysfunctional uterine bleeding  Brown vaginal discharge  Genital lesions  Vaginal bleeding after intercourse  Itching genital  Bloodstained vaginal discharge
  • 19. Condylomatous  SYMPTOMS continued:  Itching of scrotum  Cauliflower like growths, perineum  Vaginal itching  Vaginal burning sensation  Vaginal lump  Rash on genitals  Cauliflower-like mass
  • 20. Pelvic inflammatory disease  Infection of the upper genital tract that may cause chronic pelvic pain due to inflammation  CAUSE:   Primary sources of infection include Chlamydia trachomatis and N. Gonorrhoeae May result from organism that is associated with sexually transmitted infection
  • 21. Pelvic inflammatory disease  SYMPTOMS:  Lower abdominal pain and tenderness  Purulent vaginal discharge or vaginal bleeding  Pain with intercourse  Fever  Nausea  Pain with urination  Chronic inflammation causes scarring and adhesions can lead to infertility and ectopic pregnancy
  • 22. PID
  • 23. Cervicitis  Inflammation of the cervix  CAUSE: Result of an infection  Can be an injury or irritation (a reaction to the chemicals in douches and contraceptives, or a forgotten tampon) 
  • 24. Cervicitis  SYMPTOMS:  Vaginal discharge that becomes more pronounced immediately following your menstrual period  Bleeding, itching, or irritation of the external genitals  Pain during intercourse  Burning sensation during urination  Lower back pain
  • 25. Endometritis  Inflammation of the endometrium, the inner lining of the uterus  CAUSE:  Infection  SYMPTOMS:  Lower abdominal pain  Fever and abnormal vaginal bleeding or discharge
  • 26. Salpingitis  Infection and inflammation in the fallopian tubes  CAUSE: Infection in the vagina and ascends to the fallopian tube  Infection can spread to lymph vessels, infection in one fallopian tube usually leads to infection of the other 
  • 27. Salpingitis  CAUSE  continued: Bacteria most associated with     N. Gonorrhoeae Chlamydia Staphylococcus Streptococcus
  • 28. Therapeutic interventions  With serious infections, hospitalization and IV antibiotics may be indicated  Laparoscopic surgery may be done to release adhesions and reduce complications  Testing and treatment should be considered for both the patient and partner
  • 29. Herpes  Two types Herpes Simplex type 1  Herpes Simples type 2  Type 1-usually found on lips, can be transmitted to genitals  Type 2-usually found on genitals can be spread to lips 
  • 30. Herpes
  • 31. Herpes cont’d  Acyclovir is a common medication that can deter outbreaks and lessen       symptoms Pregnant mothers can deliver vaginally if they do not currently have an outbreak Neonatal herpes is not a reportable disease in most states, so there are no hard statistics on the number of cases nationwide Unfortunately, when infants do contract neonatal herpes, the results can be tragic. About half of infants who are treated with antiviral medication escape permanent damage. But others may suffer serious neurological damage, mental retardation or death. It's fear of these terrible consequences, rather than the level of risk, that makes neonatal herpes a concern.
  • 32. Crabs
  • 33. Chlamydia  Can be transmitted sexually, by blood, and body fluid contact  Often asymptomatic in women, but can cause urethritis, MPC, and conjunctivitis  Fitz-Hugh-Curtis syndrome is a surface inflammation of the liver and can be caused by Chlamydia  Causes nausea, vomiting  Sharp pain at base of ribs  Frequent cause of PID, infertility and increases of risk of ectopic pregnancy  Can be passed from Mom to baby during delivery
  • 34. Common test used to diagnose Chlamydia?  Nucleic acid amplification testing (NAT or NAAT) identifies the presence of Chlamydia DNA or RNA in urine, cervical or urethral specimens
  • 35. Gonorrhea  Gonorrhea is the second most commonly reported notifiable      disease in the United States. In 2011, a total of 321,849 cases of gonorrhea were reported in the United States. Gonorrhea is a sexually transmitted disease (STD) caused by a bacterium. Gonorrhea can grow easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus The bacterium is called Neisseria gonorrhoeae
  • 36. Routes to transmit Gonorrhea  Vaginally  Rectally  Orally  Contact with blood or body fluids
  • 37. Gonorrhea
  • 38. Symptoms of Gonorrhea  Men may be asymptomatic or may have urethritis with a yellow discharge  Women may also be asymptomatic or may have  Sore throat  MPC  Urethritis  Abnormal menstrual symptoms such as break through bleeding  Gonorrhea may infect the throat and the rectum and may cause disseminated gonococcal infection resulting in inflammation of the joints, skin, meninges, and lining of the heart
  • 39. Gonorrhea  Why is having intercourse during menstruation a risky time for transmission of microorganisms such as gonorrhea?  Removal of the cervical mucous barrier can promote the growth of the gonococcus in the higher reproductive tract
  • 40. How is gonorrhea diagnosed?  NAT in urine or smears and cultures of discharge
  • 41. Syphilis  Treponema pallidum spirochete enters through the skin or mucous membranes  Three stages of syphilis Primary  Secondary  Tertiary   Organism responsible for syphilis is what?  Treponema pallidum spirochete
  • 42. Syphilis – Primary stage  Begins with entry of organism  Between 3-90 days later papule develops at site of entry, sloughs off, leaving a painless red ulcerated area called a chancre  Chancre eventually heals but spirochete remains active and can be passed on
  • 43. Syphilis – Secondary stage  Begins 2-8 weeks later and affects body more generally, flulike symptoms, joint pain, hair loss, skin rashes, mouth sores
  • 44. Syphilis – Tertiary stage  10-30 years later, can involve any organ system of the body  Usually the primary and secondary symptoms disappear  Symptoms of the late stage of syphilis include:   difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. In the late stages of syphilis, the disease damages the internal organs including the: brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.  This damage can result in death.
  • 45. Diagnosis of Syphilis  Venereal disease research laboratory (VDRL)  Rapid plasma reagin (RPR)  Automated reagin test (ART) These test indirectly test for syphilis by detecting antibodies----- false positives can occur
  • 46. Syphilis  Treatment  Penicillen G
  • 47. Trichomoniasis  Generally considered a STD, but may be transmitted through nonsexual contact with infected articles  The parasite is passed from an infected person to an uninfected person during sex.  Carriers may be asymptomatic for several years
  • 48. Trichomoniasis  SYMPTOMS include: Redness, pain, swelling, itching, and burning of genital area  Pain with intercourse  Frothy foul smelling discharge  Men can develop prostatitis and infertility  Visualization of cervix (“strawberry cervix”)  May cause abnormal PAP smear readings **About 70% of infected people do not have any signs or symptoms. 
  • 49. AIDS  Acquired Immunodeficiency Syndrome  Infectious disorder  Eventually fatal  Profoundly weakens immune system  HIV/AIDS is considered a pandemic
  • 50. AIDS  Human Immunodeficiency Virus  HIV  HIV positive Can remain asymptomatic for up to 10 years or longer  Remains communicable during asymptomatic period   AIDS  Rare cancers and opportunistic infections occur
  • 51. AIDS and HIV  Understanding what it means to be HIV positive is relatively simple -- either you are infected with the virus or you aren't -but how do you understand AIDS?  AIDS, which stands for "Acquired Immune Deficiency Syndrome" is a way of describing a whole group of symptoms and diseases associated with the damage HIV does to the immune system.  As an HIV infection progresses, there is ongoing damage to immune defense cells and the body becomes increasingly less able to fight off infection.  This means that individuals with advanced HIV disease are susceptible to infections that don't show up in people with healthy immune systems.
  • 52. How HIV affects the body           1. The immune system protects the body by recognizing invading antigens on pathogens (bacteria, viruses, fungi, and parasites) and reacting to them. 2. T lymphocytes, or T cells, regulate the immune system and destroy antigens. 3. HIV continuously uses new host cells to replicate itself. 4. The HIV life cycle includes six phases: binding and entry, reverse transcription, integration, replication, budding, and maturation. 5. Once HIV is in the circulatory system, it targets the CD4+ lymphocyte. 6. Two types of HIV cause AIDS: HIV type 1 (HIV-1) and HIV-2. 7. Primary infection refers to the time when HIV first enters the body. 8. Clinical latency refers to the time before onset of symptoms and complications in the HIV-infected individual. In HIV-infected adults, this phase may last 8-10 years. 9. Early signs and symptoms of HIV can include candidiasis, lymphadenopathy, cervical carcinoma, herpes zoster, and peripheral neuropathy. 10. Late signs and symptoms of HIV and AIDS-defining illnesses can include the development of life-threatening infections and malignancies.
  • 53. AIDS Fast Facts  More than 1.1 million people in the United States are living with HIV infection, and almost 1 in 5 (18.1%) are unaware of their infection.  Gay, bisexual, and other men who have sex with men, particularly young black/African American, are most seriously affected by HIV.  By race, blacks/African Americans face the most severe burden of HIV.
  • 54. 2010 AIDS Statistics
  • 55. AIDS  HIV is believed to be an altered form of simian (monkey) immunodeficiency virus  Jumped from chimpanzee to human when meat was consumed
  • 56. AIDS  HIV attaches itself to T₄(also referred to as CD₄) Cells  Allows virus to duplicate itself  Impairs ability of T₄cells to recognize foreign antigens  B cell lymphocytes not stimulated
  • 57. AIDS  Transmitted by direct contact  Blood, semen, vaginal secretions, breast milk  Prevention Abstinence  Monogamous partner  Use of condom and spermicide  Refrain from IV drug use  Autologous blood transfusion  New trials using medication prevention  Pregnant mothers should be tested for HIV 
  • 58. AIDS-PREVENTION-CDC Trials  A new approach to HIV prevention established in     2010 Called Pre-exposure Prophylaxis or PrEP These people take a HIV treatment pill daily to reduce their risk of becoming infected By inhibiting HIV from replicating as it enters the body, PrEP can prevent the virus from establishing permanent infections. The medication is called Viread, used alone or in combination with Truvada has shown to provide 44% additional protection against HIV infection.
  • 59. AIDS Diagnosis  People are diagnosed with AIDS when they have certain signs or symptoms defined by the U.S. Centers for Disease Control and Prevention (CDC). The CDC's definition of AIDS includes:  Less than 200 CD4+ T cells per cubic millimeter of blood, compared with about 1,000 CD4+ T cells for healthy people.  CD4+T cells are white blood cells that play an important role in the body's immune system. These cells are destroyed by HIV. Even when a HIVpositive person feels well and is not experiencing any symptoms of the disease, CD4+ T cells are being infected by HIV.  CD4+ T cells accounting for less than 14 percent of all lymphocytes, a type of white blood cell.  In addition to having a positive blood test, there must be one or more of these illnesses: NEXT SLIDE
  • 60. AIDS Diagnosis cont’d Candidiasis of bronchi, esophagus, trachea or lungs Cervical cancer that is invasive Coccidioidomycosis that has spread Cryptococcosis that is affecting the body outside the lungs Cryptosporidiosis affecting the intestines and lasting more than a month Cytomegalovirus disease outside of the liver, spleen or lymph nodes Cytomegalovirus retinitis that occurs with vision loss Encephalopathy that is HIV-related Herpes simplex including ulcers lasting more than a month or bronchitis, pneumonitis or esophagitis Histoplasmosis that has spread Isosporiasis affecting the intestines and lasting more than a month Kaposi's sarcoma Lymphoma Mycobacterium avium complex or disease caused by M kansasii Mycobacterium tuberculosis in or outside the lungs Other species of mycobacterium that has spread Pneumocystis Pneumonia that is recurrent Progressive multifocal leukoencephalopathy Salmonella septicemia that is recurrent Toxoplasmosis of the brain, also called encephalitis Wasting syndrome caused by HIV infection Symptoms also may include anxiety, dementia, depression and insomnia.
  • 61. HIV Tests      ELISA Test — ELISA, which stands for enzyme-linked immunosorbent assay, is used to detect HIV infection. If an ELISA test is positive, the Western blot test is usually administered to confirm the diagnosis. If an ELISA test is negative, but you think you may have HIV, you should be tested again in one to three months.ELISA is quite sensitive in chronic HIV infection, but because antibodies aren't produced immediately upon infection, you may test negative during a window of a few weeks to a few months after being infected. Even though your test result may be negative during this window, you may have a high level of the virus and be at risk of transmitting infection. Home Tests — The only home test approved by the U.S. Food and Drug Administration is called the Home Access Express Test, which is sold in pharmacies. Saliva Tests — A cotton pad is used to obtain saliva from the inside of your cheek. The pad is placed in a vial and submitted to a laboratory for testing. Results are available in three days. Positive results should be confirmed with a blood test. Viral Load Test — This test measures the amount of HIV in your blood. Generally, it's used to monitor treatment progress or detect early HIV infection. Three technologies measure HIV viral load in the blood — reverse transcription polymerase chain reaction (RT-PCR), branched DNA (bDNA) and nucleic acid sequence-based amplification assay (NASBA). The basic principles of these tests are similar. HIV is detected using DNA sequences that bind specifically to those in the virus. It is important to note that results may vary between tests. Western Blot — This is a very sensitive blood test used to confirm a positive ELISA test result.
  • 62. HIV Test for Pregnant Women  The chance that HIV infection will be transmitted from an HIV-infected pregnant woman to her child can be reduced to 2% or less (fewer than 2 out of every 100).  This is possible because better medicines are available to treat HIV. But first, the pregnant woman and her doctor must know if she is infected with HIV.
  • 63. HIV Transmission to Babies  Taking anti-HIV drugs can dramatically reduce the risk of passing on     HIV to babies. There are two different ways in which these drugs act. First, they reduce the viral load so the baby is exposed to less HIV while in the womb and during birth. The aim of HIV treatment is to get, and keep, the viral load to undetectable levels (below 40 or 50 depending on the sensitivity of the test the clinic uses). Second, anti-HIV drugs may cross the placenta and enter the baby’s body, preventing the virus from ever taking hold. Newborn babies are given a short course of anti-HIV drugs after they are born when their mother is known to be HIV-positive. Two drugs have been shown to be very effective at preventing motherto-baby transmission of HIV in the second of these ways. These are the nucleoside analogue (Retrovir) and the non-nucleoside (Viramune). It’s also likely that other drugs are also very effective, but these haven’t been tested as extensively.
  • 64. HIV-------Symptoms                Fever Swollen tender lymph nodes Pharyangitis Rash on face, trunk, palms, soles Joint pain Headache Nausea & vomiting Diarrhea Enlarged liver and slpeen Weight loss Kaposi sarcoma Pneumocystis pneumonia Abnormal PAP test PID Persistent vaginitis
  • 65. AIDS--------Symptoms Seizures and lack of coordination Difficult or painful swallowing Mental symptoms such as confusion and forgetfulness Severe and persistent diarrhea Fever Vision loss Nausea, abdominal cramps, and vomiting Weight loss and extreme fatigue Coma Cough and shortness of breath Severe headaches with neck stiffness
  • 66. Aids------Treatment  Antiretroviral drugs  Supportive care during opportunistic infections  Drug therapy to boost immune system  Pneumonia, flu and HepB vaccine

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